South African Government Calls for Development of National HIV/AIDS Treatment Program by October

The South African government on Friday showed a "turnaround" in its position on a national program to provide antiretroviral medications to residents with HIV/AIDS and called for the Health Ministry to develop such a program by Oct. 1, South Africa's Mail & Guardian reports. The announcement came after a special meeting of the cabinet to consider a Joint Health and Treasury Task Team cost report on providing HIV/AIDS drugs to the public (Deane, Mail & Guardian, 8/9). South Africa has five million people living with HIV/AIDS -- or more than 11% of its 43.8 million people -- the largest number of HIV-positive individuals of any country in the world, according to UNAIDS (SAPA/Mail & Guardian, 8/10). The cabinet said in a statement, "Government shares the impatience of many South Africans on the need to strengthen the nation's armory in the fight against AIDS. Cabinet will therefore ensure that the remaining challenges are addressed with urgency and that the final product guarantees a program that is effective and sustainable" (Kraft, AP/Long Island Newsday, 8/9). The cabinet also said that the program will follow World Health Organization guidelines that describe the most effective combinations of antiretrovirals and the "simplest acceptable laboratory tests" to monitor their use, the New York Times reports (Altman, New York Times, 8/9). According to the cabinet, "Policy and funding commitments made in the last two years leave South Africa well placed to offer a comprehensive package of prevention and care in the health sector" (AP/Long Island Newsday, 8/9). The South African Health Ministry, assisted by South African HIV/AIDS physicians and researchers and experts from the William J. Clinton Presidential Foundation HIV/AIDS initiative, will develop the program (South African Press Association, 8/9). According to people close to former President Clinton and South African AIDS policy, Clinton has urged South African President Thabo Mbeki to address HIV/AIDS treatment, the Wall Street Journal reports.

Cost Still Needs To Be Determined, Health Minister Says
Although the cabinet's announcement calls for the development of an HIV/AIDS plan "as a matter of urgency," its statement does not "explicitly promise" that the government will provide antiretroviral drugs, according to the Wall Street Journal (Schoofs, Wall Street Journal, 8/11). Health Minister Manto Tshabalala-Msimang said that "a number of questions must be answered" before the South African government can establish a program to provide antiretroviral medications to residents with HIV/AIDS, Agence France-Presse reports. She said, "I can't say we have a roll-out, because the plan has not been adequately costed" (Graham, Agence France-Presse, 8/10). In the past, Tshabalala-Msimang and Mbeki have questioned the use and effectiveness of antiretroviral medications (Kaiser Daily HIV/AIDS Report, 8/6). Tshabalala-Msimang has been quoted as saying that antiretrovirals are "poison" and that a combination of garlic, onions, olive oil and African potatoes would strengthen the immune systems of people living with HIV/AIDS, according to Agence France-Presse (Agence France-Presse, 8/10). Tshabalala-Msimang said that she supports the cabinet's decision, adding, "As minister of health, I am part of the cabinet and therefore this was a collective decision owned by all of us ministers" (Bezuidenhout et al., Sunday Times, 8/10).

Concerns Over Implementation, Leadership
Democratic Alliance party officials yesterday questioned whether Tshabalala-Msimang should lead the effort to develop the HIV/AIDS program. DA spokesperson Mike Waters said, "I do not believe that she will be the best person to drive the roll out of ARVs. She has almost run the entire health system into the ground and she has made a mess of the program to prevent mother-to-child transmission of HIV" (South African Press Association, 8/10). Marthinus van Schalkwyk, leader of the New National Party, said, "What will be vital now is the implementation and sustainability of any such plan, and ... this government will need help and we are willing to assist." Ruth Rabinowitz, spokesperson of the Inkatha Freedom Party, said, "The decision is correct, long overdue and we hope it will herald change in the public debate that has for too long been characterized by acrimony and discord" (South African Press Association, 8/9). Waters also said that the South African government may have decided to develop such a program because "with an election just around the corner, their dithering on a proper response to the AIDS pandemic would hurt them on election day," adding, "It is quite cynical of them to have waited till now to make an announcement on antiretrovirals with a thousand people dying each day" (South African Press Association, 8/10). Patricia de Lille, head of the Independent Democrats party, said, "Tshabalala-Msimang should not only resign, but she should be tried by the Human Rights Commission for gross human rights violations (and) for her stubborn refusal in rolling out treatment for AIDS sufferers," adding, "She is responsible for the deaths of thousands" (Agence France-Presse, 8/10).

Reaction From Advocates
While many AIDS advocates lauded the announcement, some advocates "privately expressed skepticism," the Journal reports (Wall Street Journal, 8/11). Treatment Action Campaign Chair Zackie Achmat said that he will "wait to see the actual operational plan before celebration." He added, "For all of us living with HIV in South Africa, and our families, this is the first sign of hope" (New York Times, 8/9). TAC officials on Saturday said that the group will end a civil disobedience campaign against the HIV/AIDS policies of the South African government (Graham, Agence France-Presse, 8/10). Earlier this month, TAC voted to renew a civil disobedience campaign to force the South African government to provide antiretroviral medications to residents with HIV/AIDS (Kaiser Daily HIV/AIDS Report, 8/6). Professor Jakes Gerwel, chair of the Nelson Mandela Foundation, said, "The government's decision is great news for the millions of people living with HIV/AIDS," adding that former South African President Nelson Mandela and the foundation are "overjoyed by the government's announcement." Eric Goemaere, head of Medecins Sans Frontieres in South Africa, said that the group supports the announcement, adding that MSF has "witnessed first-hand the daily devastation caused by the AIDS epidemic in South Africa, the clinical benefits of ARV treatment, and the hope that the availability of treatment brings to the community" (Agence France-Presse, 8/10). HIV-positive South African Supreme Court of Appeals Justice Edwin Cameron said that he was "elated and optimistic" about the "irreversible commitment by government" to establish a national HIV/AIDS plan, adding, "I think this is going to translate within months into many lives being saved. ... There is a long hard road ahead and at least we've now embarked on it" (Sunday Times, 8/10). Swazi Hlubi, executive director of the Network of AIDS Communities of South Africa, said, "Our hopes have been raised and crushed many times before ... we will watch closely to ensure that ARV treatment truly becomes a reality" (Agence France-Presse, 8/9).

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