Gauteng Premier Never Promised Nevirapine Roll-Out, Spokesperson Says
Mbhazima Shilowa, premier of South Africa's Gauteng province, never promised a full-scale government roll-out of nevirapine, the antiretroviral drug that can reduce the risk of mother-to-child HIV transmission by up to 50%, Business Day/AllAfrica.com reports. "An impression was created that it was a roll-out by the way it was reported (in the media)," Thabo Masebe, Shilowa's spokesperson, said on Sunday, adding that the provincial government would "continue with the extension of its [pilot] sites for the purposes of research." Last Monday, Shilowa said in defiance of national health policy that his government would "ensure that all public hospitals and large community centers provide nevirapine." South Africa's national policy states that the drug is experimental and relegates its use to 18 pilot sites across the country (Xundu, Business Day/AllAfrica.com, 2/25). The announcement by Shilowa, a member of the ruling African National Congress, was seen as a watershed moment in South Africa's HIV/AIDS epidemic because it marked the first time that an ANC province had broken rank with the national government on the issue. Many South African leaders have become increasingly dissatisfied with President Thabo Mbeki's leadership on HIV/AIDS. Mbeki, who has publicly questioned the causal link between HIV and AIDS and suggested that poverty plays a larger role in the disease, has only a 31% approval rating, according to a poll released last year (Kaiser Daily HIV/AIDS Report, 2/20). Last Monday's announcement prompted a rebuke from the national Department of Health, which called the plan "contrary to national policy." Shilowa apparently decided to clarify his remarks after a meeting with national Health Minister Manto Tshabalala-Msimang on Friday. After that meeting, the government issued a statement saying that the pilot sites are "for purposes of research" and "more time and work [are] required to establish the long-term impact of the administration of nevirapine." Some of the problems under study include drug resistance and possible negative side effects for the woman or the newborn. The government added that it would consider "whether it was advisable to introduce universal access" only after determining these outcomes (Business Day/AllAfrica.com, 2/25). On Sunday, the Congress of South African Trade Unions again called on the government to expand access to nevirapine to all HIV-positive pregnant women through the public health system. "COSATU cannot see any more reasons that convinces us about a strategy to step back when there is evidence that [nevirapine] is effective," General-Secretary Zwelinzima Vavi said, adding, "I don't care whether ... they call it a full roll-out, as long as no woman who is pregnant and needing nevirapine will be sent back from any public institution on the basis it cannot be provided in the particular hospital because it is confined to certain sites" (South African Press Association/AllAfrica.com, 2/24).
Evaluation of Test Sites to be Released This Week
In related news, a "detailed," independent evaluation of the 18 test sites, commissioned by the health department and performed by the non-governmental organization Health Systems Trust, will be released later this week. The report is currently circulating within the department, but Health-e News Service reports that the report was likely not shared with provincial health ministers at a recent meeting. Co-author Dr. David McCoy of HST said the report is particularly important now because "issues around [the project] and the challenges around the expansion of the program are being reported in the media in a distorted and, at times, factually incorrect manner." He added, "Misunderstandings and half-truths are therefore being added to the politicization of what should be a public health issue." Mark Heywood of the Treatment Action Campaign, which last December won a lawsuit requiring the government to expand the nevirapine program to all national health institutions, welcomed the release of the report, saying that he had been told the report was a "useful and critical analysis" of the pilot projects and reached an "honest conclusion that there needed to be a national roll-out and implementation plan."
Health Minister Denies Questioning HIV-AIDS Link
Also this weekend, Tshabalala-Msimang denied a newspaper report that she had questioned the causal link between HIV and AIDS at a recent ANC caucus meeting, thereby "re-open[ing]" the government's long-standing debate over whether the virus causes the syndrome. "I said that we had to tell HIV-positive people that by eating properly, managing their stress and using condoms they can live longer (and not enter the AIDS stage for many years)," she said, adding, "Health workers are sometimes unsympathetic and may tell the ill person that he or she is going to die [when they have pneumonia], this is not true. We have good protocols in place to manage opportunistic infections" (Thom, Health-e News Service, 2/24).
Newspapers and columnists continue to focus on South Africa's HIV/AIDS crisis. A summary of articles, editorials and op-eds appears below:
- Economist: The South African government is "still doing far too little to fight" HIV/AIDS, the Economist states. Mbeki "gives no leadership" and "denies the scale of the problem," while the government "refuses to provide antiretroviral drugs which prolong life and make an infected person less infectious," it states, calling the lack of leadership "woeful." When Mbeki does address HIV/AIDS, his "few remarks are so ill-judged that those close to him are desperate to keep him quiet." The Economist notes that signs of "exasperation" are showing within the South African political landscape, best exemplified by former President Nelson Mandela's recent statements and Archbishop Desmond Tutu's call for a declaration of a national emergency. Leaders in nations such as Uganda and Botswana have "set the example" for their people by taking HIV tests in public, but Mbeki dismisses such gestures as a "meaningless game" and instead "surfs the Internet for new ideas about the virus, promoting academic debates and eccentric medical views that confuse otherwise clear messages on how to tackle AIDS." He also maintains that AIDS drugs are too expensive and could be harmful, the Economist notes. However, Nigeria and Uganda, which do not have the resources of South Africa, have taken steps to make the drugs more available. Mbeki also seems to dismiss the scale of the problem because he thinks "outsiders" have exaggerated the numbers because they think Africans are "doomed to a mortal end because of our unconquerable devotion to the sin of lust." If the government tackled any of these problems -- "lean resources, cultural insensitivity, political sycophancy" -- it might make headway against HIV/AIDS, the Economist says. "And if men like Mandela continue to speak out, [Mbeki] may realize that it is not just distant racists who grow emotional about the terrible dangers of AIDS, but his own furious countrymen," the Economist concludes (Economist, 2/23).
- Minneapolis Star Tribune: Mbeki, an "otherwise bright and thoughtful leader," is finally "coming around" on HIV/AIDS "thanks to domestic and international pressure," a Minneapolis Star Tribune editorial states, adding, "The pressure needs to continue." Mbeki's "poor leadership on the issue has hindered progress" in South Africa. "Having given a little, Mbeki should now completely abandon his perplexing earlier stand" and "wage an all-out campaign against the epidemic," the editorial states, concluding, "South Africans don't need further stigma, silence, confusion or denial about this deadly disease. They need leadership that will put their survival first and make combatting HIV/AIDS a national policy" (Minneapolis Star Tribune, 2/25).
- Syracuse Post-Standard: Mbeki has allowed the battle against HIV/AIDS to "flounde[r]" at his feet, a Syracuse Post-Standard editorial says. While Mbeki's fiscal policies led Mandela to call him "the best leader the nation has ever had," Mandela more recently has criticized Mbeki for "debating ... [and] arguing" about HIV/AIDS, "when people are dying." Mbeki may be "cracking," however, as AIDS education and counseling, nevirapine pilot programs and condom distribution will see increased government funding over the next three years. "The sooner Mandela and Mbeki join forces in an all-out campaign to battle the deadly AIDS virus, the sooner South Africa can lead the effort to contain the pandemic in all of sub-Saharan Africa as well," the editorial concludes (Syracuse Post-Standard, 2/25).
- Richard Tren, Wall Street Journal Europe: Breaking South African patent laws to import generic AIDS drugs from Brazil may be a "bold decision," but it is not a "wise one," Richard Tren, director of Africa Fighting Malaria, writes in a Wall Street Journal Europe op-ed. Medecins Sans Frontieres recently announced that it was importing generic drugs from Brazil's government-run FarMaguinhos laboratory. The lab does not conduct research to develop the drugs, but instead "reverse engineer[ed]" the drugs to determine the formulas. Brazil says that it will use the money from MSF to fund research into AIDS and other infectious diseases such as malaria. "One has to wonder how much meaningful research and actual drugs will be produced by the Brazilians from the sale of cut-price ripoffs to the NGO sector," Tren says, adding that if the lab did develop a cure or effective treatment for a disease, he "would wager that they would ... change their stance on intellectual property rights" rather than give the drug away for "next to nothing." How would they fund more research if they did not charge competitive prices?, he asks. "It is precisely this kind of double morality -- a disdain for property rights in the name of supposedly helping the sick -- that is discouraging innovation" in AIDS drug development. AIDS advocacy groups call for increased competition from drug manufacturers to drive prices down. "Competition is all well and good, but there are certain rules that apply," Tren notes, adding, "Protecting private property in a competitive free market is one of the most fundamental; otherwise ... competition just becomes sanctioned theft." Tren states that activists are correct to call for more funding in the fight to gain access to treatment for AIDS. However, "good intentions do not create new drugs. Future AIDS patients, seeking new, more effective treatment against evolving strains of the disease will look in vain for those drugs if they have to rely on the patent-breakers in Brazil," he concludes (Tren, Wall Street Journal Europe, 2/25).