Kaiser Daily HIV/AIDS Report-Tue,11 Sept. 2001
----------------------------------------------
*Mbeki Reiterates That 'External Causes,' Not AIDS, Lead Mortality
Rates Among South Africans
*White Families in South Africa Illegally Testing Black Nannies,
Domestic Workers for HIV
*Elizabeth Glaser Foundation Announces Grants to Recruit Pediatric
AIDS Researchers in Developing Nations
*Nigeria Begins AIDS Drug Program After Delay
*Lack of Medical Resources to Diagnose, Treat AIDS Mentioned in ABC's
'Nightline' Series 'Heart of Darkness'
Global Challenges
Mbeki Reiterates That 'External Causes,' Not AIDS, Lead Mortality
Rates Among South Africans
South African President Thabo Mbeki has ordered the government to re-
evaluate its social policy spending in light of 1995 data from the
World Health Organization that said "external causes" such as acci-
dents, homicide and suicide, not HIV/AIDS, constitute the leading
cause of death in the nation, South Africa's Business Day reports.
The WHO figures, which Mbeki reportedly found on the Internet, showed
external causes to be responsible for 19.8% of deaths, while HIV/AIDS
accounted for 2.2% of deaths (Business Day, 9/10). UNAIDS spokesper-
son Richard de Luyt confirmed that the data came from the WHO Web
site, but noted that WHO receives the data from national governments
(Reuters, 9/10). In an Aug. 6 letter to Health Minister Manto Tsha-
balala-Msimang, Mbeki asked that she share the statistics with the
cabinet's "social cluster" and consider what policies the government
has in place to reduce deaths, whether resources are properly allo-
cated in light of the statistics and whether the country's medical
institutions are properly prepared to deal with the types of deaths
mentioned in the report. The letter, which was confirmed Sunday by
presidential spokesperson Bheki Khumalo, echoed statements first made
by Mbeki in an interview with the BBC last month. That interview was
followed by a similar statement by Tshabalala-Msimang on Aug. 7, the
day after Mbeki sent her the letter, citing a 1999 study that found
violence to be the major cause of death in the country (Business Day,
9/10).
Coming Under Fire
The decision to review funding based on the WHO data is likely to
bring criticism because the pattern of AIDS deaths has been signifi-
cantly altered since 1995, Agence-France Presse reports. UNAIDS said
today that the number of AIDS-related deaths in South Africa has in-
creased "massively" since 1995, and Mbeki's claim that AIDS-related
deaths are not the leading cause of death in the country "underesti-
mate[s] the real impact of the disease." The agency estimates that
during 1999, 250,000 people died from the disease, but the 1995 fig-
ure quoted by Mbeki is 2,653 (Agence France-Presse, 9/11). "The fig-
ures from 1995 are absurdly out of date. A reliable argument cannot
be made on statistics based on six-year-old information", Democratic
Alliance HIV/AIDS spokesperson Kobus Gous said (SAPA News Agency/BBC
Monitoring, 9/10). The WHO statistics also include a separate cate-
gory for tuberculosis deaths (5.3%), even though many of those deaths
were probably AIDS-related as well, according to Business Day. In ad-
dition, the South African Medical Research Council is expected to re-
lease a report in the next few weeks stating that AIDS-related deaths
were the nation's leading cause of death from 1999 through mid-2001.
A spokesperson for the council said it was in the process of confirm-
ing its findings and would not release the report before its presi-
dent, Malegapuru Makgoba, returned from a trip abroad later this
week. The council is believed to be making sure its figures are "be-
yond reproach" because of pressure from the government to delay re-
leasing its results. The council's report is expected to support a
report by ABT Associates, published in June by Business Day, that
predicted AIDS-related complications will become the leading cause of
death among public service employees by 2003 and will account for 75%
of deaths among this group by 2010. Mbeki, who previously caused con-
troversy by publicly questioning the causal link between HIV and
AIDS, acknowledged his decision would likely "provoke a howl of dis-
pleasure and a concerted propaganda campaign from those who have con-
vinced themselves that HIV/AIDS is the single biggest cause of
death," according to his letter (Business Day, 9/10). United Democ-
ratic Movement leader Bantu Holomisa said Mbeki's letter "should
serve as the final verdict on his incompetence and incapability to
look after the best interests of the country" (SAPA News Agency/BBC
Monitoring, 9/10).
White Families in South Africa Illegally Testing Black Nannies, Do-
mestic Workers for HIV
A growing number of white families in South Africa are engaging in
the "illegal" but "widespread" practice of screening their black do-
mestic workers for HIV, the San Francisco Chronicle reports. Although
white South Africans have been "relatively unaffected up to now" by
the country's AIDS epidemic, many families fear that their children
might contract HIV from their nannies and domestic workers, who some-
times comfort the babies by letting them suck on their breasts. The
"hysteria" over HIV infection has led many white families to ask
their doctors to administer a blood test to their domestic workers
and report the results directly back to them. South Africa's Employ-
ment Equity Act bans "covert" HIV testing of employees and prohibits
the dismissal of a worker based on his or her HIV status. However,
many employers attempt to "get around the law" by screening workers'
CD4+ cell counts or having them tested for diseases such as tubercu-
losis or "any other ailment that may indicate an underlying immune
disorder." The Chronicle reports that many wealthy employers send
their HIV-positive workers home on full pay while hiring a second
maid to work on the other employee's behalf. Because HIV infection
rates are especially high for individuals ages 20 to 29, some employ-
ers hire elderly women to serve as domestic workers.
Legal Issues
Doctors who agree to perform the tests are coming under legal scru-
tiny. Approximately 30 physicians in the Johannesburg area are under
investigation for "divulging the HIV status of patients to third par-
ties". Anita Kleinsmidt, an attorney with the AIDS Law Project of the
University of the Witwatersrand, said that doctors will likely be
taken "directly to court" instead of to the Health Practitioner's
Council over charges of disclosure of HIV status. She added that the
council -- the "highest medical body" in South Africa -- has not yet
turned in a guilty verdict for a physician.
Little Cause for Alarm
Dr. Ruben Sher, a South African HIV researcher, said that the risk
only applies to children who receive milk from a woman. In situations
where a woman is not releasing breast milk, the chance of HIV trans-
mission is "almost zero", Sher said. "There is a lot of hysteria
about this, and I keep hoping that we have got past this issue. If
the domestic worker is not lactating and is just using the breast as
a comforter, there is very little risk", Sher said. He added that in
these situations, children could only contract HIV if there are sores
on the woman's breast and in the child's mouth (Du Venage, San Fran-
cisco Chronicle, 9/10).
Elizabeth Glaser Foundation Announces Grants to Recruit Pediatric
AIDS Researchers in Developing Nations
The Elizabeth Glaser Pediatric AIDS Foundation has announced the
creation of a number of grants to help recruit scientists in develop-
ing nations to fight HIV/AIDS among infants and children, according
to a foundation release. The new International Leadership Award pro-
gram, unveiled yesterday at the third conference on Global Strategies
for the Prevention of HIV Transmission from Mothers to Infants in
Uganda, will include three-year, $450,000 grants designed to "invest
in trained individuals" in developing nations who "have the potential
to develop programs which will have a direct impact on the pediatric
HIV epidemic in their country." Each grant recipient will receive
funding to offset salary and program costs and will mentor a "mini-
mum" of three additional people to work on the projects. Grant re-
cipients will be tasked with initiatives such as creating HIV/AIDS
research and implementation programs in the areas of epidemiology,
vaccine development, prevention of vertical transmission, treatment
of HIV-positive mothers and infants and development of national poli-
cies or strategies to combat pediatric HIV/AIDS. Kate Carr, CEO of
the foundation, said, "We expect these scientists will ... succeed in
establishing programs that change the pediatric HIV epidemic in their
country" (Elizabeth Glaser Pediatric AIDS Foundation release, 9/10).
DRUG ACCESS
Global Petition to Support WTO Patent Rules that Improve Cheaper Drug
Access to Developing World
The Third World Network, Oxfam International and Health GAP Coalition
last week launched a global online petition to "demonstrate the
strength of global public support" for World Trade Organization pat-
ent rules that "put people before the profits of powerful drug compa-
nies," according to the South African Health-e News Online News Ser-
vice. The petition is addressed to President Bush, who is described
in the statement as "a leading international figure whose government
is blocking changes and clarifications to the [Trade Related Aspects
of Intellectual Property Rights] Agreement that would mean cheaper
medicines for people in developing countries". The current agreement
states that by 2006 all WTO members must give drug firms 20 years'
patent protection on their inventions. It includes the right to issue
compulsory licenses, or permission for a local firm to copy an expen-
sive patented drug while compensating the patent holder, when a pat-
ent holder is shown to be abusing its monopoly position. Further,
while drug makers say that parallel importation of generic drugs con-
flicts with WTO rules on intellectual property, a TRIPS article says
that the agreement does not cover parallel importation. Oxfam advo-
cacy coordinator Mercedes Sayagues said that the groups hope to gar-
ner 250,000 signatures for the petition, as "mass support" is neces-
sary for it to be successful. The petition can be viewed online on
the Oxfam International Web site (Thom, Health-e Online News Service,
9/6).
Nigeria Begins AIDS Drug Program After Delay
After a one-week delay from a scheduled Sept. 1 kick-off, Nigerian
officials on Friday began an AIDS treatment pilot program to supply
inexpensive antiretroviral drugs to HIV-positive citizens, the
AP/Nando Times reports. Health Minister Alphonsus Nwosu told journal-
ists that he "would rather have the program right and the deadline
wrong, than vice versa," although he "admitted" that the generic
drugs have not yet been received and the medication administration
and tracking system has not been completely developed. The country's
$4 million program will only provide drugs to 10,000 adults and 5,000
children, a "tiny fraction" of those infected. Indian generic drug
maker Cipla Ltd. has contracted with Nigeria to sell a three-drug
combination for $350 per year per patient; program participants will
pay $120, with the government subsidizing the remaining cost. Ranbaxy
Laboratories, another India-based drug firm, is also being considered
to supply drugs to the program. Officials face several challenges in
administering the program, including fraudulent HIV claims from the
nation's "notorious crime rings" that are trying to pose as patients
to obtain the drugs and resell them on the black market, and NGOs
representing people with HIV/AIDS who are "aggressively lobbying" the
government to distribute the drugs through their organizations
(McKenzie, AP/Nando Times, 9/7).
Media & Society
Lack of Medical Resources to Diagnose, Treat AIDS Mentioned in ABC's
'Nightline' Series 'Heart of Darkness'
ABC News' "Nightline" began a five-part series, "Heart of Darkness,"
on Friday that examines the effects of civil war and genocide on life
in Democratic Republic of Congo. The second segment in the series,
airing tonight, focuses on the town of Shabunda, where nearly every
female has been raped by rebel forces. Italian priest Father Jean Pi-
erre, who has worked for several years to "pressure" outside organi-
zations to bring aid to the women of Shabunda, described the "deplor-
able state" of Congolese women's health, as many villages lack access
to a physician or an "efficient hospital" that can diagnose and treat
diseases, such as AIDS, that may be a consequence of rape. Pierre
said, "[W]e do not know what the consequences are inside their bod-
ies, whether they got AIDS. We do not have the possibility of analy-
sis. ... [I]n the hospital we lack everything. We even lack the prod-
ucts that are used to test for AIDS." Pierre added that he thinks the
authorities are "afraid to know the truth" about how many in the
population are HIV-positive. When asked by host Ted Koppel if there
is a "great deal" of AIDS in Shabunda, Pierre responded, "As I said
before we cannot assess it, but there is the TB. The TB is endemic in
this region and it is at the basis of all the other diseases includ-
ing AIDS. We do not have instruments to calculate an incidence of
these diseases."
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. � 2001 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
--
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>'.