Lynne Altenroxel

Manto delays anti-Aids drugs decision The offices of President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang have delayed the cabinet's decision on providing anti-Aids drugs. In the past few weeks Tshabalala-Msimang and Minister in the Office of the Presidency Essop Pahad have scrutinised a report on the cost of providing anti-retroviral triple therapy and have raised several questions. Now they have sent the report back to its authors, asking for further details about the type of infrastructure needed in each province to provide treatment, sources have confirmed. Questions about infrastructure cover three aspects of treatment provision: Training of doctors, nurses and Aids counsellors; Laboratories for blood tests to determine when HIV-positive patients need to start treatment and to monitor their progress on antiretrovirals; Trained staff to counsel people before and after they undergo HIV tests. Experts say that while the necessary infrastructure is not available countrywide, it is up and running at many government hospitals and clinics. Places such as Johannesburg hospital, Helen Joseph hospital, Groote Schuur, Tygerberg hospital and Gugulethu Day hospital are already providing anti-Aids drugs to patients who can afford to pay for them. Helen Joseph hospital diagnoses between 80 and 90 new HIV-positive patients every week. More than half the patients on the hospital's database have reached the critical point where they need anti-retrovirals to stay alive. Less than five percent can afford the medication. This is the infrastructure that is needed: Training for doctors, nurses and Aids counsellors to administer the drugs, monitor side-effects, help patients to adhere to strict drug regimens and recognise opportunistic infections which usually affect only people with compromised immunity. All of them need to undergo two days' training. Blood tests are used to work out when a HIV-positive patient should start anti-retrovirals and to monitor patients' progress on treatment. The National Health Laboratory Service, which provides these tests, has 300 laboratories across the country. HIV testing: People need to be diagnosed as HIV-positive before being offered treatment. HIV testing is already available at a quarter of all government clinics. (Source: Lynne Altenroxel and Jo-anne Smetherham, the Star, July 02 2003)

HIV prevalence figures have jumped by almost two percentage points in the past year possibly the reason why the government has not released them. The new national prevalence rate is 26,5 percent for 2002, compared with a 24,8 percent in 2001. The figures are based on a survey among pregnant women attending government antenatal clinics in October each year. The results have been available for several months and have been alluded to by Health Minister Manto Tshabalala-Msimang. But, with just three months to go before the next round of screening, they haven't been made public. This is despite the fact that, according to experts, the two-percentage-point increase might not be statistically significant. This doesn't indicate a change in trend, said Professor Rob Dorrington, head of the AIDS committee of the Actuarial Society of Southern Africa. It probably indicates statistical variation and that last year's figure was probably on the low side. Government sources have confirmed the increase. They are sensitive about it, that's true, one official said. However, several attempts to obtain comment from the Department of Health have been unsuccessful. In the past two years Tshabalala-Msimang has hailed the antenatal data as proof that the HIV epidemic was tapering off. The Treatment Action Campaign expressed concern about the delayed release.(Source: Lynne Altenroxel: The Star, 3 July 2003)

A year-long investigation into the anti-Aids drug nevirapine has found beyond doubt that the treatment is safe and effective. The finding is made in a report by the United States National Institutes of Health and is to be discussed by South Africa's Medicines Control Council on Friday at a special meeting about Nevirapine's possible deregistration. Panic over reports about the possible banning, which surfaced during last year's Constitutional Court battle over the drug, were fuelled by the political debacle over Aids dissidents and the government's insistence that nevirapine was dangerous. But the 50-page report, which scrutinises the standards of the 1997 Ugandan drug trial where nevirapine was first tested on pregnant women, recommends that the treatment continue to be used. Its findings are pivotal for the council, which based its registration of nevirapine for prevention of maternal transmission on the Ugandan study and has been waiting for the report to be completed before deciding whether to withdraw its approval. The problems with the data were largely administrative. For example, the report explains, investigators found that dating methods were not consistent and written errors had been crossed out in the incorrect way. But, despite the data problems, investigators conclude that these shortcomings did not affect the scientific results of the study nor did they compromise the standard of care given to the mothers or infants in Uganda. Only three serious adverse events among the trial's 645 mothers were believed to be drug related - two were in mothers who received AZT and one who received a placebo. (Source: Lynne Altenroxel, The Mercury, 23 April 2003)

A respected South African researcher has called for South Africa's AIDS debate to move beyond the simplistic 'for or against' stance of President Thabo Mbeki's denials that HIV causes AIDS. The plea is made in an article co-written by Helen Schneider, director of Wits University's Centre for Health Policy, which was published in the British Medical Journal this month. The July Constitutional Court judgment ordering the government to make Nevirapine universally available to pregnant women infected with HIV, followed in October by a cabinet statement supporting wider access to antiretrovirals, may have finally ushered in a new era, the article states. Schneider and her co-writer, Didier Fassin of the University of Paris, argue that understanding the social factors which place some South Africans at a higher risk of contracting the virus would make it easier to resolve the differences between supporters and opponents of the AIDS dissident view. For example, ascribing AIDS to poverty - as dissidents do, oversimplifies a complex set of social circumstances, including sexual violence and the role of apartheid's seasonal labour migrations, in fuelling the country's HIV epidemic. Inequality mobility and violence are partly the legacy of centuries of colonial exploitation and racial segregation, culminating in the institution of apartheid in the second half of the 20th century the article states. Epidemiologically, this segregation translates as differential HIV sero-prevalence between black and white groups and between social classes. To focus attention solely on behaviour change or on treatment is to overlook the powerful social determinants of HIV in South Africa. (Source:The Cape Times, 10 March 2003)

A respected South African researcher has called for South Africa's AIDS debate to move beyond the simplistic 'for or against' stance of President Thabo Mbeki's denials that HIV causes AIDS. The plea is made in an article co-written by Helen Schneider, director of Wits University's Centre for Health Policy, which was published in the British Medical Journal this month. The July Constitutional Court judgment ordering the government to make Nevirapine universally available to pregnant women infected with HIV, followed in October by a cabinet statement supporting wider access to antiretrovirals, may have finally ushered in a new era, the article states. Schneider and her co-writer, Didier Fassin of the University of Paris, argue that understanding the social factors which place some South Africans at a higher risk of contracting the virus would make it easier to resolve the differences between supporters and opponents of the AIDS dissident view. For example, ascribing AIDS to poverty - as dissidents do, oversimplifies a complex set of social circumstances, including sexual violence and the role of apartheid's seasonal labour migrations, in fuelling the country's HIV epidemic. Inequality mobility and violence are partly the legacy of centuries of colonial exploitation and racial segregation, culminating in the institution of apartheid in the second half of the 20th century the article states. Epidemiologically, this segregation translates as differential HIV sero-prevalence between black and white groups and between social classes. To focus attention solely on behaviour change or on treatment is to overlook the powerful social determinants of HIV in South Africa. (Source:The Cape Times, 10 March 2003)

The World Health Organisation and the Food and Agriculture Organisation have published a new guide on nutrition for people living with HIV.The manual outlines the basics of a good diet, which can delay progression to AIDS. It also includes chapters on traditional remedies and dietary advice for common ailments in HIV patients. AIDS has a devastating effect on a person's nutritional well-being, for these reasons: nutrient absorption is reduced due to damage to the gut wall; appetite and metabolism are disrupted as the body uses more energy to fight HIV infection; muscles, organs and other tissues waste away; and, secondary infections and other stresses increase demands for energy and nutrients. HIV-related illness, such as nausea, can decrease the appetite, and painful opportunistic infections of the mouth and gut can make eating difficult. The manual offers advice on making food easier to eat during severe illness and tips on basic hygiene, and includes a chapter on herbal remedies for symptoms such as fever, nausea, inflammation and diarrhoea. By bolstering the immune system and boosting energy levels, balanced nutrition can help the body to fight back against the ravages of HIV, the UN agencies say. The manual is available at www.fao.org (Source: Lynne Altenroxel: The Star, 3 March 2003)

The cabinet has approved a plan to provide antiretroviral triple therapy at six government hospitals, in a further indication of an AIDS policy turn-around. Sources have 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-AIDS 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 antiretrovirals 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 Eastern Cape. The South African Medical Association and the Nelson Mandela Foundation have joined forces to raise R80-million for a project which, it is envisaged, could treat 9 000 patients. In Khayelitsha, Medècins Sans Frontières 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 antiretrovirals 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% of the total health budget in 2001. One study, published in the South African Medical Journal late last year, estimated that providing 107 000 patients with a bare minimum package of drugs could cost R409-million a year. (Source: Lynne Altenroxel,The Star, 13 February 2003)

NGO questions if government can turn words into deeds Despite a promising start, negotiations over a national AIDS policy could drag on into the new year. A meeting between negotiators at the National Economic Development and Labour Council (Nedlac) is expected to take place before the end of the week, and AIDS activists have requested that an agreement be reached by tomorrow. But yesterday, business sector negotiator Vic van Vuuren said it was unlikely that all parties who needed to be consulted about the far-reaching agreement could be canvassed this year. The delay is a dramatic change from the position a week ago, when negotiators at Nedlac appeared ready to announce a major breakthrough on Sunday as part of World AIDS Day commemorations.But, last Thursday night, the process came to a halt as government and business negotiators said they still needed to get a mandate. More meetings were held and, by Saturday, a joint statement announcing that an agreement had been reached was prepared. But, due to disagreement about the wording, it was never released. On Sunday, the Department of Labour said the announcement of an agreement had been premature. Now, AIDS activists from the Treatment Action Campaign say, the negotiations have turned into a demoralising controversy. Each day wasted is a day in which lives are lost, the TAC said yesterday. The framework agreement under discussion covers a broad spectrum of AIDS issues and includes provisions for treatment with antiretroviral triple therapy and extending access to the anti-AIDS drug Nevirapine to pregnant women across the country. It seems that the government is unable to turn policy into practice, the TAC said.(Source: Lynne Altenroxel,The Star, 5 December 2002)

There is still no certainty over the future of the R720-million allocated to KwaZulu Natal by an AIDS fund. Four months have passed since the Global Fund for HIV/AIDS, TB and Malaria approved the donation, provoking the anger of Health Minister Dr Manto Tshabalala-Msimang. She met the fund's executive director, Dr Richard Feachem, in Geneva on Friday to discuss her opposition to the allocation of the money to KwaZulu Natal. But they failed to resolve the fight that has raged over the donation. The fund approved two lots of money for South Africa: $93-million (about R970-million) to the national government for prevention programmes, including more money for loveLife; and, $72-million (about R750-million) to KwaZulu Natal for a programme which, unlike the national proposal, includes the provision of antiretrovirals. Tshabalala-Msimang is insisting that the KwaZulu-Natal portion should be distributed equitably among all nine provinces, but the Global Fund's rules stipulate that donations can be used only for projects approved. The latest statement said both parties had agreed to keep the public informed about the progress of negotiations, but not to conduct these discussions via the media. It was agreed that Dr Tshabalala-Msimang would consult further on the KwaZulu-Natal proposal with the SA AIDS Council and relevant stakeholders in KwaZulu-Natal, and advise the Global Fund secretariat on how to proceed with the implementation of the proposal, the statement said. Meanwhile Gauteng has announced it will apply for money from the Global Fund during the next round of submissions, which closes on September 27. (Lynne Altenroxel: The Star, 9 September 2002 )

THEY'VE taken on the pharmaceutical industry and they've taken on the state. Now the AIDS activists from the Treatment Action Campaign (TAC) have decided to target pathology laboratories in a bid to cut the cost of blood tests for HIV patients. The cheaper blood tests they want are a crucial part of antiretroviral triple therapy. Blood tests are done every three months to measure a patient's immunity (called a CD4 count) and the amount of HIV in their blood (viral load) while they are undergoing treatment. The total blood test package costs R1 200, substantially increasing the costs. The cost of triple therapy has dropped to around R700 a month due to pressure on drug companies, but the cost of blood tests has remained high. Yesterday, Fatima Hassan, an attorney at the AIDS, Law Project, said one pathology company had offered to cut blood test costs from R1 200 to R500.That is not a below-cost price, she said. They would still be making a profit.The pathology group offering the discount was part of an umbrella body that negotiates tariffs with medical AIDS each year. If one laboratory could halve the cost of the tests and still make a profit, it should be viable for other pathology firms as well, Hassan said. Lynne Altenroxel: 6 August 2002