Phill Wilson thought he'd never work again. At times, in fact, he thought he'd never see another sunrise.

He had been living with HIV since 1980 and with full-blown AIDS since 1990. By 1995, he had barely survived bouts with pneumonia and pericarditis, an inflammation of the membrane enclosing the heart. He had seen the disease's progression as he watched countless friends get sick and die. "It's like you're in a queue, and the people in front of you are going through a turnstile," says Wilson, now 48. "Every time someone goes through, you feel that much closer to the front of the line. And you know the next infection is likely to be more horrible than the previous one."

Just in the nick of time for him, medical science produced a miracle--the three-drug cocktail, including new protease inhibitors, called antiretroviral therapy that, since 1996, has prolonged and enhanced thousands of lives. By 1999, Wilson was well enough to get back to work, so he founded the Black AIDS Institute." I looked at what had changed in the intervening years," he recalls, "and to my great disappointment, there had not been a lot of progress in fighting AIDS in the black community." He saw that, in the public mind, AIDS had been transformed. "This epidemic came about in 1980, and that epidemic was perceived as a gay epidemic. And then following the protease inhibitors, the epidemic came to be seen as a global epidemic," he says. But most Americans didn't consider the United States as part of that worldwide disaster. "There was a shifting of view. We went from being internally focused on AIDS in young, white gay men, to AIDS in Africa, the Caribbean, and Eastern Europe. But through all of that, this constant epidemic in people of color in America has been ignored. The epidemic is having a devastating effect in black communities."

Disparities. Most black AIDS organizations in the United States were small and focused largely on prevention education. There were far fewer groups educating the community about treatment, even though the epidemic has a strong hold on black Americans. African-Americans represent 12 percent of the population but account for more than half of all new HIV infections. "The disease is getting darker and darker and darker, and we see a pulling back of prevention efforts and a flatlining of treatment," he says.

The Black AIDS Institute, located in Los Angeles, has an African-American HIV University, an education fellowship aimed at training community activists on all aspects of AIDS. Debra Parmer is a graduate, class of 2002. With a background in hospital administration and a working knowledge of testing and counseling for HIV, she thought she knew a lot about the disease. "I learned I didn't know anything," she says. Now executive director of the Northeast Ohio African-American Health Network, she understands the importance of talking to people in a language they understand. That language is not medical jargon--for example, nonnucleotide reverse transcription protease inhibitors.

"The language of medicine goes over their heads," she says. But sick people, dying people, can be taught to understand the meaning of T-cell counts (higher is good) and viral loads (lower is good) and the importance of the medicines. They get the importance of taking their drugs on schedule every single day or risk having the virus mutate and render future treatment ineffective.

"I tell people that there are limited drugs available, and if they find a combination that works, they should cherish it," she says. "They often say, 'I'll never miss another dose again.' "

Facing Disaster. Getting individuals and local organizations involved is key. Wilson has spent the past five years talking with leaders in civil rights organizations, the black media, the seven major black fraternities and sororities, and historically black colleges and universities, enlisting their support in making AIDS education a priority. "We need to bridge the gap between the medical community, which is overwhelmingly white, and the HIV community, which is increasingly black," says Wilson. "We are faced with the worst health disaster that our community has seen in the last century. What I do is ordinary. It's only extraordinary because we're not all doing it."

That the organization is successful is bittersweet. It is increasingly easy to debunk the myth that AIDS is a white gay male problem because people see otherwise. "We've reached a critical mass where everyone knows someone, and it breaks my heart that so many people had to be infected with HIV, to get AIDS, to die, before we got to this point," he says.

In America's black communities, AIDS needs a Marshall Plan. Wilson has started one, and, using the Swahili word for purpose, calls it the Nia Plan.

AIDS: Darkening In America (Supplement)
Big Business Barriers To Fighting AIDS

It takes just 15 ingredients to make Triomune, the orange and white pill that could treat most of the world's AIDS cases for about 60 cents per day.

A combination of three antiviral drugs that would sell in the United States for about $12,000 a year, Triomune is vastly cheaper because its maker, Cipla Ltd., ignores the international patents owned by the giant U.S. and European pharmaceuticals firms that brought the three medicines to market.

Pirated copies of AIDS drugs are illegal to sell in the United States, but under rules hammered out during years of contentious debate, they may be sold to poor nations. The World Health Organization in June endorsed Triomune for its "3-by-5" program, which aims to put 3 million AIDS patients in poor countries on antiretroviral drugs by 2005.

India has been slow to provide the drugs to its population. A government plan to provide them free to 100,000 AIDS patients was launched in April, but only a few hundred have been enrolled thus far.

At its plant in Patalganga, in an industrial zone east of Bombay, 750 miles southwest of New Delhi, Cipla stamps out 4 million Triomune pills per month, selling them for about 30 cents each.

Just outside the factory gates, another India co-exists in the shadow of the drug plant and of the neighboring petrochemical factories. Cows, held sacred in India, and the occasional pig wander across the asphalt. Women walk balancing jugs of water on their heads for their homes, which for many is a sheet-metal-roofed shack.

It would take a fifty-fold increase in production to meet the WHO's 3-by- 5 goal. Nevertheless, Cipla managers said that they and other generic drugmakers could do it.

"Overnight!" insisted Muku K. Hamied, director of domestic operations in Bombay, and brother of Yusuf Hamied, Cipla's London-based chairman.

"The more important issue,'' said Muku Hamied, "is whether governments have the commitment of resources. Will the rich nations help out?"

Cipla's Patalganga plant is one of 22 factories it has in India. Ingredients for Triomune arrive at the loading dock in large, plastic blue barrels, shipped from bulk chemical suppliers in Japan, China and elsewhere in India. The plant itself operates like a high-tech bakery. Under sterile conditions in air-locked rooms under strict temperature and pressure controls, Triomune's components are sifted, measured and blended in giant, stainless steel containers into a doughy mass. The drug preparation is dried, worked into granules and mixed with lubricants and binding agents.

Then the mixture is precisely measured into the revolving cylinders of the pill press, which can stamp out 2,000 pills per minute. Each pill is passed through a metal detector, to spot microscopic contaminants. The newly minted pills are sprayed with a polymer coating to seal in odors and protect them from humidity.

Highly automated packing equipment loads 30 Triomune pills into a plastic bottle, each of which is sealed and boxed for shipment by workers wearing surgical gowns.

"There is no scarcity of technical staff, no scarcity of raw materials,'' said P.P. Deshpande, production manager at Patalganga. "The capacity of this plant is for 100 million tablets, of all kinds, per year.''

Cipla executives say the only thing holding back production is the political will on the part of wealthy nations to pay for it. The Bush administration, however, has cited quality concerns, refusing to accept the WHO process that cleared Triomune.

A study in the July 3 issue of the British journal The Lancet found that Triomune was "at least as good" at knocking down the AIDS virus and boosting infection-fighting CD4 blood cells as the Western-made cocktails.

"There is no question about the safety and efficacy of generic antiretrovirals,'' said Dr. N. Kumarasamy, who has cared for more than 6,000 AIDS patients since 1994 at the Y.R.G. CARE clinic in Madras, on India's southeast coast.

U.S. Health and Human Services Secretary Tommy Thompson, under pressure to buy the lower-cost Indian drugs for the president's $15 billion overseas AIDS initiative, announced in May a "fast track" Food and Drug Administration approval for copied drugs. If the FDA determines that they are as safe and effective as the original patented products, they can be approved in a matter of weeks. None of the four Indian companies making these copied medicines has won approval, and the FDA will not confirm that any have even applied.

Meanwhile, Cipla has run into trouble over bioequivalence for two other AIDS drugs previously approved by the WHO. In late June, the U.N. agency abruptly delisted the drugs, finding inadequate written proof that the pills were equivalent to the patented, brand-name pharmaceuticals they are meant to copy.

Cipla executives insist that the pills meet the WHO standard and that the problem lies with paperwork at an independent firm that conducted bioequivalence studies. Cipla pledged to repeat the studies by the end of this month.

"We believe the issue will be resolved shortly," said Amar Lulla, Cipla's managing director.