Dr. Osborn Tembu, a diabetes physician who works north of Nairobi, has a chilling story to tell about a man who came into a clinic in rural Kenya. The man, Dr. Tembu explained last week, thought he was losing weight because of HIV/AIDS.

"After we ran his tests, we told him he had diabetes instead," Tembu said. "We thought he would be relieved, but he was disappointed. He said it was because his family does not have enough money for food. He was told that if he had HIV, he could get free flour along with his drugs."

The idea that diabetes is a less desirable condition than HIV sounds shocking in industrialized nations, where most cases of diabetes are easily treatable. Yet in Kenya and across the developing world, the prevalence of chronic conditions such as diabetes is exploding. Poverty, combined with a tight focus by governments and donors on high-profile conditions such as HIV, means that a great many of those who need treatment do not get it.

Tembu was speaking at an international conference, sponsored by the World Diabetes Foundation and the Danish Ministry of Foreign Affairs, on non-communicable diseases. (I was a panelist.) His account echoed what a Ugandan diabetes doctor told me last year about patients who prefer having AIDS to diabetes. Donor aid makes HIV/AIDS drugs free, while unsubsidized drugs for chronic diseases are catastrophic in cost for families eking out a living.

According to the World Health Organization, diabetes care for a family member in developing countries costs up to a third of a typical family's annual income.

Patients cope as best they can: Some families sell off parcels of land, livestock, home possessions, and even move in with relatives to rent out their own homes to pay for diabetes care. Robert Maregwa Kamau, a Nairobi slum dweller and foundry worker who has diabetes, spoke at the conference on his efforts to organize door-to-door awareness brigades. "We tell people to get care, and many do, but many others fear the cost of the drugs or they go to clinic and there are no drugs," Kamau said.

To make matters worse, hospitalization for the poor can become "imprisonment" as hospitals demand out-of-pocket payment before discharge.

Health officials in afflicted countries wish they could do more. Dr. William Maina, the director for non-communicable diseases in Kenya's health ministry, said only half of 1 percent of the nation's health budget is designated for chronic diseases. He estimates that at least 30 percent should go toward prevention and medical care for diabetes, heart and lung diseases, and stroke. But Kenya's government is heavily influenced by donor priorities tilted almost completely toward HIV, malaria, and other infectious diseases.

Dialysis only for the wealthy

Maina's division is reduced to literature drops at clinics and supporting information campaigns like Kamau's. More people are now coming regularly to clinics, reducing emergency room admissions. They see more people jogging and more schools restoring physical education. But Maina says the country has only half the diabetic drugs it needs. Dialysis is only for the wealthiest Kenyans.

Even poor countries can take some steps to discourage the spread of diseases like diabetes. Maina said Kenya must implement controls for unhealthy foods similar to those used to cut tobacco use. Yet efforts to promote personal behavior change will not help those patients who are suffering now.

"You feel so bad for the people who have no money for insulin," Dr. Tembu said. "I've given out of my pocket, but you quickly realize you are not making much of a dent."

International efforts to prevent and treat HIV and malaria remain critical. But when poverty across a continent makes people wish they had AIDS instead of diabetes, that means chronic diseases need a response as intense as the response to AIDS. Diabetes doctors should not be alone in their struggles. Developing countries and their donors must help them make more than a dent in a growing problem.

Derrick Z. Jackson is with The Boston Globe