August 5, 2003
Abdool Karim said, "Along with a rising number of deaths, there will continue to be a high rate of infections and more AIDS orphans will be stranded. A rising mortality rate should not be allowed to mask the fact that many people are still being infected." She added, "We have reached a critical period in this epidemic, which will have major implications for decision makers" (Agence France-Presse, 8/4). Rod Hoff, acting chief of the international research branch of NIH's National Institute of Allergy and Infectious Diseases Division of AIDS, said at the conference, "Mortality [in South Africa] is really just starting and won't peak for another three to four years," adding, "The social and economic impact will be considerable. Industry is really going to take a hit as people get sick" (Reuters, 8/4). Dr. Jong-Wook Lee, director general of the World Health Organization, in an interview with Agence France-Presse compared the worldwide AIDS crisis to "Armageddon," saying that a large-scale increase in efforts to fight HIV/AIDS worldwide is needed. "In the African continent it would be wrong to talk about prevention, voluntarily counseling and testing, when people are actually dying. You have to provide treatment as well as prevention," Lee added (SAPA/AFP/Mail & Guardian, 8/5).
Historical Disease Progression
Abdool Karim also presented data on the progression of the disease in South Africa from the early 1980s through 2001, Xinhua News Agency reports. She said that although HIV was first detected in the country "largely" among men who have sex with men and transfusion recipients between 1982 and 1987, the virus has moved into the heterosexual population, with the country experiencing an "explosive spread" of HIV between 1994 and 1998. According to Abdool Karim, 50% of pregnant women in some parts of the country are HIV-positive (Xinhua News Agency, 8/4). The data also indicate that HIV prevalence among pregnant women in certain areas of the country is higher than the prevalence among female sex workers, the South African Press Association reports.
Government Rejects Nevirapine Data
The data come as the country's Medicines Control Council is considering barring the use of 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, 8/4). 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 says it will revoke nevirapine's temporary approval (Kaiser Daily HIV/AIDS Report, 8/4).
The administration of nevirapine to an HIV-positive pregnant woman to reduce the risk of vertical HIV transmission to her infant costs the South African government about $4, while the government pays about $80 each month to treat an HIV-positive infant, the South African Press Association reports. In addition, an HIV-positive infant has an average life expectancy of four years and will acquire medical bills costing the government more than $3,760 over its lifetime (South African Press Association, 8/4). Conference Chair Dr. Jerry Coovadia of the Nelson R. Mandela School of Medicine at the University of Natal said, "The nevirapine issue has to be faced. But I am more worried about the acrimony over the issue. They (government officials) are caught in the web of their own rhetoric. We can understand that. They are politicians. But we must all make accommodation so that this epidemic can finally be addressed" (Quinn, Reuters, 8/5). Inkatha Freedom Party health spokesperson Dr. Ruth Rabinowitz called for a "revolt on behalf of the entire medical fraternity so that we are not found guilty of complicity with genocide," adding, "The South African government is determined to have its way. Doctors of conscience should not assist them. Life, it appears, has become disposable in the rainbow nation." Coovadia said that he was unsure if there was more that doctors in the country could do regarding the provision of nevirapine, the South African Press Association reports. He added, "We make a noise whenever and however we can" (South African Press Association, 8/4).
Western Cape Model
Western Cape Director of Health Fareed Abdullah said today at the conference that the approach used in the Western Cape province of South Africa -- which has "pioneered" the administration of antiretroviral therapy for pregnant women, infants and a growing number of adults -- could serve as a model for a national treatment plan, according to Reuters (Quinn, Reuters, 8/5). 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," Agence-France Presse reports (Graham, Agence-France Presse, 8/5). The Western Cape started its program in 1999 focusing on mother-to-child HIV transmission prevention, a program that is now universal in the province, according to Reuters. Vertical HIV transmission in the Western Cape has been reduced by 50% since 1999, according to Abdullah. In addition, the province has introduced pilot programs to provide antiretroviral drugs to adult AIDS patients in poor township areas such as Khayelitsha. He said that although the pilot programs are small and rely on funding from foreign nongovernmental groups such as Medicines Sans Frontieres, the programs are proving that it is "possible to provide antiretroviral therapy, even for poor people who live in shacks" (Reuters, 8/5). Abdullah also said that counseling and drug adherence support are equally as important as providing antiretroviral therapy, according to the South African Press Association. He said, "This is not a simple intervention but its complexity should not be exaggerated." He added, "We have to get as many people on treatment as soon as possible. We need to build the infrastructure for a scale up and ensure medical staff get it right [the] first time around through tight selection criteria of those put on drug treatment programs, treatment preparedness and counseling" (South African Press Association, 8/5).
Demonstrators Demand Treatment, Inclusion
Members of the South African HIV/AIDS advocacy group Treatment Action Campaign yesterday demonstrated outside of the conference venue, calling for South African health officials to resume talks with business leaders and civil society to implement a "cohesive" national HIV/AIDS strategy, the AP/Philadelphia Inquirer reports (Sylvester, AP/Philadelphia Inquirer, 8/5). TAC on Sunday concluded its own conference with TAC Chair Zackie Achmat saying that he would begin antiretroviral therapy. Achmat, who was diagnosed with HIV in 1990, five years ago said he would not take antiretroviral medications until the South African government made the medications available to all HIV-positive South Africans (Kaiser Daily HIV/AIDS Report, 8/4). However, he said yesterday, "I am not going to die because they want us to die" (AP/Philadelphia Inquirer, 8/5). Achmat called for the "country's people to stand with us and fight the government in any way they can," adding, "We cannot do the whole job without the government. Their participation is crucial" (Graham, Agence-France Presse, 8/4). HIV-positive South African Supreme Court of Appeal Justice Edwin Cameron yesterday also lead a delegation of people living with HIV/AIDS in a protest over HIV-positive people being excluded from the conference, the South African Press Association reports. He said, "This must be the first AIDS conference I've attended in 10 years where there has been this omission." He added that he was "immensely distressed" by the exclusion of people living with HIV/AIDS. A conference organizer blamed Clarence Mini, who was responsible for organizing the community section of the conference, for the omission. Mini was unavailable for comment, according to the South African Press Association. Cameron is scheduled to deliver the conference's closing address tomorrow, the South African Press Association reports (South African Press Association, 8/4).
The following broadcast programs reported on the second day of the conference:
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2003 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.