HIV/AIDS Advocates, Researchers Call for National HIV/AIDS Antiretroviral Policy at Close of South African AIDS Conference

HIV/AIDS researchers and advocates at the close of the South African AIDS Conference 2003 today in Durban, South Africa, called for a "rapid ... rollout" of a national antiretroviral therapy policy to address the country's epidemic, Reuters reports (Quinn, Reuters, 8/6). Research presented at the conference shows that 600 people out of the 14,000 people newly infected with HIV worldwide each day live in South Africa. In addition, AIDS-related death rates in the country are beginning to surpass the number of new HIV infections (Kaiser Daily HIV/AIDS Report, 8/5). Salim Abdool Karim, scientific chair of the conference, said, "The message is: don't wait. You've got to do something, and you have got to do it now. This is not an attack on the government. This is a scientific fact." Although South African President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang have questioned the use of antiretroviral drugs, Reuters reports other officials say that "change may be coming," as the cabinet prepares to receive a "long-delayed" report detailing the cost of a national antiretroviral drug plan. Health Ministry Director-General Ayanda Ntsaluba said that the question now is "when, not if" the government will implement an antiretroviral drug policy, adding, "All of us are seized with a sense of urgency on this issue."

Orphans, Vertical HIV Transmission
Pediatrician and University of Natal researcher Raziya Bobat said at the conference that if no AIDS treatment plan was implemented between now and 2010, the country could have 20 million orphans, Agence France-Presse reports. She added that in order to address the problem, treatment to prevent mother-to-child HIV transmission is "vital," according to Agence France-Presse (Graham, Agence France-Presse, 8/5). Her comments came as the Medicines Control Council is considering barring the use of the antiretroviral drug nevirapine to prevent mother-to-child HIV transmission unless drug maker Boehringer Ingelheim provides data proving that the drug is safe (South African Press Association, 8/5). 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 July 2002 ruling by the Constitutional Court that said 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 says it will revoke nevirapine's temporary approval (Kaiser Daily HIV/AIDS Report, 8/5). "As we progress with mother-to-child treatment, the number of HIV-infected children will come down, and it will be an easier problem to handle," Bobat said (Agence France-Presse, 8/5).

Hospital, Clinic Transmission
There could be a "high risk" of HIV transmission at hospitals and clinics because of poor clinical practices, inadequate sterilization facilities and a high HIV/AIDS prevalence rate among young health care workers, according to a Human Sciences Research Council study presented at the conference, Business Day reports. Researchers surveyed 2,000 health care workers and 2,000 patients in more than 200 hospitals and clinics throughout the country and found that 86% of workers had access to protective gloves and 56% had access to protective gowns. In addition, 59% never stocked HIV testing kits, Business Day reports. Researchers also found that more than 16% of health care workers are HIV-positive; 20% of participants between the ages of 18 and 35 tested positive, and 16.6% of respondents between the ages of 36 and 45 tested positive. Olive Shisana, executive director of the HSRC's HIV/AIDS research programs, said that the results raise "the question of bloodborne infection in health care facilities" and present "major implications for the future supply of health care professionals" (Kahn, Business Day, 8/5).

Treatment Action Campaign
Treatment Action Campaign Chair Zackie Achmat said that the conference has shown "that there is overwhelming support for the government to develop a treatment plan" (Reuters, 8/6). Achmat said that the fight against the disease has become a "political issue, because everyone that is infected needs access to anti-AIDS drugs." He added that the reason the country cannot move forward with a national HIV/AIDS plan is because Mbeki and Tshabalala-Msimang are "HIV denialists" (Agence France-Presse, 8/6). 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 (Kaiser Daily HIV/AIDS Report, 8/4). The African National Congress, the country's ruling party, yesterday called for "patriotic South Africans" not to participate in TAC's civil disobedience campaign. ANC spokesperson Mtholephi Mthimkhulu said, "We view this as an irresponsible act that seeks to undermine all constructive discussions" that took place at the conference. He added, "Our democratically elected government is always prepared to engage in constructive debates around many issues, including HIV/AIDS. The call by TAC is, therefore, tantamount to reducing the challenge of HIV/AIDS to an inhumane public relations exercise" (South African Press Association, 8/5).

Archbishop Calls AIDS 'As Serious As Apartheid'
Anglican Archbishop of Cape Town Njongonkulu Ndungane yesterday said that the HIV/AIDS epidemic has become "a world disgrace as serious as apartheid," according to the South African Press Association (South African Press Association, 8/5). He said, "We as a church feel let down by our elected government, who shows no political will at all in trying to save the lives of people who are dying each day from AIDS." Ndungane added that he is "embarrassed" when traveling outside of South Africa because "people know that this country is failing its people." He said, "We have a crisis on our hands that is only getting worse as we see more AIDS orphans, more households headed by children and grandmothers in frailty and poverty and having to raise families." The archbishop also said that the country's Constitutional Court "thought it best to give mothers and babies nevirapine. How can the government now want to ignore that? It makes no sense" (Sylvester, Associated Press, 8/5). The national health department said that Ndungane's remarks demonstrate that he is uninformed about the government's role in the situation. The department said that the government had "no role in regulating medicines, including nevirapine" because "in terms of the law, this is the responsibility of an independent Medicines Control Council." The health department also said that it was "unfortunate" that the archbishop "had chosen to issue an irresponsible and politically dangerous statement at the time when government and civil society are meeting in Durban to address the very challenge of HIV and AIDS" (South African Press Association, 8/5).

Die Burger Editorial
The Cape Town-based newspaper Die Burger today in a front-page editorial called on the government to end the "insanity" in dealing with HIV/AIDS, Agence France-Presse reports (Agence France-Presse, 8/6). The South African government has repeatedly been criticized for failing to establish a national HIV/AIDS plan, instead saying that people living with the disease should focus on "nutritional diets" (Kaiser Daily HIV/AIDS Report, 8/5). Die Burger Editor Arrie Rossouw said that placing the editorial on the front page -- directly below the masthead -- was an unusual step (South African Press Association, 8/6). Rossouw said, "It is the strongest form of protest available to us to express the concern and disapproval of our editorial staff and our readers over the government's handling of the crisis" (Agence France-Presse, 8/6).

SABCNews.com yesterday reported on the MCC's decision not to deregister nevirapine (SABCNews.com, 8/5). The full segment is available online in RealPlayer.

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