War

Botswana's efforts to curb the AIDS epidemic will be shaped by attempts to make men more sexually responsible.According to a 1999 study on HIV/AIDS commissioned by the Community Health Services Division, men feel entitled to have multiple sex partners. The study found that there was extreme mobility of the population in Botswana and also frequent and long-established work-related separation of spouses or partners, which in turn leads to extra-marital or extra-relationship sexual encounters. More than half the mobile workers had sexual intercourse twice or more often per week, and only one-third went home every weekend or every other weekend. Women were at special risk of HIV infection because of their lack of control over sexual practices, it emerged at the workshop.

Luanda - Sleeping sickness, a vector-borne parasitic disease, is ravaging Angola, threatening a third of the population across 14 of the 18 provinces in the south-west African country which is still struggling to rebuild after a 27-year civil war that ended in April 2002. In 2003, 96 Angolans died of sleeping sickness by official count while 3 115 new cases and 270 000 suspected cases were detected nationwide, Dituvanga said. However, it is virtually endemic in the seven northern provinces of Bengo, Kuanza north and Kwanza south, Luanda, Malange, Uige and Zaire. The ICCT, the French acronym for the Institute, admitted that there were vast areas in the east of the war-ravaged country where it had been completely unable to intervene. Despite a crippling lack of funds, the ICCT said it had last year managed to destroy one million tsetse flies, which spread the disease, in the seven worst-hit provinces, including the province of Luanda, where the Angolan capital - which bears the same name - is located. Dituvanga said sleeping sickness was for Angola a social, economic and political problem as it had hit provinces which are rich in in mineral resources such as oil-bearing Zaire province and diamond-bearing Malange. The ICCT has 21 diagnostic and treatment centres for sleeping sickness. They are run by nine doctors, five researchers, an entomologist, 148 nurses and 53 laboratory staff. The institute also runs periodic campaigns to try to detect new cases and follow up with treatment, working in partnership with eight international non-governmental organisations. The biggest treatment and research facility is located in Viana, close to Luanda and has 84 beds which are constantly occupied. A report published by the African Union in February last year said sleeping sickness seriously threatened development across the continent, with more than half-a-million suffering from the disease, 80 percent of whom perish. Sleeping sickness threatens about 50 million cattle in Africa, according to a recent report by the UN Food and Agricultural Organisation. (Source: Sapa-AFP, 3 February 2004)

A recent row in South Africa over the deployment of HIV-positive soldiers on peacekeeping missions has turned the spotlight on the issue of HIV testing and the exclusion of HIV-positive individuals from the army. South Africa's Minister of Defence Mosiuoa Lekota sparked controversy earlier this month when news reports quoted him as saying: Anybody with the condition [HIV/AIDS] cannot be recruited [into the defence force]. Activists said the policy was unconstitutional, and threatened to take the defence department to court. The South African cabinet distanced itself from Lekota's comments, saying there was no policy to prevent the recruitment of HIV-positive personnel into the South African National Defence Force (SANDF) merely because they were HIV-positive. Lekota attributed his position to the United Nations peacekeeping regulations, which recommend that countries should not deploy HIV-positive individuals on peacekeeping missions. Although the UN's Department of Peacekeeping Operations (DPKO) maintains that it does not prescribe mandatory testing prior to deployment, it nevertheless issued guidelines recommending that countries should not second HIV-positive individuals to peacekeeping duties. According to DPKO, available medical treatment may not be adequate to meet the requirements of those living with HIV when they are sent on mission. Peacekeepers may also have to undergo pre-deployment vaccinations, and they may be exposed to diseases during deployment, posing additional risks to their health. But an expert panel, convened by UNAIDS and DPKO in 2001, revised this policy and agreed that HIV should no longer be a criterion for exclusion from peacekeeping missions. Defence ministry spokesman Sam Mkhwanazi admitted that army recruits had to undergo a comprehensive assessment, including HIV testing. But they are not compelled to join - it would be unconstitutional. You can obviously refuse to go for a medical, he commented. According to Robyn Pharoah, senior researcher at the AIDS and Security project of the Pretoria-based Institute for Security Studies (ISS), this was still completely contrary to UN guidelines. Despite the cabinet's statements that there was no government policy to exclude individuals from the South African National Defence Force ( SANDF) solely on the basis of their HIV status, SANDF continues to practice a blanket policy of excluding job applicants with HIV, the AIDS Law Project (ALP) said in a statement. According to the review, data on HIV prevalence in the uniformed services was limited, as prevalence studies were seldom conducted. Authorities were also reluctant to release data that could imply strategic weaknesses within their services. While the SANDF may ban the recruitment of HIV-positive personnel, it does try to care for those already in uniform and living with the virus. The SANDF's 'Masibambisane' Campaign (www.mil.za/CSANDF/SurgeonGeneral/AIDSCampaign/MasiWeb2/index.htm) was quite a good workplace programme, which offered peer education, prevention projects, and care and support for employees living with HIV/AIDS, observed Richard Delate, co-author of a review of HIV/AIDS policies and programmes among peacekeepers. With South Africa now playing a key peacekeeping role on the continent, the issue of deploying HIV-positive troops on missions remains a contentious one. The UNAIDS review - prepared for the UN General Assembly Special Session in September this year - found that establishing guidelines on HIV testing and peacekeeping operations was still an uphill battle. Most countries required mandatory testing prior to deployment, but various interpretations of the protocol regarding permission to test had been reported. A lot of debate about HIV/AIDS in the military that went beyond testing policies was still taking place, Delate said. There is no information in the public domain around AIDS in the military. Prevalence levels are still an area of contestation. According to the review, data on HIV prevalence in the uniformed services was limited, as prevalence studies were seldom conducted. Authorities were also reluctant to release data that could imply strategic weaknesses within their services. Delate called for a shift in public perceptions about HIV/AIDS in the armed forces. Let's not apportion blame, but rather look at how peacekeepers can be seen as agents of change in the fight against HIV/AIDS. (Source:PLUSNEWS 29 October 2003).

The death of a family member due to Aids is often only the first, and not the worst, ordeal the survivors have to face, an anthropological economist said on Tuesday. We are seeing households seriously weakened, Catherine Cross of the Human Sciences Research Council said at a seminar in Pretoria. Particularly when a youth took over as head of a rural household, there was a big risk that the family might lose their land tenure rights, she said. Cross conducted a study among Aids-affected households in KwaZulu-Natal, 20 of which were in a peri-urban area 24km from Durban. Although the concept of child-headed households was commonly used, she did not find any households headed by a child under the age of 16, she said. Households headed by 16- to 25-year-old males were found though. Female orphans were generally absorbed into other households. According to Cross, the term child-headed was probably used because many rural communities regarded anyone who had not yet married or had children of their own, as a child, she said. The community near Durban where she did some of the research also did not regard such youths as fit to be given the right to the land their late father had occupied. They were deemed to be unreliable until they were married. Another problem was the vulnerability of youth-headed households to land-snatching by unscrupulous guardians, or even impostors pretending to be their guardians. Traditionally, there was a custom that dictated how to take care of orphans. The more recent past, however, saw the emergence of dishonest guardians who took over the land and assets left by someone who had died due to Aids, and put the children out on the street. Of the 20 households, the proportion of potential earners who did bring in money, dropped from 60% before the Aids death to 42 % afterwards, Cross said. Women and youths as heads of households were not regarded with the same authority as men, so it was more difficult for them to mobilise all those who could, to contribute to the income of the family, Cross said. (Source: Sapa, Mail and Guardian, 15 July 2003)

Occupational Diseases in Mines and Works Amendment Bill ************************************************** Latest Developments: The department has confirmed that the Bill was signed into law by the President on the 22 January 2003. The full title is the Occupational Diseases in Mines and Works Amendment Act no. 60 of 2002 Background: Introduced by the Minister of Health 20-Aug-02. The ODMWA Act amends the Occupational Diseases in Mines and Works Act of 1973 so as to provide for the increase of the period within which the director of the Medical Bureau for Occupational Diseases (MBOD) may refuse an application for medical examination of a person who has worked in a mine from 6 to 24 months. Matters incidental to this amendment are also provided for; in addition, the so-called community representatives and attorneys who assist miners in claiming benefits in terms of the Act are prohibited from charging fees in excess of 0.5% of the benefit awarded. Regulations relating to the fortification of foodstuffs ************************************************** Latest Developments: The deparment has confirmed that they have received comments on the proposed regulations. Their legal units are currently in the process of reviewing them. It will then be edited and if it goes through it is expected to be published in April. Background: The Minister of Health intends, in terms of s.15(1) of the Foodstuffs, Cosmetics and Disinfectants Act, 1972 (Act No. 54 of 1972), to develop regulations.(Source: Contract Trust Updates, alison@contacttrust.org.za)

Latest Developments: The Draft Bill is at this stage still with the State Law Advisors. A meeting between the State Law Advisors and the Department was held during the week of 10 February 2003 during which issues affecting the Bill were discussed. The dialogue, which focuses on the structuring of the Bill, is ongoing and aims to ensure its constitutionality. At this stage, it is difficult for the Department to say when it will be tabled, since this depends on whether the State Law Advisors are satisfied with its constitutionality. Background: The Draft National Health Bill will repeal the 1977 National Health Act and create a new regulatory framework for the national health system. The Draft Bill also sets out the rights and obligations of both users and health care providers. The re-drafting of the Health Act provides an opportunity for the gains that have been made in health care services since 1994 to be entrenched into national legislation. For more information contact Debbie Pearmain at 012 312 0611 Medicines and Related Substances Amendment Bill Latest Developments: The Bill was signed by the President in December 2002. It is expected to come into operation in April 2003. Background: The Medicines and Related Substances Amendment Bill (B40-2002) was introduced by the Minister of Health on 21 August 2002, published in Government Gazette No 23684 of 29 July 2002 , and classified by the Joint Tagging Mechanism as a section 75 Bill (ordinary bills not affecting the provinces). This bill amends a 37-year-old act controlling, among other things, the dispensing and manufacture of medicines in South Africa. For more information contact H.Z. Zokufa at 012 312 0355 Provision of anti-retroviral drugs in public hospitals Latest Developments: The cabinet has approved a plan to provide anti-retroviral triple therapy at six government hospitals, in a further indication of an Aids policy turn-around. It has been confirmed that money for the programme, which has been drafted by some of South Africa's leading Aids experts, will come from the William J Clinton Presidential Foundation in New York. The foundation will donate $35-million (about R290-million) for the life-extending anti-retroviral drugs, which will be provided to 2 100 people. This makes it one of the largest donations to South Africa for the provision of triple therapy, along with money from a donation from the Global Fund to Fight Aids, Tuberculosis and Malaria. Part of a Global Fund donation of $72-million (R600-million) to KwaZulu-Natal is intended to start a limited programme to provide anti-retrovirals to HIV patients in that province. The Clinton Foundation money will be deployed at Mariannhill Clinic in KwaZulu-Natal, Johannesburg Hospital, Chris Hani Baragwanath Hospital in Soweto, Masiphumelele Clinic in Fish Hoek, Groote Schuur Hospital in Cape Town, and one clinic in the Eastern Cape. The programme is one of several that are making expensive anti-Aids drugs available to South Africans who cannot afford them. In Khayelitsha, Medecins Sans Frontieres provides triple therapy to nearly 350 needy patients. Dozens of other people are accessing treatment by participating in clinical trials. But this is not nearly enough to help the estimated 200 000 South Africans who are expected to suffer Aids-related deaths this year. The cheapest triple therapy currently available costs about R900 a month. But despite the hefty price tag, epidemiologists and health economists have worked out that providing anti-retrovirals would save the government money by cutting back on the expense of hospitalising Aids patients. According to the department of health, patients suffering from Aids-related illnesses comprised a quarter of hospital admissions in 2000. The department estimated that their hospitalisation would use up 12,5 percent of the total health budget in 2001. Thousands of Aids activists, trade unionists, religious leaders and members of the public marched on Parliament at its opening on 14 February 2003 in a bid to urge the government to implement a national Aids treatment plan by the end of February. Before proceeding to Parliament, the Treatment Action Campaign (TAC), organisers of the Stand up for our Lives march, handed over a memorandum to the United States Consulate General, asking the US government to allow poor countries to import generic medicines. It was widely expected that the TAC would announce plans for a non-violent civil disobedience campaign. The campaign would begin in March, but according to the TAC it would only proceed should the government fail to implement - by the end of February - a national Aids prevention and treatment plan that includes antiretroviral therapy (ART). The plan would also have to include a commitment by the government to produce generic Aids drugs, the TAC said. Background: Cabinet is studying the possibility of providing anti-retroviral drugs (ARVs) in the public health sector as a means of improving the quality of life for those living with HIV/AIDS. A bilateral technical task team of the Department of Health (DOH) and the Treasury is working on cost implications of an expanding response to the impact of HIV/AIDS on all sectors of society. For more information contact Joanne Collinge at 012 312 0713 (Source: Contract Trust http://www.contacttrust.org.za)

The burden of disease resulting from working in mines is unacceptably high in South Africa, Health Minister Dr Manto Tshabalala-Msimang said on Tuesday. Speaking in the National Assembly during debate on the Occupational Diseases in Mines and Works Amendment Bill, she said about 25 000 compensation applications were made each year for occupational lung diseases resulting from working in mines. In the past, occupational health has often been neglected, and yet the fact remains that globally over one million workers die from work-related diseases and injuries, and there are over 160-million cases of work-related diseases annually. The amendments in the bill might appear to be minor, but had far-reaching implications, as they will unblock some of the problems experienced thus far, she said. Among other things, the bill extended the length of time during which an ex-miner could apply to be medically examined from six to 24 months. Tshabalala-Msimang said one of the most important provisions in the bill was one that limited commission for agents who assisted mineworkers in accessing compensation. A fee of not more than half a percent of the benefit paid to the sick worker could be charged, and the bill made it an offence to charge more. The measure received the support of all sides of the House, and will now go to the National Council of Provinces for concurrence.(Source:SAPA, 22 October 2002)

African countries have scaled up their HIV/AIDS response, but more needs to be done, according to UN Under Secretary-General and Economic Commission for Africa (ECA) Executive Secretary, KY Amoako. Amoako said that the key to tackling most of the continent's health problems was to strengthen economies. He was optimistic that the Abuja Declaration on HIV/AIDS in April 2001 would be implemented. He also discussed the impact of the Global Fund in Africa and the role of women in fighting the HIV/AIDS pandemic. With respect to the Abuja Declaration and the consensus reached at ADF 2000 on HIV/AIDS, efforts are underway to translate these commitments into reality. We at the ECA have established a health unit in the Economic and Social Policy Division to enable us provide assistance to member states in their efforts to follow through on these commitments. ECA and OAU, with assistance from UNAIDS and WHO are preparing an annual report on HIV/AIDS, TB, and malaria which will report and serve as a monitor of the implementation of the commitments made. It is hoped that this report will be presented to African heads of state during their summit meeting in Pretoria, South Africa, later this year. (The full text of this interview raises a number of interesting topical issues on the HIV/AIDS debate - please read the full text online, or contact editor@hst.org.za if you do not have web access)

The Western Cape government is to receive free supplies of the antiretroviral drug Nevirapine, which is used to prevent HIV-positive women from infecting their unborn babies, from German pharmaceutical company Boehringer Ingelheim for the next five years. The application was made and approved yesterday and will result in a R750 000 saving for the provincial government. In the past, it bought the drug from the company. Premier Peter Marais' announcement follows a similar one by KwaZulu-Natal premier Lionel Mtshali earlier this week. In addition to the deal announced by Marais yesterday, the Western Cape has negotiated a 70% discount on AZT from GlaxoSmithKline for its pilot project in Khayelitsha. This programme, which started in January 1999 and has treated 3200 people, will be extended to other regions soon. Marais said the free Nevirapine would become available immediately at 38 maternity centres where the programme has been implemented, and at all other maternity service centres as the programme was rolled out. Marais has declared war on HIV/AIDS in the province and has committed his government to reducing the infection rate among pregnant women from its current 8,5% to 5% by 2004. Western Cape deputy health director-general Fareed Abdullah said the Western Cape programme, which started in January last year, was the largest in Africa in terms of the number of patients treated and facilities involved. By June, 95% of transmission cases would be treated and by March next year there would be 100% coverage. Abdullah said the cost of the drug (R25 per birth), was less than 5% of the total cost of the anti-transmission programme, the most expensive item being formula for the baby for six months (about R500 a child). Other costs were for counselling and testing, antenatal care and delivery and follow-up care. (Source: Business Day, 25 January 2002)

South African multi-millionaire Mark Shuttleworth, 28, will conduct Aids experiments in space when he becomes the first African astronaut in April next year. Interactive Africa, which is handling Shuttleworth's communications, on Tuesday said four experiments had been short-listed for the African Space programme. HIV attacks the immune system of the body, and one of the experiments will research the interaction of immune cells in a microgravity environment. However, scientists have to deal with the problem of size - the combatants are too small to observe directly. They have to study several pieces of evidence to infer what happens during the immune cell interaction. The experiment will use the unique microgravity or weightlessness of space flight to attempt to create crystals of some of these human immune system proteins. This experiment would also help understand other abnormally regulated immune reactions such as allergies, asthma and cancer as well as virus infections like ebola, measles and dengue fever which is transmitted by mosquitoes. The immune cell experiment will cost about R22 000 and will be sponsored by Shuttleworth along with the three other studies. The other experiments will explore stem cell research, the affect of microgravity on the human body and the impact of the launch on educational objectives. In the second experiment, Shuttleworth will be monitored by a team on earth who will record his heart rate and the way his muscles react to weightlessness. Shuttleworth will conduct other experiments proposed by Russian specialists with an African or high technology theme. (Source: SAPA, 12 December 2001)