Kaiser Daily HIV/AIDS Report - Dec 17-20, 2001
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* Officials Overseeing Global Fund to Fight AIDS, Tuberculosis and
Malaria to Hold First Meeting in January
* South African Government 'Never Denied' HIV/AIDS Problem, South
African Ambassador Says
* Female Condom to be Offered Free of Charge to South African Women
* Companies Struck 'Secret Deal' to Distribute Unregistered Herbal
AIDS Treatment in 12 African Countries
* South African Government Will Appeal Court Ruling on Mandatory
Provision of Nevirapine for HIV-Positive Pregnant Women
* Botswana Seeking Technical Assistance From Brazilian HIV/AIDS Pro-
gram
* Globe Editorial Calls Increased Funding for Foreign HIV/AIDS Ef-
forts Better But Still 'Far from Adequate'
* South African Government 'Questions' Obligation to Comply with
Court Order to Provide Nevirapine to All HIV-Infected Pregnant
Women
* African Leaders Gather in St. Louis for Fundraising Summit to
'Coordinate Efforts' Against AIDS in Africa
* Burkina Faso Conference Ends With Statement of Commitment to Fight-
ing HIV/AIDS, Calls for Increased Treatment Access
--
Officials Overseeing Global Fund to Fight AIDS, Tuberculosis and Ma-
laria to Hold First Meeting in January
Officials overseeing the Global Fund to Fight AIDS, Tuberculosis and
Malaria will hold their first meeting Jan. 28 and 29 in Geneva to de-
termine protocols for dispensing the $1.6 billion already pledged to
the fund, the AP/Las Vegas Sun reports. In a "unique arrangement,"
the fund's 18-member policy-making board will consist of seven seats
each for donor nations and developing countries and two seats each
for non-governmental organizations and the private sector. The United
States, which has so far pledged $200 million to the fund, will have
one seat on the board and a representative is expected to be named
"soon," according to an administration official speaking on the con-
dition of anonymity. The official called the committee an "innovative
way to assemble resources and get them to the people who need them
the most." Dr. Chrispus Kiyonga, the former health minister of Uganda
and chair of the 40-member working group that created the fund's
structure, said that the fund "is not just about money, it is about
partnership ... working together in a new way to achieve lasting re-
sults" (AP/Las Vegas Sun, 12/17).
--
South African Government 'Never Denied' HIV/AIDS Problem, South Afri-
can Ambassador Says
The South African government "has never denied that it has an
HIV/AIDS problem," Ambassador of South Africa Sheila Sisulu writes in
a New York Times letter to the editor in response to a Dec. 13 Times
editorial. The editorial said that South Africa is the "most notori-
ous example" of a country denying its HIV/AIDS problem. According to
Sisulu, South Africa's HIV/AIDS program "has been designed and car-
ried out under government leadership, with financing increasing more
than tenfold since the current government took leadership in 1994."
The South African government has demonstrated its "commitment" to the
HIV/AIDS epidemic in the country by addressing "social deprivation,
unemployment and widespread poverty" -- all factors that "fuel" the
spread of HIV -- through "programs that focus on prevention, care,
treatment of opportunistic infections, addressing discrimination and
providing financing for research into a vaccine for the viral strain
prevalent in southern Africa," Sisulu concludes (Sisulu, New York
Times, 12/20).
--
Female Condom to be Offered Free of Charge to South African Women
The female condom will be offered free of charge to South African
women through a collaborative effort between several South African
governmental agencies, companies and Planned Parenthood of South Af-
rica, Health-e News reports. Planned Parenthood, the Reproductive
Health Research Unit, the Society of Family Health and the South Af-
rica Department of Health will supply the female condom. Mitchell
Warren, vice president of the Female Health Company, which produces
the female condom, said that South Africa receives three million of
the eight million female condoms distributed around the world each
year. The condom is made of polyurethane and is packaged and stored
in an oil-based lubricant. Women who have tried the condom say the
material "makes it feel more like a 'second skin'" than the latex
male condom, and men have praised the female condom because it "does
not feel tight," can be inserted before sex and does not require im-
mediate withdrawal after ejaculation. Dr. Sunanda Ray, who has been
involved in introducing the female condom in Zimbabwe, said that the
condom is most popular with women over the age of 25, possibly be-
cause they are "better educated and more confident" than younger
women. Although many women say that they enjoy how the female condom
feels, the polyurethane material makes it much more expensive to pro-
duce than the male condom. Initial research from the RHRU indicates
that the female condom can be washed and reused up to eight times be-
fore developing holes, although the World Health Organization is the
only group with the authority to issue a definitive statement on the
safety of reusing the condom (Cullinan, Health-e News, 12/18).
--
Companies Struck 'Secret Deal' to Distribute Unregistered Herbal AIDS
Treatment in 12 African Countries
Phyto Nova, a South African company that grows and sells a plant ru-
mored to help treat HIV/AIDS, had a "secret deal" to dispense Suther-
landia, an unregistered herbal tablet developed from the plant, to
HIV-positive people in 12 African countries, the South African Sunday
Times reports. The Times states that Sutherlandia manufacturer Phyto
Nova brokered a deal with Virodene Pharmaceutical Holdings to dis-
tribute the herbal treatment to HIV-positive people in Tanzania, Bot-
swana, Namibia, Zimbabwe, Mozambique and other African nations. Vi-
rodene Pharmaceuticals produces the controversial AIDS drug Virodene,
which has been banned for use in humans in South Africa and other
countries because it contains an industrial solvent that has been
linked to deadly liver damage. Officials at Phyto Nova say that Suth-
erlandia helps delay the progression of HIV and increases blood cell
counts and weight gain in HIV/AIDS patients. Under the deal between
Phyto Nova and Virodene Pharmaceuticals, Virodene was to purchase
120,000 bottles of Sutherlandia tablets over one year. However, the
deal that was struck in January fell through in June due to defaulted
payments, and it is "unclear" where the early shipments went. Some of
the bottles were sent to Tanzania, the Times reports, but it is not
known what happened to them after they reached the country. Dr. Carl
Albrecht, one of the owners of Phyto Nova, said that the company
"ha[s] no knowledge of where and how" Virodene is using the tablets.
South Africa's Medicines Control Council plans to investigate Suther-
landia, which by law must be registered as a medicine with the gov-
ernment, and the MCC expects to receive an application for permission
to conduct a clinical trial on the substance in January (Bezuiden-
hout, Sunday Times, 12/16).
--
South African Government Will Appeal Court Ruling on Mandatory Provi-
sion of Nevirapine for HIV-Positive Pregnant Women
South African Health Minister Manto Tshabalala-Msimang Wednesday an-
nounced that the government will appeal last week's High Court ruling
that ordered the government to create a plan to provide the antiret-
roviral drug nevirapine to all HIV-positive pregnant women in the
public health system by March 31, the Associated Press reports. "We
have instructed our legal counsel to appeal the judgment to the Con-
stitutional Court as soon as practicable. Having examined the reason-
ing of the judgment and the orders made, we came to the conclusion
that this judgment could have far-reaching implications in defining
our constitutional democracy and in shaping the state's responsibil-
ity for the delivery of social services," she said in a statement
(Cohen, Associated Press, 12/19). The lawsuit was originally filed
this summer by the Treatment Action Campaign, the Children's Rights
Center and Haroon Saloojee, a physician in charge of community pedi-
atrics at the University of the Witwatersrand, against the South Af-
rican Department of Health and eight of nine provincial health de-
partments. In a 70-page ruling, Pretoria High Court Judge Chris Botha
said on Friday that the government was "obliged" to provide the drug
-- which can reduce the risk of vertical HIV transmission by half --
under the constitutional right to health treatment. Botha gave the
government until March 31 to create a comprehensive plan for dispens-
ing the drug and reducing vertical transmission throughout the coun-
try (Kaiser Daily HIV/AIDS Report, 12/14). Nathan Geffen, a spokes-
person for TAC, called the government's decision to appeal "regretta-
ble," adding that his organization is "concerned that this delay will
result in further unnecessary HIV infections and loss of life" (Asso-
ciated Press, 12/19). Tshabalala-Msimang said that the appeal is not
meant to halt the creation of a program to prevent vertical transmis-
sion, but "is aimed at clarifying a constitutional and jurisdictional
matter which -- if left vague -- could throw the executive policy-
making into disarray and create confusion about the principle of the
separation of powers, which is a cornerstone of our democracy"
(Agence France-Presse, 12/19).
Government Content to Play 'Buffoon,' Editorial Says
"The South African government, its reputation already tattered by
President Thabo Mbeki's misguided AIDS policy, seems to make matters
worse," an Atlanta Journal-Constitution editorial states, saying that
officials "wast[ed] time debating whether to appeal a judge's order
to provide antiretroviral drugs to HIV-positive pregnant women."
Mbeki has publicly questioned the causal link between HIV and AIDS,
and he has also said that antiretroviral drugs are toxic. The edito-
rial states that the government is "balking, following a president
determined to discredit the drug," and as a result, "a country ex-
pected to take a leadership role on a continent plagued by the AIDS
epidemic instead appears the buffoon." The editorial states that al-
though poverty and malnutrition certainly "aggravate HIV and AIDS,"
they "should not be obstacles" to prevention and treatment, espe-
cially since nevirapine is being offered free of charge by the drug's
manufacturer. "Every day that the government delays implementing the
court order brings another 200 HIV-positive babies into the world,"
the editorial concludes (Atlanta Journal-Constitution, 12/18).
--
Botswana Seeking Technical Assistance From Brazilian HIV/AIDS Program
Officials from Botswana are negotiating a deal with the Brazilian
Ministry of Health that would bring Brazil's HIV/AIDS treatment model
to the African nation, Kyodo News reports. Under the agreement, Bot-
swanan medical workers would be trained by Brazilian health profes-
sionals, and Brazil would export the technology it uses to produce
generic AIDS drugs to Botswana. The Brazilian Ministry of Health
manufactures generic versions of patented AIDS drugs in local labora-
tories as part of its national HIV/AIDS program, lowering the annual
cost of treatment to about $1,000 per person. Brazil has reduced new
infections from 20,000 to 15,000 this year through the "aggressive"
program. Brazil's tactics had raised strong objections from pharma-
ceutical companies and the U.S. government, but opposition has de-
creased since a declaration this fall by the World Trade Organization
that said international patent rights "do not take precedence over
public health crises." Brazil has already signed cooperation agree-
ments with Angola, Guinea-Bissau, Mozambique, Sao Tome and Principe,
and six other African countries have inquired about establishing
medical exchange programs with Brazil. Botswana has an adult HIV in-
fection rate of about 36%; in total, nearly 300,000 people out of a
population of 1.6 million are thought to be infected (Kyodo News,
12/15).
--
Globe Editorial Calls Increased Funding for Foreign HIV/AIDS Efforts
Better But Still 'Far from Adequate'
"Six months after the first U.N. General Assembly special session on
AIDS, Congress is getting close to agreement on a level of spending
for international AIDS programs that is much better than this year's
but still far from adequate," a Boston Globe editorial states. Con-
gress' international AIDS appropriation for next year will likely in-
clude about $460 million in bilateral assistance to nongovernmental
groups, as well as the $200 million committed by President Bush last
summer to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Although the appropriation is an improvement over the $325 million
spent on international HIV/AIDS programs this year, "the effort is
dwarfed by the threat AIDS poses to life and social stability in the
countries where it is spreading," the editorial states. It notes that
the House recently approved by voice vote a $1.3 billion authoriza-
tion for international HIV/AIDS programs, which includes $750 million
for the global fund and $50 million for a pilot program to help de-
veloping countries acquire antiretroviral drugs. The authorization
does not itself allocate money but signals "broad-based support for
more U.S. funding," the Globe says. According to the editorial, less
than 1% of the federal budget, or about $15 billion, is spent on for-
eign aid. "That figure, embarrassingly lower on a per-capita basis
than in other developed countries, reflects indifference to what goes
on beyond America's borders. The United States should fight AIDS with
the resolve and leadership worthy of a world power," the editorial
concludes (Boston Globe, 12/16).
--
South African Government 'Questions' Obligation to Comply with Court
Order to Provide Nevirapine to All HIV-Infected Pregnant Women
South African government officials said last weekend that they are
"unperturbed" by a court ruling last week ordering the government to
provide nevirapine to all HIV-infected pregnant women through the
public health system, adding that the government will not "immedi-
ately comply" with the ruling, Reuters reports (Reuters, 12/15). Last
summer, the Treatment Action Campaign, the Children's Rights Center
and Harron Saloojee, a physician in charge of community pediatrics at
the University of Witwatersrand, filed a lawsuit against the South
African Department of Health and eight provincial health departments
to force the government to provide the antiretroviral drug to all
HIV-positive pregnant women through public hospitals and clinics to
prevent vertical transmission of the virus. The government has been
dispensing nevirapine to pregnant women only through two pilot pro-
jects initiated last spring, not on a national scale (Kaiser Daily
HIV/AIDS Report, 8/21). On Friday, Pretoria High Court Judge Chris
Botha ruled that the government is "obliged" under the constitutional
right to health treatment to provide the drug to all HIV-infected
pregnant women. Botha gave government officials until March 31 to de-
vise a comprehensive plan to dispense the drug and reduce the na-
tion's HIV vertical transmission rates (Kaiser Daily HIV/AIDS Report,
12/14). South African Health Minister Manto Tshabalala-Msimang said
on Saturday that the ruling is "not a blow to government policy." In
a statement issued last Friday, the health department "questioned"
whether the government is obliged to comply with the ruling, saying,
"Government is studying the detail of the judgement in order to es-
tablish its premise, including such critical issues as the role of
the judiciary in relation to executive policy decisions." The state-
ment also says that the government is committed to providing the drug
to all state clinics and hospitals, but it will "wait for results" of
the nevirapine pilot project (Reuters, 12/15). The project makes
nevirapine available to HIV-infected pregnant women in 18 sites
around the country, and pregnant women in those areas also can re-
ceive counseling, AIDS testing and other support. About 10% of the
one million women who give birth each year in South Africa have ac-
cess to the program (Murphy, Baltimore Sun, 12/15). A health depart-
ment spokesperson said he was not certain when the project would be
completed or when results would be available. Tshabalala-Msimang in-
dicated that the government will issue a statement on the ruling
sometime this week (Reuters, 12/15).
Advocates Weigh In
The government may appeal the ruling to the country's Supreme Court,
although activists have said that they hope officials will not do so,
the Los Angeles Times reports (Simmons, Los Angeles Times, 12/15).
Various groups and individuals have praised Botha's decision. Manny
da Camara, a spokesperson for the Democratic Alliance, said, "It is
the most powerful statement yet of the harmfulness of the govern-
ment's AIDS policies in general, and its policies on mother-to-child
HIV transmission in particular" (Kraft, AP/Washington Times, 12/15).
Saloojee added, "Potentially this is going to save the lives of
50,000 babies next year" (Los Angeles Times, 12/15).
--
African Leaders Gather in St. Louis for Fundraising Summit to 'Coor-
dinate Efforts' Against AIDS in Africa
Representatives from 15 African nations gathered in St. Louis, Mo.,
on Monday for a two-day summit meeting to discuss the AIDS epidemic
in Africa and raise funds for new clinics, the St. Louis Post-
Dispatch reports. The conference is sponsored by Africans United
Against AIDS Globally, a not-for-profit organization founded in Au-
gust by St. Louis-area AIDS activist Tiahmo Ra-uf and singer Robert
Bell of the musical group Kool and the Gang. The meeting will include
discussions, led by African experts, "about the current state of
HIV/AIDS in Africa." In addition, St. Louis University and Washington
University medical professionals will share information about ad-
vancements in medical treatments for HIV/AIDS. The event will also
feature a dinner and a televised fundraiser including a concert given
by Kool and the Gang. The sponsoring organization intends to build
new clinics in "each African country or ... renovate existing struc-
tures." Ra-uf said that each clinic will cost $200,000 to build, and
each laboratory will cost an additional $75,000. The organization
also hopes to work with African governments to establish the neces-
sary "infrastructure for the proper storage and administration" of
HIV/AIDS medicines. Ra-uf called the meeting a "solution-oriented
summit" that he hopes will bring together "U.S. AIDS experts, citi-
zens, community leaders and officials in a collective effort to lay
groundwork for broader and better coordinated efforts in seeking so-
lutions to the AIDS epidemic" (Hollinshed, St. Louis Post-Dispatch,
12/14).
--
Burkina Faso Conference Ends With Statement of Commitment to Fighting
HIV/AIDS, Calls for Increased Treatment Access
The 12th International Conference on AIDS and Sexually Transmitted
Diseases in Africa ended last Thursday in Ouagadougou, Burkina Faso,
with the release of a statement that "reassert[ed]" African leaders'
"will to pursue the fight" against HIV/AIDS and a call for increased
access to AIDS drugs, Agence France-Presse reports. Although the cost
of antiretroviral drugs in Africa has fallen by an average of 85% in
the past year, many observers said the prices were still prohibi-
tively high for most Africans. Currently, only about 30,000 Africans
are receiving the drugs, even though Africans account for 70% of the
world's 40 million HIV/AIDS cases (Ingham, Agence France-Presse,
12/14). Speaking Thursday at the conference, Mariane Ngoulla, head of
WHO's research unit on traditional medicine in Zimbabwe, said the
governments of Zimbabwe and Ghana are negotiating with Thailand's
Government Pharmaceutical Organization to learn how to produce ge-
neric HIV drugs themselves for under $350 per patient per year. "We
have the facilities, and they are underutilized. Now the question is
how to produce cheaper drugs with equal quality and efficiency,"
Ngoulla said, adding that Thai officials would supply the expertise
needed (Ouedraogo, AP/Miami Herald, 12/14). However, delegates to the
conference noted that cheaper drugs alone are "not enough" to improve
treatment and called for fortification of the continent's health in-
frastructure.
Refocusing Prevention Efforts
Delegates to the five-day conference also called for a renewed empha-
sis on HIV prevention, especially among sex workers. According to a
study presented at the conference, every dollar spent on counseling
prostitutes and supplying them with condoms is 2,000 times more cost-
efficient in managing HIV than antiretroviral treatment. Prevention
was stressed particularly in light of the lack of progress on an HIV
vaccine. Only one vaccine has reached Phase III clinical trials and
most vaccine work is "overwhelmingly focused" on HIV subtype B, the
strain most commonly found in North America but not in Africa. Over-
all, however, despite "years of neglect and indifference" toward AIDS
by most African governments, Agence France-Presse reports that many
are now "working hard" to fight the disease. Delegates cited the
Ivory Coast, Senegal, Rwanda and Uganda as "being ahead of the field"
and commended Botswana, where more than one in three adults is in-
fected, for its increased efforts. Although conference delegates
placed emphasis on leadership and political will, Blaise Compaore,
president of host nation Burkina Faso, was the only African leader to
attend the conference (Agence France-Presse, 12/14).
Traditional Healers Seek Role in HIV/AIDS Treatment
In other conference news, a group of more than 150 traditional Afri-
can healers on Thursday issued a statement asking "all countries to
put in place legal measures allowing the free practice of traditional
medicines" in HIV/AIDS treatment and calling for the creation of an
international body for the "protection of traditional medicines." The
statement also asked governments to use traditional healers as
"agents of information, education and communication" (Agence France-
Presse/New York Times, 12/13).
--
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.
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