Kaiser Daily HIV/AIDS Report - Tue, 26 Feb 2002
-----------------------------------------------
* Gauteng Premier Never Promised Nevirapine Roll-Out, Spokesperson
Says
* Evaluation of Test Sites to be Released This Week
* Health Minister Denies Questioning HIV-AIDS Link
* Opinion Round-Up
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Gauteng Premier Never Promised Nevirapine Roll-Out, Spokesperson Says
Mbhazima Shilowa, premier of South Africa's Gauteng province, never
promised a full-scale government roll-out of nevirapine, the antiret-
roviral drug that can reduce the risk of mother-to-child HIV trans-
mission by up to 50%, Business Day/AllAfrica.com reports. "An impres-
sion was created that it was a roll-out by the way it was reported
(in the media)," Thabo Masebe, Shilowa's spokesperson, said on Sun-
day, adding that the provincial government would "continue with the
extension of its [pilot] sites for the purposes of research." Last
Monday, Shilowa said in defiance of national health policy that his
government would "ensure that all public hospitals and large commu-
nity centers provide nevirapine." South Africa's national policy
states that the drug is experimental and relegates its use to 18 pi-
lot sites across the country (Xundu, Business Day/AllAfrica.com,
2/25). The announcement by Shilowa, a member of the ruling African
National Congress, was seen as a watershed moment in South Africa's
HIV/AIDS epidemic because it marked the first time that an ANC prov-
ince had broken rank with the national government on the issue. Many
South African leaders have become increasingly dissatisfied with
President Thabo Mbeki's leadership on HIV/AIDS. Mbeki, who has pub-
licly questioned the causal link between HIV and AIDS and suggested
that poverty plays a larger role in the disease, has only a 31% ap-
proval rating, according to a poll released last year (Kaiser Daily
HIV/AIDS Report, 2/20). Last Monday's announcement prompted a rebuke
from the national Department of Health, which called the plan "con-
trary to national policy." Shilowa apparently decided to clarify his
remarks after a meeting with national Health Minister Manto Tsha-
balala-Msimang on Friday. After that meeting, the government issued a
statement saying that the pilot sites are "for purposes of research"
and "more time and work [are] required to establish the long-term im-
pact of the administration of nevirapine." Some of the problems under
study include drug resistance and possible negative side effects for
the woman or the newborn. The government added that it would consider
"whether it was advisable to introduce universal access" only after
determining these outcomes (Business Day/AllAfrica.com, 2/25). On
Sunday, the Congress of South African Trade Unions again called on
the government to expand access to nevirapine to all HIV-positive
pregnant women through the public health system. "COSATU cannot see
any more reasons that convinces us about a strategy to step back when
there is evidence that [nevirapine] is effective," General-Secretary
Zwelinzima Vavi said, adding, "I don't care whether ... they call it
a full roll-out, as long as no woman who is pregnant and needing
nevirapine will be sent back from any public institution on the basis
it cannot be provided in the particular hospital because it is con-
fined to certain sites" (South African Press Associa-
tion/AllAfrica.com, 2/24).
Evaluation of Test Sites to be Released This Week
In related news, a "detailed," independent evaluation of the 18 test
sites, commissioned by the health department and performed by the
non-governmental organization Health Systems Trust, will be released
later this week. The report is currently circulating within the de-
partment, but Health-e News Service reports that the report was
likely not shared with provincial health ministers at a recent meet-
ing. Co-author Dr. David McCoy of HST said the report is particularly
important now because "issues around [the project] and the challenges
around the expansion of the program are being reported in the media
in a distorted and, at times, factually incorrect manner." He added,
"Misunderstandings and half-truths are therefore being added to the
politicization of what should be a public health issue." Mark Heywood
of the Treatment Action Campaign, which last December won a lawsuit
requiring the government to expand the nevirapine program to all na-
tional health institutions, welcomed the release of the report, say-
ing that he had been told the report was a "useful and critical
analysis" of the pilot projects and reached an "honest conclusion
that there needed to be a national roll-out and implementation plan."
Health Minister Denies Questioning HIV-AIDS Link
Also this weekend, Tshabalala-Msimang denied a newspaper report that
she had questioned the causal link between HIV and AIDS at a recent
ANC caucus meeting, thereby "re-open[ing]" the government's long-
standing debate over whether the virus causes the syndrome. "I said
that we had to tell HIV-positive people that by eating properly, man-
aging their stress and using condoms they can live longer (and not
enter the AIDS stage for many years)," she said, adding, "Health
workers are sometimes unsympathetic and may tell the ill person that
he or she is going to die [when they have pneumonia], this is not
true. We have good protocols in place to manage opportunistic infec-
tions" (Thom, Health-e News Service, 2/24).
Opinion Round-Up
Newspapers and columnists continue to focus on South Africa's
HIV/AIDS crisis. A summary of articles, editorials and op-eds appears
below:
* Economist: The South African government is "still doing far too
little to fight" HIV/AIDS, the Economist states. Mbeki "gives no
leadership" and "denies the scale of the problem," while the govern-
ment "refuses to provide antiretroviral drugs which prolong life and
make an infected person less infectious," it states, calling the lack
of leadership "woeful." When Mbeki does address HIV/AIDS, his "few
remarks are so ill-judged that those close to him are desperate to
keep him quiet." The Economist notes that signs of "exasperation" are
showing within the South African political landscape, best exempli-
fied by former President Nelson Mandela's recent statements and
Archbishop Desmond Tutu's call for a declaration of a national emer-
gency. Leaders in nations such as Uganda and Botswana have "set the
example" for their people by taking HIV tests in public, but Mbeki
dismisses such gestures as a "meaningless game" and instead "surfs
the Internet for new ideas about the virus, promoting academic de-
bates and eccentric medical views that confuse otherwise clear mes-
sages on how to tackle AIDS." He also maintains that AIDS drugs are
too expensive and could be harmful, the Economist notes. However, Ni-
geria and Uganda, which do not have the resources of South Africa,
have taken steps to make the drugs more available. Mbeki also seems
to dismiss the scale of the problem because he thinks "outsiders"
have exaggerated the numbers because they think Africans are "doomed
to a mortal end because of our unconquerable devotion to the sin of
lust." If the government tackled any of these problems -- "lean re-
sources, cultural insensitivity, political sycophancy" -- it might
make headway against HIV/AIDS, the Economist says. "And if men like
Mandela continue to speak out, [Mbeki] may realize that it is not
just distant racists who grow emotional about the terrible dangers of
AIDS, but his own furious countrymen," the Economist concludes
(Economist, 2/23).
* Minneapolis Star Tribune: Mbeki, an "otherwise bright and thought-
ful leader," is finally "coming around" on HIV/AIDS "thanks to domes-
tic and international pressure," a Minneapolis Star Tribune editorial
states, adding, "The pressure needs to continue." Mbeki's "poor lead-
ership on the issue has hindered progress" in South Africa. "Having
given a little, Mbeki should now completely abandon his perplexing
earlier stand" and "wage an all-out campaign against the epidemic,"
the editorial states, concluding, "South Africans don't need further
stigma, silence, confusion or denial about this deadly disease. They
need leadership that will put their survival first and make combat-
ting HIV/AIDS a national policy" (Minneapolis Star Tribune, 2/25).
* Syracuse Post-Standard: Mbeki has allowed the battle against
HIV/AIDS to "flounde[r]" at his feet, a Syracuse Post-Standard edito-
rial says. While Mbeki's fiscal policies led Mandela to call him "the
best leader the nation has ever had," Mandela more recently has
criticized Mbeki for "debating ... [and] arguing" about HIV/AIDS,
"when people are dying." Mbeki may be "cracking," however, as AIDS
education and counseling, nevirapine pilot programs and condom dis-
tribution will see increased government funding over the next three
years. "The sooner Mandela and Mbeki join forces in an all-out cam-
paign to battle the deadly AIDS virus, the sooner South Africa can
lead the effort to contain the pandemic in all of sub-Saharan Africa
as well," the editorial concludes (Syracuse Post-Standard, 2/25).
* Richard Tren, Wall Street Journal Europe: Breaking South African
patent laws to import generic AIDS drugs from Brazil may be a "bold
decision," but it is not a "wise one," Richard Tren, director of Af-
rica Fighting Malaria, writes in a Wall Street Journal Europe op-ed.
Medecins Sans Frontieres recently announced that it was importing ge-
neric drugs from Brazil's government-run FarMaguinhos laboratory. The
lab does not conduct research to develop the drugs, but instead "re-
verse engineer[ed]" the drugs to determine the formulas. Brazil says
that it will use the money from MSF to fund research into AIDS and
other infectious diseases such as malaria. "One has to wonder how
much meaningful research and actual drugs will be produced by the
Brazilians from the sale of cut-price ripoffs to the NGO sector,"
Tren says, adding that if the lab did develop a cure or effective
treatment for a disease, he "would wager that they would ... change
their stance on intellectual property rights" rather than give the
drug away for "next to nothing." How would they fund more research if
they did not charge competitive prices? he asks. "It is precisely
this kind of double morality -- a disdain for property rights in the
name of supposedly helping the sick -- that is discouraging innova-
tion" in AIDS drug development. AIDS advocacy groups call for in-
creased competition from drug manufacturers to drive prices down.
"Competition is all well and good, but there are certain rules that
apply," Tren notes, adding, "Protecting private property in a com-
petitive free market is one of the most fundamental; otherwise ...
competition just becomes sanctioned theft." Tren states that activ-
ists are correct to call for more funding in the fight to gain access
to treatment for AIDS. However, "good intentions do not create new
drugs. Future AIDS patients, seeking new, more effective treatment
against evolving strains of the disease will look in vain for those
drugs if they have to rely on the patent-breakers in Brazil," he con-
cludes (Tren, Wall Street Journal Europe, 2/25).
--
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. � 2002 by National Journal Group Inc. and Kaiser
Family Foundation. All rights reserved.
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