For many years, AIDS care and treatment in Africa has long been dismissed as unfeasible - the drug therapies too expensive, the health care infrastructure too inadequate and the infection rate too great. But a Stanford University Medical Center researcher who has spent three to four months a year in Africa since 1989 is tackling the problem head on, launching pilot projects with limited populations in Zimbabwe to get people on the life-saving medications that are widely available in the West.

David Katzenstein, MD, associate professor of medicine, has gone from doctor/scientist to self-proclaimed activist. "There has been precious little attention paid to the 95 percent of people with AIDS living outside of the United States," said Katzenstein, who specializes in infectious diseases and geographic medicine. "Until a few months ago, no one thought it was feasible to treat AIDS in Africa. Not even me."

Katzenstein has created AIDS Care and Treatment Now, or ACT Now, a not-for-profit organization established to bring care and treatment to Africa. Through the organization, Katzenstein is developing the first HIV clinic in Zimbabwe, which is scheduled to open by August of this year. In a pilot project, the clinic will treat 1,000 University of Zimbabwe employees who are covered by CIMAS, the country's largest health insurance company. In addition to testing and counseling, the clinic will provide primary care and appropriate pharmaceutical treatment for HIV infection.

The primary limitation restricting the use of antiretroviral therapies for HIV-infected Africans has been cost - a factor that is rapidly changing with the advent of generic drugs and negotiated price agreements between governments and pharmaceutical companies. At the current cost of $1,000 per year, treatment is within the reach of thousands, if not millions, of HIV-infected individuals in Africa, Katzenstein said.

In addition to setting up clinics, ACT Now will facilitate training sessions between AIDS experts and African practitioners to set up treatment protocols for antiretroviral therapies. Katzenstein, along with 12 other experts from the United States, Europe and Australia, will travel to Africa at the end of June to train 200-300 African physicians, nurse-midwives, pharmacists, nutritionists and community-outreach and social workers.

"We will begin by developing a private-sector model," Katzenstein explained, "and then determine how to transfer that structure and knowledge to treating the general community." The goal? To build a sustainable health care infrastructure that will ultimately be led by Africans.

"Unless we are able to affect the HIV crisis differently in Africa, people will continue to die," he said. "Morally, it's more satisfying to try, even if you fail. At least you've tried to do something."

Of the estimated 35 million people in the world living with HIV/AIDS, 25 million reside in the southern and eastern portions of Africa, a region known as the sub-Sahara. In Zimbabwe, one in four people are infected with HIV - the virus that causes AIDS. "This is resulting in more than 150,000 unnecessary deaths each year in Zimbabwe due to HIV," Katzenstein said. "This strikes me as injustice on a grand scale. It's a grand apartheid in terms of resources."

In the United States, where powerful antiretroviral therapies have been available for the past five to six years, the death rate from HIV has plummeted 90 percent. "The disparate availability of resources is not only unfair, it is morally intolerable," Katzenstein added.