First National South African AIDS Conference Opens Amid Anger Over Government Decisions on Providing HIV Drugs

The first-ever South African AIDS Conference 2003 opened yesterday in Durban, South Africa, amid "mounting ... anger" from HIV/AIDS advocates over the government's "tepid" response to the epidemic and its lack of action to provide antiretroviral drugs to people living with HIV/AIDS in the country, Reuters reports (Quinn, Reuters, 8/3). As Health Minister Manto Tshabalala-Msimang opened the meeting, which is being attended by about 2,500 delegates, demonstrators held signs that said, "Save Our Youth, Save Our Future," Reuters/Boston Herald reports. Some protestors "heckled" Tshabalala-Msimang, who some advocates blame for delaying the government's delivery of antiretrovirals (Reuters/Boston Herald, 8/3). Government officials have said that the drugs are "unproven and potentially toxic," a position that is "widely challenged" by AIDS researchers and advocates, according to Reuters (Reuters, 8/3). Tshabalala-Msimang said that South Africa would establish the country's HIV/AIDS strategies "without influence from foreign agendas.'' She also said that "[s]ome say that providing antiretrovirals is as simple as administering aspirin. Far from the truth." She added, "The provision of antiretroviral drugs in the public health sector is a subject which must be considered soberly, and the government is doing so.'' However, critics of the government, which has refused to allow public sector hospitals to use antiretroviral drugs, say that it has moved too slowly on HIV/AIDS. South African President Thabo Mbeki's administration argues that "priority must go to fighting the widespread black poverty that remains nine years after the end of white rule," according to Reuters/Boston Herald (Reuters/Boston Herald, 8/3).

Possible Legal Action
Some members of the South African HIV/AIDS advocacy group Treatment Action Campaign stood silently during Tshabalala-Msimang's speech, holding signs that said, "Two pills a day saves lives," Agence-France Presse reports. TAC yesterday announced that it plans to file a lawsuit against the government for not implementing a national AIDS treatment plan (Graham, Agence-France Presse, 8/3). The suit would be the second filed by TAC challenging the government's AIDS policies, Agence-France Presse reports. TAC spokesperson Siphokazi Mthathi said, "We want to believe the government is committed and has the best interest of our people at heart, but we are not seeing that, we are not getting it, so we are preparing to make sure we get that kind of leadership" (Agence-France Presse, 8/3). AIDS advocates say that 600 people die of AIDS-related causes each day in South Africa, which has the highest number of AIDS cases in the world, with about 4.7 million HIV-positive people. Economists say that the AIDS epidemic poses a "significant threat" to the future of the nation, with average life expectancy estimated to be only 45 years by 2005, according to Reuters/Boston Herald (Reuters/Boston Herald, 8/3).

Treatment, Prevention
South African Deputy President Jacob Zuma said, "HIV and AIDS are regarded as a national priority," adding that government officials are "only trying to understand the causal factors beyond the virus" (Associated Press, 8/3). He added that the "challenge lies in powerful and continuous action to prevent new infections and to provide care and support for the many who are infected or affected" (Xinhua News Agency, 8/3). UNAIDS Executive Director Peter Piot, addressing the conference through a videotaped speech, said, "Throughout the world the debate is not whether to offer antiretroviral treatment, but how to do it. For heaven's sake, let's not wait until we have the perfect solution'' (Reuters/Boston Herald, 8/3). Speaking in Durban, U.N. Special Envoy for HIV/AIDS in Africa Stephen Lewis said that HIV/AIDS treatment currently is the "highest priority," Xinhua News Agency reports (Xinhua News Agency, 8/3). He added that his "emphasis on treatment is not meant, in the slightest, to diminish the need for prevention." Lewis said, "I well recognize that the two work, irreplaceably and inseparably, hand in hand" (Lewis speech text, 8/3).

Nevirapine
Mbeki, who did not attend the conference on Sunday, on Friday said that he supports the decision by the country's Medicines Control Council to prohibit the use of nevirapine to prevent mother-to-child HIV transmission unless drug maker Boehringer Ingelheim provides data proving that the drug is safe, Reuters reports (Reuters, 8/1). Last year, the South African government approved nevirapine for universal distribution to state hospitals in an attempt to reduce the nation's mother-to-child HIV transmission rate. The announcement followed a Pretoria High Court ruling in December 2001 that said the government must provide nevirapine to HIV-positive pregnant women through the public health system. The government appealed the decision, citing concerns over the drug's safety and efficacy, but the Constitutional Court in July 2002 denied the appeal, saying that the government's restriction of the drug's distribution to 18 pilot sites "fell short of its constitutional obligation to offer the best treatment available." MCC officials last week rejected a 1999 Ugandan study that showed the drug's efficacy in preventing vertical HIV transmission, and MCC Chief Precious Matsoso gave the company 90 days to offer additional safety and efficacy information. If the drug maker fails to provide alternate data, the government will revoke nevirapine's temporary approval (Kaiser Daily HIV/AIDS Report, 8/1). In a weekly online letter to the African National Congress ruling party, Mbeki said, "This announcement illustrated the challenge we face, to ensure that even on this vexed question ... (we refuse) to allow the never-ending search for scientific truth to be suffocated by self-serving beliefs." He added that the country must have "the courage to stand up for what we think and feel is correct" (Reuters, 8/1).

Other Voices
The South African Paediatric Association on Friday "added its voice" to the debate over the nevirapine announcement, saying that the "efficacy and safety of nevirapine usage ... has been adequately established beyond reasonable doubt." The group added in a statement, "We believe that failure to continue to administer nevirapine at this time would constitute a dereliction of the ethical duties of individual health care professionals as well as an unconstitutional abdication of responsibilities of our health authorities." The group called for the MCC to "immediately repeal their decision that is out-of-step with the extensive reviews and statements of authoritative bodies," including the NIH, FDA and the World Health Organization (SAPA/AllAfrica.com, 8/3). Conference Chair Dr. Jerry Coovadia said, "The AIDS epidemic has been bedeviled by unscientific, irrational, unreasonable and downright perverse attitudes," adding, "I really am left breathless by the decision of the MCC to question the validity of the scientific results around nevirapine" (Reuters, 8/3). In addition, TAC said in a statement that if the "MCC has information to the contrary, it must make this available because of the public interest in this issue." Meanwhile, TAC said that it will seek legal opinions from its lawyers on how to proceed on the issue (SAPA/AllAfrica.com, 8/3). The Elizabeth Glaser Pediatric AIDS Foundation on Friday launched a petition, which will be presented tomorrow at the conference and then sent to the MCC, calling for the continued use of nevirapine to reduce mother-to-child HIV transmission, the South African Press Association reports. The petition says, "We urge you to continue to expand the availability of this lifesaving intervention" (South African Press Association, 8/3). In addition, James McIntyre, head of the Chris Hani Baragwanath Perinatal HIV Unit, is expected to present data at the conference showing that 100,000 South African women have received the drug over past two years. The conference has added a special plenary session on Wednesday to discuss the issue, SAPA reports. The session, titled "Nevirapine for the Prevention of Mother to Child Transmission: Is it safe? Does it work?," will include a panel discussion featuring McIntyre and Kathy Wilford of EGPAF (South African Press Association, 8/3).

TAC conference
TAC on Sunday concluded its own conference by voting to renew civil disobedience to force the government to provide antiretroviral drugs to all HIV-positive people, according to Reuters. "We will be marching, that is for sure," TAC spokesperson Desmond Mpofu said (Reuters, 8/3). The conference also called for its chair Zackie Achmat to begin antiretroviral therapy (SAPA/AllAfrica.com, 8/3). Achmat, who was diagnosed with HIV in 1990, five years ago said he would not take antiretroviral medications until the South African government makes the medications available to all HIV-positive South Africans (Kaiser Daily HIV/AIDS Report, 5/15). However, Achmat today told about 1,500 demonstrators outside the conference venue that he has decided to suspend his protest and take medications to treat his HIV infection. "We do not want Manto and Thabo to get their way. Manto and Thabo want me to die and I am not going to hang in there and let them kill me," Achmat said to the cheering crowd. He added, "We say, Manto, come with us to our homes and our graveyards, and see what is happening to our people" (Agence France-Presse, 8/4).


BBC News today reported on the start of the conference. The segment includes comments from Coovadia and South African AIDS advocate Sihle Mlaba (Biles, BBC News, 8/4). The full segment is available online in RealPlayer.

WAMU's "Kojo Nnamdi Show" today will include an update on Africa in the second hour of the program. Guests on the show include Africa Action Executive Director Salih Booker and Stephen Morrison, director of the Africa program at the Center for Strategic and International Studies and director of the CSIS Task Force on HIV/AIDS (Nnamdi, "Kojo Nnamdi Show," WAMU, 8/4). The full segment will be available online in RealPlayer after the broadcast, which ends at 2 p.m. ET.

Webcasts of selected sessions of the conference are available online through kaisernetwork.org's HealthCast.