Kaiser Daily HIV/AIDS Report- 7 Aug 2001
----------------------------------------
*Thabo Mbeki States Violence, Not AIDS, is the Leading Killer Among
South Africans
*President of Nigeria Recommends Free Condoms for Military Personnel
*Sex Between Teachers and Students Spreads HIV in Central African
Republic
*Cipla Releases Three-in-One Drug Combination of Stavudine,
Lamivudine and Nevirapine
*Ethiopians Rally for Cheaper AIDS Drugs
*Gene May Determine Why HIV Drugs Are Less Effective in Some
Ethnic Groups
GLOBAL CHALLENGES
Thabo Mbeki States Violence, Not AIDS, is the Leading Killer Among
South Africans
South African President Thabo Mbeki yesterday said that violence, not
AIDS, is the leading cause of death in his country, Reuters reports.
During a BBC interview, Mbeki said, "The largest single cause of
death as we sit here is what in the medical statistics is called 'ex-
ternal causes' and that is violence in this society," adding that
more than 50% of South Africans between the ages of 16 and 45 will
die of "external causes." Mbeki continued, "You cannot say to me I
must ignore that and not take into account the fact that the majority
of the people in that particular age group, which is the working
population, is dying from the violence that is so terrible in this
society." Current South African police statistics estimate that South
Africa will have a total of approximately 220,000 murders over the
next 10 years, while the United Nations estimates that approximately
seven million South Africans will die from AIDS-related causes during
the same time period. Reuters reports that Mbeki's remarks are
"likely to attract further doubts over [his] stance on HIV/AIDS."
Mbeki has publicly questioned the causal link between HIV and AIDS,
stating that although he believes HIV is one cause of AIDS, he does
not believe it is the "only cause" (Reuters, 8/6).
President of Nigeria Recommends Free Condoms for Military Personnel
Nigerian President Olusegun Obasanjo has urged Nigeria's military
leaders to "consider" distributing free condoms to their troops,
Reuters reports. "You must not allow AIDS to ravage our armed
forces," Obasanjo told officers during a one-day retreat. Obasanjo
"promised" to implement a policy that would have the military stock
condoms in barrack clinics to be "given freely to military person-
nel." Nigerian military leaders say that "hundreds" of soldiers re-
turning from peace-keeping duty in Liberia and Sierra Leone were
found to be HIV-positive, and "scores" of Nigerian soldiers have died
from AIDS-related complications. Obasanjo said that soldiers should
"either use [condoms] or abstain" from sex altogether (Chiahemen,
Reuters, 8/4).
Sex Between Teachers and Students Spreads HIV in Central African
Republic
Teacher-student sex is a major route for HIV transmission in the Cen-
tral African Republic(CAR), where AIDS is the leading cause of death among
educators and a girl's first sexual partner is often her teacher, ac-
cording to UNICEF, the San Francisco Chronicle reports. "The very
people upon whom we rely to teach pupils how to protect themselves
against AIDS are often the ones passing on the virus," Adjibad Kari-
mou of the UNICEF office in Bangui said. But Francoise Nboma, head of
the English department at a CAR high school, explained, "Girls often
come to school without eating and without proper clothing. They see
their teacher as someone to help them. Many parents want their daugh-
ters to marry teachers, so they encourage their children to have re-
lationships with them, and the staff don't refuse." In CAR high
schools and universities, some girls will trade sex for grades in or-
der to secure a diploma.
Staffing Shortage
Teachers say they want to see teacher-student sex end but add that
"the practice is ingrained in the educational system." The government
also would be "hard-pressed to dismiss teachers or professors" found
to be sexually involved with students because of a "severe staffing
shortage" as the result of poor pay and AIDS, the Chronicle reports.
A UNICEF study found that 85% of teacher deaths in the CAR were AIDS-
related and projected that 25% to 50% of all teachers in the country
will die of AIDS-related illnesses by 2005. From 1996 to 1998, 107
schools were forced to close because too many teachers had died. Now,
with half of the country's teaching posts empty, only 60% of children
nationwide are receiving an education.
Safe Sex Education for Teachers, Students
Safe sex programs are uncommon in CAR high schools because the
Health Ministry has focused its "meager" $7 million AIDS budget on
treating HIV-positive workers and pregnant women rather than offering
education campaigns. Yet female teachers are "increasingly warning
the girls against having sexual relations with their teachers," Nboma
said, adding, "We're even telling male teachers that they need to re-
gard the girls as their own children, not simply as pupils." In addi-
tion, Population Services International will begin distributing three
million condoms at discounted prices throughout the CAR this week,
with health workers visiting schools to teach safe sex "to teachers
as well as pupils" (Jones, San Francisco Chronicle, 8/6).
DRUG ACCESS
Cipla Releases Three-in-One Drug Combination of Stavudine, Lamivudine
and Nevirapine
Indian drug maker Cipla Ltd. yesterday unveiled its new pill
Triomune, a three-in-one combination of the antiretrovirals sta-
vudine, lamivudine and nevirapine, Reuters reports. Triomune, which
comes in tablet form, is the first three-in-one combination of the
three drugs, the patents for which are held by three different phar-
maceutical firms. GlaxoSmithKline holds the patent for lamivudine,
Boehringer Ingelheim has the patent on nevirapine and Bristol-Myers
Squibb has the patent on stavudine. Cipla is legally allowed to pro-
duce its own version of the three drugs because Indian patent law
stipulates that patents apply only to the processes by which the
drugs are made, not the drugs themselves. A month's supply of
Triomune will cost approximately $38, a five- to six-fold reduction
in the price of treatment with the brand-name drugs (Reuters, 8/6).
Because the tablet contains all three antiretrovirals, the "pill bur-
den" for people with HIV or AIDS will be reduced from six pills to
two pills per day. Cipla is also developing a pediatric version of
nevirapine called Nevimune Suspension. The Hindu Business Line re-
ports that when combined with zidovudine and lamivudine, Nevimune
Suspension should "considerably help treat HIV" in children (Hindu
Business Line, 8/7).
Ethiopians Rally for Cheaper AIDS Drugs
Thousands of Ethiopians rallied in the streets of Addis Ababa on Sun-
day, calling on the government to pass legislation allowing for the
importation of cheaper generic AIDS medications, Reuters/Contra Costa
Times reports. The rally, organized by Dawn of Hope, a charity run by
HIV-positive people, was intended to encourage the Ethiopian govern-
ment to "follow the example" of South Africa and Kenya, which have
both passed laws allowing for the importation and manufacture of ge-
neric AIDS drugs. "We appeal to the government to make life-
prolonging drugs available without delay, as is being done in the
rest of sub-Saharan Africa. If they are imported tax-free, people
like us who cannot afford the expensive medicines might be able to
prolong our lives," Tadesse Aynalem of Dawn of Hope said to the pro-
testors. According to officials at the Ethiopian HIV/AIDS Secre-
tariat, the agency is working to make cheaper antiretroviral medica-
tions available to the public within the next three months and is
also "encourag[ing]" local drug makers to produce the drugs, which
have "dramatically" reduced the number of AIDS-related deaths in the
United States and Europe. The Ethiopian government announced plans in
June for a five-year public awareness campaign designed to promote
safer sex. The campaign "warn[s]" that if HIV transmission is not
"rapidly controlled," a third of all Ethiopians between the ages of
15 and 20 could die of AIDS-related complications. Nearly three mil-
lion of the country's 60 million people are infected with HIV, and
there are more than 900,000 AIDS orphans in Ethiopia (Reuters/Contra
Costa Times, 8/5).
Gene May Determine Why HIV Drugs Are Less Effective in Some Ethnic
Groups
A mutation in the P-glycoprotein (PGP) gene, also known as the
"multi-drug resistance protein," may enable doctors to more effec-
tively tailor HIV drug regimens to specific patients according to
ethnic group, Reuters Health reports. A study published in the Aug. 4
issue of the Lancet shows that the mutation, which increases the
amount of PGP -- a protein that "pumps" certain drugs like antiretro-
virals out of cells, causing the drugs to lose their effectiveness --
is more widely found among West Africans and African Americans than
among whites and Asians. A team from the Dr. Margarete Fischer-Bosch
Institute of Clinical Pharmacology in Stuttgart, Germany, tested sam-
ples from 142 Ghanians, 41 African Americans, 537 whites and 50 Japa-
nese volunteers and found that 83% of the Ghanians and 61% of the Af-
rican Americans carried two copies of the mutation, or a double al-
lele, while only 26% of the whites and Japanese carried two copies
(Reuters Health, 8/3).
A double allele is associated with increased production of PGP
in the cells of the stomach. The increase in PGP, which is "quite
similar" to the antiretroviral medications used to treat HIV, means
that "it might be difficult for the drug proteins to find vacant re-
ceptors on the cells they need to target for the medication to work,"
BBC News reports. Although the researchers are uncertain why some
populations have a higher incidence of the double mutation, they
theorized that the PGP mutation may "naturally" protect these popula-
tions from certain gastrointestinal disorders (BBC News, 8/3). Ac-
cording to the study's authors, bacterial and viral gastroenteritis
is "endemic in tropical countries" such as the nations of West Africa
and has been linked with "substantial infant morbidity and mortal-
ity." A "higher frequency" of the mutation may afford these groups a
"selective advantage against gastrointestinal infections," the au-
thors theorized (Schaeffeler et al., Lancet, 8/4).
Not an Excuse
AIDS activists said that the possibility of decreased effectiveness
of some antiretroviral drugs in African populations "should not in-
fluence any arguments over" making drug treatment available in Africa
and other parts of the developing world. A spokesperson for the Ter-
rence Higgins Trust Lighthouse, a British HIV/AIDS charity, said
there are a "wide variety" of drug combinations available to treat
HIV and if one combination is unsuccessful, "there is likely to be
another which is more effective," adding, "Everybody responds differ-
ently to treatment" (BBC News, 8/3). Dr. Matthias Schwab, one of the
researchers, cautioned that more research is needed to "directly
measure" drug response in subjects with two copies of the mutation
before the findings can have clinical applications (Reuters Health,
8/3).
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org,
a free service of The Henry J. Kaiser Family Foundation, by National
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved
Contact Daily Reports Staff Editorial
Tel: +1-202-672-5952
Fax: +1-202-672-5767
mailto:dailyreports@kaisernetwork.org
--
Send mail for the `AFRO-NETS' conference to `<afro-nets@usa.healthnet.org>'.
Mail administrative requests to `<majordomo@usa.healthnet.org>'.
For additional assistance, send mail to: `<owner-afro-nets@usa.healthnet.org>'.