South African Health Minister Stressed Poverty Issues at U.N. Special Session

South African Health Minister Manto Tshabalala-Msimang said Friday that her country succeeded during the U.N. General Assembly special session on HIV/AIDS in "getting the world community to recognize the crucial role" that poverty plays in the spread of HIV in Africa, Reuters reports. Tshabalala-Msimang said that the nations of the South African Development Community "highlight[ed] issues of poverty, underdevelopment and illiteracy." During the conference, the United Nations General Assembly approved a "detailed blueprint" that sets "timetables for countries to devise and implement strategies for education, prevention, treatment and a network of care programs," especially for orphans. "We believe that our input has contributed to shaping a global response that is relevant to the social conditions in most affected countries," she said (Reuters, 6/29).

Will Wait for 'Western Style' Treatment
Tshabalala-Msimang also "surpris[ed] AIDS doctors and activists in her own country" by saying that South Africa "will not provide AIDS drugs in public hospitals unless [the country] can provide exactly the same standard of care as offered in Western nations," the Wall Street Journal reports. During an interview in New York last week, Tshabalala-Msimang cited "a lack of infrastructure" in rural areas and "maintained that the drugs and associated costs of monitoring patients were simply unaffordable." The Journal reports that "[a]s the price of AIDS drugs has fallen, the cost of monitoring treatment looms as one of the largest financial barriers to treating AIDS patients in poor countries." Tshabalala-Msimang said, "Given the budget I have, there is no way that we can have the widespread scale of administering antiretrovirals," adding, "We cannot apply substandards when it comes to our country ... We must exactly apply the same standards in the developing countries." For example, she explained, it is standard procedure in the United States to administer a viral load test when prescribing medication. But the $100 cost of the test is unaffordable for doctors and patients in many countries, and drugs are prescribed without using the test. "I would find it very unethical and morally very difficult for me to give a person medicine and then I'm not able to detect whether I am bringing down the viral load [or] whether I am increasing it," she said. However, Peter Mugyenyi, a Ugandan physician who runs the Joint Clinical Research Centre in Kampala, said that the response of patients that he is treating with medication and without the test "is excellent -- as good as those getting viral-load monitoring." He said, "It would be extremely unethical to wait for Western-style monitoring and let these patients die" (Schoofs, Wall Street Journal, 6/28).

Death Toll Could Reach Five Million
In related news, South Africa's state-funded Medical Research Council said that AIDS could kill between five and seven million South Africans by 2011 "if proper treatment is unavailable," Reuters/Chicago Tribune reports. Debbie Bradshaw, director of the council's Disease Research Unit, said, "We appreciate that treatment is costly and very difficult given the health infrastructure, but there is a critical need to explore creative mechanisms to get more access to treatment." South Africa has the largest number of HIV-positive citizens in the world (Swindells, Reuters/Chicago Tribune, 6/29).