Public Health News (Pre 2010)

Provincial health spokesman Roz Jordan said 62 of the cases were reported in Eshowe and 53 in Ngwelezane, pushing the number of cases reported since the out-break in mid August to 2039. 

All cases of diarrhoea in the province were being investigated and monitored for surveillance purposes, she said.

Meanwhile, in addition to the involvement of Departments of Provincial and Local Government, Defence and Safety and Security, Cabinet on 11/10  approved further investigations by the Department of Water Affairs and Forestry into short and longer-term measures for the supply of safe water to the affected areas. 
(Source: SAPA, 11/10/00) 

Health Minister Manto Tshabalala-Msimang and the health MECs in all nine provinces are to defend the court action launched by the Treatment Action Campaign (TAC) and hundreds of doctors to force them to provide antiretroviral treatment to HIV-positive pregnant women in the public health system.

The TAC and doctors sent a letter of demand followed by court papers asking the national health ministry and provinces to supply the antiretroviral drugs or details of a plan to do so.

Government was given until yesterday to say if it would defend the action.

Western Cape, which has a plan in place, is defending the action but notified Tshabalala-Msimang its approach would be different. A spokesman for health MEC Nick Koornhof said last night that the province would have preferred it had the TAC not included it in the action as it had a plan in operation to provide the treatment. 

The province would use its own team of lawyers and would likely try to avoid being lumped into the same action with the other respondents.

A similar approach seemed possible from Gauteng, which, while defending the action, has written a letter explaining its own rollout for the provision of treatment.

Earlier in the year, Gauteng launched the rollout of its plan, making it clear it intended to give treatment more widely than the provision of two sites would allow for.

It has become clear that the court case and the issue of the provision of antiretroviral treatment are dividing the public health system.

The letter from the health department of Gauteng shows the two sites for the national expansion programme. It then names several more sites already approved by the province and says more will be announced in due course.

Western Cape wrote to the TAC's lawyer Geoff Bud lender in July, saying the health minister has indicated she believes it to be appropriate that a single submission serve as a response to the legal moves.

Koornhof, however, sent Bud lender a copy of his letter to Tshabalala-Msimang that details the province's plans for the provisions of anti-retroviral treatment.

Source: Business Day, 13 September 2001

The Health Ministry has hit out at critics of President Thabo Mbeki's plan to review the profile of South Africa's mortality statistics.

An article in Business Day newspaper on Monday said the move was apparently intended to de-emphasise the HIV-AIDS crisis in the country in the light of 1995 death statistics Mbeki extracted from the Internet.

A statement from Health Minister Manto Tshabalala-Msimang said Mbeki had written to her in her capacity as chair of the Social Cluster of Ministers (SCM), requesting that the cluster review the profile of mortality statistics and to consider whether the government's programmes were aligned with people's needs.

We (the SCM) take issue with the suggestion in Business Day that this initiative is extended to de-emphasise the impact of HIV/AIDS, Tshabalala-Msimang said.

The significance of HIV/AIDS and the challenges it poses to our service as well as to our society in general are not in question.

United Democratic Movement leader Bantu Holomisa said Mbeki's latest comments on HIV/AIDS were conclusive proof that he did not deserve to lead South Africa.

The letter (to Tshabalala-Msimang) should serve as the final verdict on his incompetence and incapability to look after the best interests of the country," he said.

Tshabalala-Msimang said the SCM did not view Mbeki's request as an exercise to reduce the resources and energy devoted to the HIV/AIDS programme, but as a critical appraisal of whether the government were sufficiently focused in other areas of healthcare and social service.

She said South Africa also recorded a large number of deaths due to cardiovascular conditions, injury (both intentional and accidental), respiratory dysfunction and cancers each year and the SCM needed to consider whether the factors causing these were also being tackled in an effective way.

South Africa remains a highly unequal society with extremes of wealth and poverty, and this fact reflects in our complex burden of disease in which classic diseases of poverty combine with emerging diseases of lifestyle.

The Business Day article said Mbeki's request was likely to be criticised because he had based the methodology for his request on statistics form the mid-1990s, while the pattern of AIDS deaths had shifted significantly since this time.

Tshabalala-Msimang defended Mbeki's methodology, saying the President had used the statistics, because they were the latest available and formed the basis of international reports on South Africa's national health status.

However, government has been conscious of the need for more current AIDS-related mortality figures, she said.

The need for updated figures was one of the recommendations emanating from the Presidential AIDS Advisory Panel.

Largely as a result of this, an Interdepartmental Task Team on Mortality Statistics was set up.

Tshabalala-Msimang said Statistics South Africa, a participant in the task team, had prioritised the processing of general mortality data for 1997 to 2000. The figures are expected to be released by December.

These figures will constitute new 'official' death statistics for our country.

Business Day said Mbeki's request could be undone by a soon to be published report by the Medical Research Council (MRC), that was expected to find that AIDS would become the country's leading cause of death.

Tshabalala-Msimang said the report should be seen as part of this broader process.

She said on September 3 the MRC's research results were presented to a meeting that included the Statistician General, the head of the Department of Home Affairs, the Director-General of Health, representatives of the Human Sciences Research Council and the population unit of the Department of Social Development.

The meeting recommended that the report should be presented to Cabinet and the process of routing it to Cabinet has begun.

The Minister said the purpose of presenting the research to Cabinet was to inform ministers of the findings and not to seek endorsement.

We believe that the figures that underpin policy on a matter as significant as HIV/AIDS need to be interrogated and fully appreciated by national decision makers.

Given the stigma that still surrounds HIV/AIDS, the collection of data in this area presents social methodological problems and we need to understand how researchers have tackled these challenges in order to evaluate their work.

When asked for a statement on the article, the President's office said the Health Ministry statement reflected Mbeki's views.

Source: SAPA, 10 September 2001

Leading medical journals yesterday accused the pharmaceutical industry of meddling in tests of new drugs and said they would scrutinise clinical trials more carefully before deciding whether to publish their results.

The dozen signatories include prestigious media such as the New England Journal of Medicine, the Journal of the American Medical Association, the Canadian Medical Association Journal, the databank Medline and The Lancet. 

In a joint declaration, the editors said it was vital for clinical trials - human tests of prototype treatments - to be conducted independently, to ensure product was safe.

But, they said, more and more pharmaceutical companies, eager to complete the costly process of getting a drug to market, saw trials as a regulatory hurdle or a mere tool for publicising the product.

The fight for funding had enabled pharmaceutical firms, through their sponsorship, to dictate the shape and outcome of a trial and even stifle broad disclosure of any unfavourable results, they said.

Investigators may have little or no input into trial design, no access to the raw data and limited participation in data interpretation, the editors said.

These terms may be draconian for self-respecting scientists but many have accepted them because they know that if they do not, the sponsor will find someone else who will.

Even if a researcher does have some control over the trial, there remains the risk that the results may be buried rather than published if they are unfavourable to the sponsor's product, they said.

The editors pointed to a case in 1999 in which US doctors who carried out the trial of an anti-HIV drug fell out with their sponsor, the Immune Response Corporation.

The researchers said that after results found the treatment was worthless, the sponsor withheld data that would have enabled them to complete the study.

The team went ahead with publication anyway. Their paper, which ran in the Journal of the American Medical Association last November, said the conclusions were based on final but incomplete data.

The joint declaration said meddling was most commonly associated with pharmaceutical sponsors but governments and government agencies were also prone to interfere if the results of a study ran counter to official policy.

The signatories are among the cream of medical journals. These publications play a key role in the multibillion-dollar pharmaceutical business.

Publication in their pages can seal or destroy the outcome of a years-long endeavour to design a new drug, influencing a pharmaceutical company's stock value.

The editors said they would set down ethical safeguards aimed at identifying any intrusion in a trial by its sponsors. The cost of bringing a drug to market in the US is about half a billion dollars.

Source: The Sunday Independent, 9 September 2001

New findings contradict President Mbeki's denial that the epidemic is the leading cause of deaths in this country

AIDS is now the single biggest killer of South Africans and will have taken the lives of about six million people by 2010.

A groundbreaking SA Medical Research Council report estimates that the deaths of 40% of all South Africans aged 15 to 49 last year were because of AIDS.

The July report, titled The Impact of HIV/AIDS on adult mortality in South Africa, contradicts President Thabo Mbeki's denial of AIDS being SA's leading killer.

Based on data from the Health Department's annual antenatal survey and the Actuarial Society of SA's AIDS model, the report documents rapid changes in SA's mortality data, with an increasing trend in the deaths of young adults since 1997, interpreted to be mostly caused by AIDS.

• There will be a threefold increase in deaths among children aged between one and five;
• The number of AIDS deaths is expected to rise to double the number of deaths attributed to all other causes; and
• Population growth will be halted by the epidemic.

The report, which has not officially been released, but which the Sunday Times has a copy of, has already been seen by top government officials.

There seems to be confusion in government circles about the status of the report. On Thursday, Minister of Health Dr Manto Tshabalala-Msimang told a press briefing in Parliament that the researchers had worked alone outside the collective which had been established, something which worries us. This is despite an earlier statement released on Monday by the Department of Health, with the minister's name on it, that said the report was part of a broader process which had emanated from a recommendation by the Presidential AIDS Advisory Panel to compile current AIDS mortality figures.

This week it was also reported that in a letter to Tshabalala-Msimang, Mbeki had questioned government spending on AIDS based on 1995 mortality data he had found on the World Health Organisation website.

On the basis of 1995 figures Mbeki called for a re-examination of South Africa's spending priorities when it comes to social policy, warning Tshabalala-Msimang that this move would provoke a howl of displeasure and a concerted propaganda campaign from those who have convinced themselves that HIV/AIDS is the single biggest cause of death in South Africa.

Writing in the preface to the report, council President Dr Malegapuru William Makgoba, says that the denial of AIDS was predictably the first African public response to the epidemic.

He writes that in 1982, when the first cases of what was to become known as HIV/AIDS among homosexual men were discussed, the seeds of denial to justify why AIDS would not be prevalent in African communities were first sown.

When AIDS was first wrongly linked to homosexual practice many Africans promoted the notion that homosexual practices were 'unAfrican'."

He writes that even at that time he believed that the syndrome was more common than people believed in Africa.

Bheki Khumalo, spokesman for the President, declined to comment on issues of statistics or on why President Mbeki had not spoken to local researchers about South Africa's mortality data.

Source: Sunday Times: 16 September 2001

The King Committee on Corporate Governance has criticised the South African corporate community for having an inadequate understanding of the economic impact of AIDS.

In a statement on Monday, the committee called on company directors to move beyond putting HIV/AIDS policies in place, towards monitoring performance indicators and reporting to stakeholders on a regular basis.

The committee was formed in 1992 under the auspices of the Institute of Directors, to put the increasing global interest in corporate governance in the South African context.

The report's recommendations will become the Code of Corporate Practice and Conduct as from January next year.

The growing practical impact of AIDS on SA businesses is potentially huge. Some current indications show that over 20 percent of our country's economically active population will be directly affected by HIV/AIDS within the next five years, the committee said.

Tobe Hope, managing director of Group Solutions and Capital Alliance (CA), said directors needed to be aware of the full extent to which AIDS impacted on their business, while keeping HIV-infected employees healthy for as long as possible.

SA companies need to operate in a global environment and need to compete with companies that are located in countries where HIV prevalence and associated costs are lower, Hope said.

He said few employers made provision for the expected cost of HIV in their financial statements, mostly because the incidence of the disease amongst employees and the associated cost was unknown.

This insurance is designed to protect claimant confidentiality and to prevent possible discrimination in the workplace. Only aggregate claims data will be provided to employers, assisting them in adhering to some of the King Report's recommendations, said Hope.

He said it showed that the business sector could do more in addressing the HIV/AIDS scourge in the country.

CA's move has been met with the approval of members of the AIDS Consortium, Oxfam and all six leading trade unions.

CA will provide five percent of the profit from LifeAid to the Southern African HIV Clinicians Society to train additional doctors via an internationally accredited course on the epidemic.

Source: SAPA, 17 September 2001

Eight more health professions are to be drawn into the community service net from 2003, Health Minister Manto Tshabalala-Msimang and her provincial counterparts have decided.

They are radiographers, physiotherapists, speech and hearing therapists, occupational therapists, environmental health officers, dieticians, clinical psychologists, and professional nurses.

The decision was made at a meeting between the minister and MECs in Cape Town at the weekend, ministry spokesman Sibani Mngadi said in a statement on Monday.

The new groups will join doctors, dentists and pharmacists, who already do a year of community service on completion of their academic studies.

The proposal to bring in the seven so-called scarce skills groups was mooted by the health department in late 1999, the year in which the first doctors began their service.

Mngadi said service for the new groups would be phased in from 2003, starting with the clinical psychologists and dieticians.

The last group would be professional nurses in 2007.

Mngadi also said the minister and MECs met representatives from university medical faculties at the weekend to discuss racial representivity among their students.

It said though some progress had been made, attention had to be given to the high level of student dropouts especially in the early years of their studies.

This had led to an imbalance in the output of graduates.

It had been agreed that faculties would be assessed separately to ensure that progress was made in all the institutions.

The institutions and the Department of Health are to meet to look at setting targets for recruitment, retention and final output to ensure that the medical profession finally reflect the demographics of the country in terms of race and gender, the department said.

The minister and MECs also decided universities should reserve space for 100 medical students from Southern African Development Community countries.

This programme - meant mainly for Botswana, Lesotho, Mozambique, Mauritius and Namibia, which did not have their own medical schools - would be phased in from next year.

Source: SAPA, 17 September 2001

The findings in summary are:

• HIV infection and AIDS have severely disrupted child health services in many developing countries
• Efforts to prevent viral transmission form mother to child are inadequate in resource poor settings
• The choice between breast feeding and feeding with formula milk remains controversial
• An effective AIDS vaccine can be expected in the next 10 years
• New antiretroviral treatments and innovative treatment strategies continue to be developed
• A focus beyond education and promoting the use of condoms is required in poor countries

(Full text available from http://bmj.com/cgi/content/full/323/7314/670)

An article on allAfrica.com (http://allafrica.com/stories/200108310306.html) suggests that AIDS could orphan one third of Africa's children - already there are reported to be some 1.2 million children in South Africa orphaned as a result of HIV/AIDS.

The death of parents due to HIV/AIDS is leaving a growing number of children vulnerable and in need of care. The more fortunate are taken in by grandparents or other relatives, but this does not protect them from the a life of poverty where food and clothing is scarce and often they are turned away unconstitutionally from schools because they can't afford school fees. In this audio report produced by Health-e, we hear from amongst others, a young girl from the Northern Province. (http://www.health-e.org.za/view.php3?id=20010909)

The report, State of the World’s Newborns, argues that high death rates could be reduced by such practices as exclusive breast feeding, keeping babies warm, and ensuring that there are skilled attendants at the birth. By combining these with other measures, such as ensuring that delivery environments are hygienic and that mothers receive basic health care and advice, thousands of unnecessary deaths could be prevented, it claims. The report is available from http://www.savethechildren.org/mothers/newborns_report.html

Calls for the release of the AIDS report by the Medical Research Council (MRC) grew louder yesterday after Gauteng and Free State announced HIV/AIDS was the biggest killer in these provinces. Gauteng Department of Health subsequently released a statement disassociating itself from this announcement [SAPA, 3 October 2001].

President Thabo Mbeki also came under scathing attack from political parties for his questioning of AIDS being the biggest cause of deaths in SA.

The Pan Africanist Congress general secretary Thami ka Plaatjie said Mbeki was not qualified to debate the AIDS issue and should leave it to experts.

We wonder whose interests Mbeki is serving. Scientific evidence cannot be challenged through political statements that are mostly thumb-sucked. We are also not aware of any medical qualifications he acquired to enable him to contradict scientific evidence on AIDS, he said.

Ka Plaatjie called on government to release the MRC report so its findings could be used as a basis to fight the scourge appropriately.

The withholding of the report leads one to suspect there is some sinister motive at play. We are sitting with a serious problem on our hands and there is no time for silly arguments too many lives have been lost already.

The Democratic Alliance health spokesman Kobus Gous said the two provinces deserved praise for their courage to come out openly about the seriousness of the situation, although it was contrary to government's line of thought: This is a welcome dose of realism and truth where mysticism and denial has been pervasive.

Gous said government's failure to release the report was ridiculous.

In addition to evidence reported on by Gauteng and Free State, there is a large body of other evidence proving the president wrong in his belief the focus on AIDS should be downgraded.

Despite this body of evidence, Gous said, government persisted in believing it could hide embarrassing information from the public indefinitely.

Inkatha Freedom Party (IFP) MP Ruth Rabinowitz said government was downplaying the AIDS problem.

We are not applying our minds urgently to the matter, she said.

Rabinowitz said that, although the IFP endorsed the call for the release of the MRC report, there was sufficient evidence to conclude AIDS was claiming more lives than any other cause.

We do not even need the (MRC's AIDS) report, people are dying in our hospitals, said Rabinowitz.

Source: Business Day, 4 October 2001

Not a single doctor reported to the Health Professions Council of SA (HPCSA) has been found guilty of misconduct, unethical or unprofessional behaviour for testing domestic workers for HIV without their consent.

The AIDS Law Project has brought several cases to the attention of the council, but according to attorney Anita Kleinsmidt not one case has delivered results. In many instances the HPCSA has taken so long to call a hearing that the patient has died, causing the file to be closed with no consequences for the doctor. In other instances the HPCSA simply stated that no improper conduct had been found. Many employers insist that domestic workers must be tested for HIV because of their fears that HIV can easily be transmitted in the household.

It is, however, medically well established that there is virtually no risk of HIV transmission where a domestic worker with HIV has cleaning duties or prepares food. In order for HIV to be transmitted, there must be a substantial exchange of bodily fluids (blood, semen, vaginal fluids and possibly saliva). It is therefore clear than there can be no transmission of HIV when a domestic worker washes dishes, does the laundry or cleans the toilet. A doctor may not test a domestic worker on the instructions of a second person (employer).

The doctor must obtain the domestic worker's informed consent, without which, the doctor acts illegally and unethically and is liable to disciplinary and legal action. An employer who deceives a domestic worker (or an applicant for such a position) into taking an HIV test opens himself/herself to action under the Labour Relations Act. This Act recognises job applicants as employees. Myrtle Witbooi, General Secretary of the Domestic Workers' Union (DWU) said that many domestic workers were being exposed to HIV tests without their knowledge. They are told they are receiving a flu injection, in the meantime they are undergoing an HIV test, Witbooi said. She said many workers were reluctant to take the cases further because they did not want to lose their jobs.

Many employers are also asking domestic workers to produce certificates proving that they are HIV negative when they interview them with the view of employing them, said Witbooi. Many domestic workers are losing their jobs because they are HIV positive. The HPCSA confirmed that it had a number of formal complaint cases that related to breach of doctor/patient confidentiality with regard to HIV/AIDS patients, but declined to give specific numbers or details.

Spokesperson Thola Nzusa said that at this stage they had not found any of the doctors guilty because they are pending professional conduct inquiries (disciplinary inquiries) into some of the cases. She confirmed there were cases that were finalised at a preliminary stage where the Preliminary Committee of Inquiry noted the explanation of a doctor and thus resolved not to proceed with disciplinary action. She did not elaborate on what explanations were offered. Nzusa explained that the role of the Preliminary Committee was to determine whether or not, on the basis of a complaint lodged, there was a prima facie case to hold a formal disciplinary inquiry.

She said the HPCSA had published a set of guidelines in which it was clear that the status of the HIV patient was confidential unless the patient gave permission for disclosure. The doctor may reveal the HIV/AIDS status of the patient only when convinced that non-disclosure may endanger the life or health of other individuals. The practitioner concerned must, however, thoroughly counsel the patient to that effect in an attempt to persuade the patient to consent to disclosure, Nzusa said.

HIV cannot be transmitted by hugging or holding another person. Employers often insist that it is in their children's best interest that the domestic worker employed by them be tested for HIV. If this reasoning is followed, then every individual who comes into contact with children should be tested for HIV (parents, grandparents, extended family, friends, teachers, food preparers).

Domestic workers may refer a dispute on the grounds of discrimination to the CCMA. In the context of HIV testing, a dispute against the employer by a domestic worker can either be lodged when the employer insists on an HIV test or once the test has been carried out. When a domestic worker is dismissed because of HIV status, it is doubtful that she or he would seek reinstatement. It is clear though that they would be able to claim compensation if they had been tested illegally and unfairly or where they were incorrectly informed that HIV testing is a prerequisite for employment. The compensation awarded depends on the circumstances of each case. If an employer dismisses a domestic worker solely on the grounds of HIV status, the dismissal is unfair and it can be challenged as unfair discrimination or as an unfair labour practice.

The dismissal will amount to unfair discrimination if it can be established that: 

• a domestic worker's HIV status has no correlation to their ability to perform their job; 
• there is virtually no risk of HIV transmission in the household - thus the fears of transmission are unfounded in the light of medical knowledge available regarding the modes of HIV transmission; 
• testing in itself created a false sense of security, as it merely acts as a tool to unfairly discriminate against people with HIV by excluding them from gainful employment.

If a domestic worker is permanently unable to work because they are incapacitated through full-blown AIDS, an employer may be allowed to dismiss the employee. The decision cannot be unilateral and there must be proof of consultation with the employee as well as proof of ill health. Even if it is established that the domestic worker is suffering from ill health and is unable to continue working, there must be a fair procedure for the dismissal. Without a fair hearing the dismissal can still be unfair. Without proof of incapacity and without a fair hearing, an employer cannot dismiss a domestic worker.

Source: Health-e News Service, 2 October 2001

South Africa is training sufficient doctors for its needs, but they do not include enough blacks or doctors prepared to serve in rural areas, Parliament's Health Portfolio Committee has been told.

The country's medical schools should be producing about 1250 doctors a year, said Professor Thanyani Mariba, acting president of the Health Professions Council, who is dean of the Medical School at the University of Pretoria.

The numbers we are producing are sufficient for this country, so we do not have a shortage of doctors in South Africa. What we have is a maldistribution, where the doctors are concentrated mainly around Gauteng, the Western Cape and other urban areas.

But there remained a gap between blacks and whites studying for the medical professions. Last month the Health Ministry called together deans of the medical schools claiming the number of black students was not increasing enough.

This we are aware of. This policy has been in place six or seven years, and the Ministry was very unhappy that the University of Stellenbosch had only two black students, said Prof Mariba.

Prof Mariba said that in the past black students with qualifications in mathematics and science could train to become doctors or nurses. Now other fields were open to them, such as engineering or IT professions.

Therefore universities had to fight over the pool of black students who qualified with science and mathematics to enter university - about 5 000 last year.

Source: The Citizen, 3 October 2001

Prices for AIDS drugs will become more affordable with the announcement this weekend of two initiatives aimed at cutting the cost of the most frequently prescribed antiretrovirals.

Multinational pharmaceutical company GlaxoSmithKline (GSK) said yesterday it was granting a voluntary licence to local firm Aspen Pharmacare to produce AZT and 3TC - as well as the combination pill Combivir exclusively for the public sector.

The deal also obliges Aspen to pay 30% of the net sale price to non-governmental organisations dealing with HIV/AIDS.

At the same time Cipla-Medpro, the local associate of Indian pharmaceutical manufacturer Cipla, has submitted a complaint to the Competition Commission alleging that GSK and Boehringer Ingelheim abused their patents. Cipla manufactures Nevirapine, an antiretroviral drug that helps to prevent the mother-to-child transmission of HIV. Cipla-Medpro CEO Jerome Smith said late last night that the complaint might now have to include Aspen Pharmacare.

The only real market in SA for antiretroviral drugs has been in the private sector as government has consistently refused to provide the life-prolonging drugs to public sector patients who could not afford them.

GSK has kept the lucrative - albeit small - market that includes medical aid schemes and larger buyers, like mining or manufacturing companies like Ford or DaimlerChrysler.

The Cipla action is groundbreaking and challenges the way the patents have been used by both companies to keep drug prices high.

Cipla has chosen to challenge the patents through the commission initially, but it will use the Patents Acts if necessary.

Cipla's complaint says that the patents and licence-holders qualify as a dominant firm in terms of the Competition Act, and claims that they have abused that dominance.

The patentees and all the licencees charge an exorbitant price for the relevant pharmaceutical products to the detriment of consumers, according to the complaint.

The claim argues that people with the virus or those who have been exposed to it are obliged to pay the sum demanded by these patentees and licencees".

At the time the complaint was filed, Cipla was unaware of the details of GSK's move, but Smith believes that the move will not impede his complaint.

He says it appears as though Aspen and GSK are now acting in concert. However, he felt that any move that sought to make much-needed drugs accessible was to be welcomed.

James Love, director of the Washington-based consumer project on technology, believes that GSK needs to be challenged further on its drug policy for the private sector, and says that the competition which the Cipla action will bring, will see prices lowered further.

The complaint describes the prices charged for the drugs until recently, as well as the prices at which these drugs could become available through Cipla.

The Indian parent company offered substantial reductions on the prices earlier this year.

The drug known as 3TC in a 150mg dose of 60 tablets would have cost R12 000, while Cipla would have supplied the same drug for R195,46. 

Aspen CEO Steven Saad said he did not have exact prices yet, and that much would depend on the demand.

However, industry sources said that the prices likely to be charged would be considerably higher than Cipla's offers.

The Cipla case also claims that the patent-holder has entered into exclusive licensing agreements with both GSK and Boehringer Ingelheim, which exclude other entities from marketing the same products in competition. 

Source: Business Day, 8 October 2001

The Medical Research Council (MRC) was free to release its controversial report on the number of South Africans dying as a result of HIV/AIDS, the cabinet said yesterday.

Government has been accused in recent weeks of keeping the report from the public because of dramatic revelations in it about the fatality rate as a result of AIDS.

The report's results were in sharp contrast to the 1995 figures used by President Thabo Mbeki in a letter to Health Minister Manto Tshabalala-Msimang, in which he asked her whether the spending priorities of her department were correctly focused.

The statement released yesterday said the (cabinet) meeting had also examined the report of the MRC on the impact of HIV/AIDS on adult mortality in SA. The meeting noted the interdepartmental task team and Statistics SA expressed concern on the methodology and findings of the report.

Chief government spokesman Joel Netshitenzhe said cabinet had decided the MRC could release its report and Stats SA would explain its reservations. 

Stats SA released a statement later saying it had difficulty with the MRC's contention that 40% of adult deaths were as a result of HIV/AIDS. It said there was a wide range of reasons for the gaps in knowledge about HIV/AIDS. For example, HIV/AIDS is not a notifiable disease. Therefore it is difficult to trace the disease and its manifestations from its origin.

Stats SA said the antenatal clinic tests used to establish HIV prevalence in the population were not necessarily a representative sample.

The only way of proceeding was to resort to demographic modelling. It welcomed the MRC report because it contributed to the debate but warned that the model had built-in risks, like the difficulty in testing underlying assumptions, and data possibly being inaccurate or unrepresentative. The main problem with the MRC model is the calculation of the probability of transmission.

Malegapuru Makgoba, the MRC president, said last night he had not yet studied the comments from Stats SA and would respond fully when the MRC released its report.

The comments by Stats SA reflect a long-running dispute between it and the MRC on mortality figures. Makgoba told Business Day last week this dispute had ended but clearly it has not.

Source: Business Day, 11 October 2001