Kaiser Daily HIV/AIDS Report - Mon, 1 Oct 2001
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* Despite High HIV Infection Rate, South Africa Maintains 'Ambiva-
lence' Toward Antiretrovirals, Washington Post Reports
* Swaziland King Orders Young Women to Obey Five-Year Celibacy to
Stem Spread of HIV
* Uganda to Provide Nevirapine for All Pregnant Women
* Lesotho Red Cross Begins HIV/AIDS Prevention, Orphan Care Initia-
tive
* Coal-Based Drug Developed in South Africa May Boost Immune System
in HIV-Positive Patients
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Despite High HIV Infection Rate, South Africa Maintains 'Ambivalence'
Toward Antiretrovirals, Washington Post Reports
The South African government continues to resist efforts to supply
its citizens with antiretroviral drugs, the "only medicines known to
slow the replication" of HIV, the Washington Post reports. One recent
example involved the eviction of the Greater Nelspruit Rape Interven-
tion Project -- a rape crisis center that supplied the drugs to those
who might have been exposed to the virus through sexual violence --
from two Nelspruit public hospitals. The project began operating out
of vacant offices in the two hospitals 18 months ago, supplying vic-
tims of sexual assault with counseling, antibiotics to treat STDs,
emergency contraception and, in cases where HIV was suspected, anti-
retroviral drugs that may cut HIV transmission rates if taken immedi-
ately after exposure. When local authorities learned that GRIP was
supplying the antiretrovirals, they quickly moved to evict the group
from the hospitals, saying in eviction papers filed in court, "It is
at this stage not the policy of the government to supply (antiretro-
virals) and it causes problems for the department to try and explain
to ordinary people ... the reason why it is not supplied while (the
two hospitals that house the project) do supply those medicines."
Government Ambivalence
The eviction is the latest in a series of events that reflect the
South African government's "ambivalence" about HIV/AIDS and antiret-
roviral drugs, the Post says. President Thabo Mbeki sparked the con-
troversy almost two years ago when he publicly questioned the causal
link between HIV and AIDS. Since then, he has "repeatedly emphasized
the role of poverty in the spread of HIV," the Post reports. Last
year, the government filed a lawsuit against the world's largest
pharmaceutical companies for the right to manufacture or import ge-
neric versions of the expensive anti-HIV drugs, but since settling
the dispute, it has not moved to offer the drugs to its citizens. It
has only recently begun to offer nevirapine, an antiretroviral that
can reduce mother-to-child transmission of HIV, to pregnant women in
18 pilot projects, despite the fact that the drug is being donated
free of charge by manufacturer Boehringer-Ingelheim. Observers have
said that the African National Congress-led government's reservations
stem partly from "deep racial suspicions" resulting from forced ster-
ilizations of black women and chemical weapons used against blacks
under apartheid. A government spokesperson earlier this year said
that a Cape Town group providing antiretrovirals to low-income blacks
was using the patients as "guinea pigs." GRIP leader Barbara Kenyon
said that the provincial health official who notified her of the
group's eviction said that GRIP was "poisoning" blacks. The govern-
ment's inaction, in a nation with the world's highest concentration
of HIV-positive people, has angered former allies who fought on the
side of the African National Congress to end apartheid. The Treatment
Action Campaign, an AIDS advocacy group led by people who "supported
the ANC's liberation struggle against the white minority's apartheid
regime," recently filed a lawsuit against Health Minister Manto Tsha-
balala-Msimang over the health department's decision to not provide
nevirapine more broadly. Rhoda Kadalie, a former anti-apartheid ac-
tivist, last week wrote an open letter criticizing the government,
stating that when she travels abroad, instead of "bask[ing] in [Nel-
son] Mandela's reflected glory," she has to "explain Mbeki as whites
used to have to explain apartheid." She added that the current situa-
tion is "not what [she] fought for" (Jeter, Washington Post, 10/1)
--
Swaziland King Orders Young Women to Obey Five-Year Celibacy to Stem
Spread of HIV
King Mswati III of Swaziland has ordered all young women in the coun-
try to abstain from sex for the next five years in order to reduce
the spread of HIV, the New York Times reports. Young women also are
forbidden to wear long pants and are expected to wear traditional
tassels, known as umcwasho, to indicate their celibacy. Men who vio-
late the ban and have sex with women wearing tassels, worn in blue
and gold by girls and teens and in black and red by young women, will
be fined one cow, the country's "true currency." According to Lungile
Ndlovu, the royally appointed leader of young women in Swaziland, the
new celibacy rule should not be a problem for Swazi women because
they "know their culture." But Swazi high school students report that
some girls are already having sex and many will refuse to wear the
umcwasho, criticizing the "royal edict's infringement on their sense
of style" (Cauvin, New York Times, 9/29). Last July, Swazi officials
banned girls from wearing miniskirts to school, as the skirts were
"widely blamed for enticing teachers" to have sex with students and
spreading HIV (Kaiser Daily HIV/AIDS Report, 7/20/00). Beatrice
Dlamini, a nurse who manages the HIV/AIDS program at a government
hospital in Mbabane, said that "without more education, reviving tra-
ditions would do little" to stop HIV transmission. At least one-
quarter of adults in Swaziland, which has a population of 900,000,
are HIV-positive, and 20,000 have already died of AIDS-related ill-
nesses (New York Times, 9/29).
--
Uganda to Provide Nevirapine for All Pregnant Women
The Ugandan Health Ministry is considering a mandate to require that
all pregnant women receive nevirapine, a drug that can reduce verti-
cal HIV transmission by up to 50%. Because many women are reluctant
to get tested for HIV, it has been difficult for the government to
get the drug to HIV-positive women, the Kampala Monitor reports. Di-
rector-General of Health Services Francis Omaswa on Thursday told the
parliamentary committee on social services that the health ministry
was working on a plan to administer the drug, which the government
already provides free of charge, at all district hospitals. Omaswa
also announced a plan to create a center for voluntary HIV testing.
At present, Mulago, Nsambya, Rugaba and Mengo hospitals, along with
the Mild May Center and the Joint Clinical Research Center, are
qualified to administer the drug. The agency has already implemented
a nevirapine training curriculum for graduate and undergraduate medi-
cal students at Makerere and Mbarara universities. The ministry also
plans to select a pharmacist to lead the National Medical Stores to
ensure that the drug is not smuggled to other countries where it can
be sold for high prices (Kampala Monitor, 9/28).
--
Lesotho Red Cross Begins HIV/AIDS Prevention, Orphan Care Initiative
The Lesotho Red Cross Society has begun a two-phased pilot project to
prevent HIV infection among youth and to care for children orphaned
by AIDS, Mopheme-The Survivor/allAfrica.com reports. The first phase,
starting in the districts of Mafeteng and Mohale's Hoek, will educate
primary school students in an effort to inform them about the disease
before they begin to make sexual decisions. This phase also will
serve to prepare students for the "challenges of adolescence" and
sexual maturity, the paper reports. In addition, the program has "em-
barked on civic education" to encouage parents and teachers to "break
the silence" on sexual education and speak "frank[ly] and free[ly]"
with their children on issues concerning sex. The second phase of the
initiative, to begin in Teyateyaneng and Leribe, will care for or-
phans by providing food, clothes and education. Rather than build an
orphanage, the society will work in partnership with orphans' rela-
tives and foster parents. Society Secretary General Ntharetso Lieta
said the organization was "devoted to fighting against the scourge of
HIV/AIDS" in Lesotho. The five-year pilot programs are funded with a
$2 million grant from the Norwegian Red Cross (Sithetho, Mopheme-The
Survivor/allAfrica.com, 9/26).
--
Coal-Based Drug Developed in South Africa May Boost Immune System in
HIV-Positive Patients
Enerkom, a South African research and development company, said Fri-
day that Oxihumate-K, a coal-based drug, may boost the immune system
in HIV-positive patients, Reuters/Contra Costa Times reports (Chege,
Reuters/Contra Costa Times, 9/28). According to University of Preto-
ria Professor Connie Medlen, the drug, sold today "on a small scale"
as a nutritional supplement, "improved the condition" of HIV-positive
patients in a recent study. She said that the Oxihumate-K prompted a
"clinical improvement" in HIV-positive patients, adding that the drug
"stimulated the type of immunity necessary to cope" with opportunis-
tic infections. However, the drug did not help HIV-positive patients
"who were already seriously ill" (BBC Monitoring, 9/28). Dr. Anthony
Surridge, Enerkom's acting CEO, said, "This is not a cure for AIDS.
It boosts the immune system. It increases the quality and quantity of
life." Enerkom began a Phase II clinical trial of the drug in late
1999 on 350 HIV-positive patients at several military clinics in Tan-
zania. The University of Pretoria has administered the trial, funded
by Enerkom's parent company, Central Energy Fund. Enerkom plans to
conduct a Phase III clinical trial of the drug in South Africa. How-
ever, Smunda Mokoena, deputy director general of South Africa's De-
partment of Energy, said that Enerkom plans to move the drug to the
market on a larger scale in about six months, after the company com-
pletes the Phase II trial. Reuters/Contra Costa Times reports that
the drug has "raised controversy" in South Africa after a separate
AIDS drug backed by the South African government "turned out to be a
toxic industrial solvent" (Reuters/Contra Costa Times, 9/28).
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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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