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Note: This document is from the archive of the Africa Policy E-Journal, published
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Africa: Treatment Access Update
Africa: Treatment Access Update
Date distributed (ymd): 010616
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +health+ +US policy focus+
SUMMARY CONTENTS:
This posting contains several documents relating to developments on
treatment access following Africa Action's letter last week
protesting remarks by USAID Administrator Andrew Natsios that used
racist and ignorant arguments to justify denying AIDS treatment to
Africans.
Despite growing public pressure, including a demonstraton by
Africa Action and colleagues outside USAID and articles in the New
York Times, Washington Post, and Boston Globe (see brief quotes
below), Mr. Natsios has yet made no public reply. Unconfirmed
reports say that while he acknowledges "insensitivity", he has not
changed his views. The e-mail address provided for Mr. Natsios on
the USAID web site no longer works, but comments can still be
submitted to the public inquiry address: pinquiries@usaid.gov.
Along with the refusal of some countries to include mention of
specific vulnerable groups such as sexworkers, men who have sex
with men and drug users in the General Assembly declaration,
treatment and funding for the Global Fund will be key contentious
issues raised but not resolved in the meetings and demonstrations
in New York beginning next weekend.
Fortunately, there are also some signs that African countries are
not waiting for "leadership" from New York or Washington, as noted
in the reports below of plans for free AIDS treatment in Botswana,
a new AIDS treatment facility in Uganda, and the vote by Kenya's
parliament for a law making it easier to import or manufacture
cheaper drugs.
NOTE: More next week on Africa Action's campaign for Africa's Right
to Health. See http://www.africapolicy.org/desk for recent letters
to President Bush and Secretary of State Powell.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
The New York Times, June 11, 2001
"Refusing to Save Africans," by Bob Herbert
"Giving the back of his hand to the suffering of millions, a key
Bush administration official is opposing any extensive use of the
life-extending anti-AIDS drugs in Africa, insisting that the health
care infrastructure is too primitive and that Africans, in most
cases, are incapable of following the regimen."
"Africans may be dying by the millions from AIDS, but the brutal
stereotyping of the Dark Continent lives on, encouraged by U.S.
government officials who should know better.
Mr. Natsios's primary response to the epidemic that is roaring like
a fireball across southern Africa is to just say no."
Washington Post, June 15, 2001
"Dead Wrong on AIDS," by Amir Attaran, Kenneth A. Freedberg And
Martin Hirsch, all of Harvard Medical School
"As the administration's man in charge of international assistance,
including helping Africans with AIDS, Natsios should know better.
His views on AIDS are incorrect and fly in the face of years of
detailed clinical experience.
Take the issue of whether AIDS should be dealt with by prevention
or treatment. In backing prevention to the total exclusion of
treatment, Natsios favors only modest changes in the strategies
that USAID has relied on for the past 15 years, which by
themselves have clearly failed to stem the pandemic. This is why
expert consensus now agrees that prevention and treatment are
inseparable."
"Harvard physicians are now treating patients in Haiti, and others
are achieving similar treatment successes in Cote d'Ivoire, Senegal
and Uganda."
"Two facts are clear.
The first is that, in Abidjan and Johannesburg, as in Manhattan,
AIDS prevention and treatment must go hand in hand. And we can
accomplish this if the Bush administration contributes adequately
to an international trust fund for that purpose (it has so far
promised only $200 million, or just 72 cents per American).
The second fact is that Andrew Natsios, by virtue of his
unwillingness to acknowledge the first fact and his willingness to
distort the true situation in Africa before Congress, is unfit to
lead USAID and should resign."
Boston Globe, June 15, 2001
"Has 'The West Wing' influenced Bush Administratio policy on AIDS
in Africa?," by John Donnelly
"That's the question AIDS activists are asking after two senior US
officials have said that distribution of cocktails of anti-AIDS
drugs would be complicated by Africans' inability to tell time.
Comments made by Andrew Natsios, the head of the US Agency for
International Development, and an unnamed senior Treasury official
quoted in the New York Times, closely parallel an episode of
NBC-TV's acclaimed 'West Wing' series aired on Oct. 25, 2000. In
the episode titled 'In This White House,' a fictitious US official,
involved in negotiations between an African head of state and a
pharmaceutical company, asserts that taking the drugs is a
'complicated regimen that requires 10 pills to be taken every day
at precise times.'
'What's the problem?' asks Josh Lyman, the deputy chief of staff
character played in the series by actor Bradley Whitford. There is
a long pause in the Roosevelt Room. Finally, communications
director Toby Ziegler (actor Richard Schiff), says, 'They don't own
wrist watches. They can't tell time.' "
Prof. Tih Pius Muffih, MPH, Ph.D.
Director of Health Services
Cameroon Baptist Convention Health Board
PO Box 9, Nso
Bui Division
Northwest Province
Cameroon
Email: hospital_banso@kastanet.org
[Posted June 15, 2001 on UNGASS-BTS listserv; archive is
available at http://www.hdnet.org]
Permit me to react to Mr. Natsios' interview in the Boston Globe
where he said the money raised by a new global fund to fight AIDS
should be used almost entirely for prevention services, not for
antiretroviral drugs, because attempting to get the drugs to
Africans any time soon would not be worth the effort. Why? His
answer is, "because of the difficulties posed by lack of roads,
shortages of doctors and hospitals, wars and other problems."
That is not all!! Probably Mr. Natsios intended to tell the whole
enlightened world that human beings living in the dark continent
of Africa have learnt nothing since the slave trade and of course
have themselves to blame for not being among the privileged ones
that were sold into slavery to America. For that helped those
slaves to learn how to read western time and how to follow
Western regimens. I happen to be the Supervisor of several
hospitals where antiretroviral drugs have been introduced. The
problem we face is not the lack of knowledge of time or
compliance as it is with the cost of the drugs. Many of our
patients cannot afford the cost of a year's treatment and this
makes it difficult to start them on the drugs. Those who are
able to pay have no problem following up the treatment. Many
patients in our hospitals understand what the virus that causes
AIDS is, and also understand that AIDS is a deadly disease. They
take their drugs as prescribed. We have doctors, few as they
are, who are not only willing to follow up the patients but
also to train nurse-screeners to administer treatment correctly.
I want to assure Mr. Natsios, that Africans have been taking
malaria drugs, antibiotics, etc which all need compliance.
Africans are human beings with brains like Americans. Africans
merit a fair treatment, equity, equality, and social justice. A
second problem is that of testing and monitoring the patients for
their viral load and CD4 cell counts. However, when you read the
consensus statement on antiretroviral treatment for AIDS in poor
countries by 128 individual members of the Faculty of Harvard
University of March 2001, there is evidence that treatment in
areas without access to CD4 counts or viral load testing, should
be based on HIV seropositivity and AIDS-defining clinical signs
and symptoms. This powerful group of intellectuals and
professional giants do declare, that I quote:- "As signers of
this consensus statement, we believe that the objections to HIV
treatment in low income countries are not persuasive and that
there are compelling arguments in favor of a widespread treatment
effort." If there is compliance with the antiretroviral drug
regimens in America, why does Mr. Natsios believe that Africans
will not comply? Sub-humans? Prevention is highly recommended but
this does not imply that effective treatment for AIDS should be
denied Africans for whatever reason.
UN Integrated Regional Information Network
[The following items are from the "africa-english" service of the
UN's IRIN humanitarian information unit, but may not necessarily
reflect the views of the United Nations. For further
information,contact e-mail: irin@ocha.unon.org or Web:
http://www.reliefweb.int/IRIN . If you re-print, copy, archive or
re-post this item, please retain this credit and disclaimer.
Reposting by commercial sites requires written IRIN permission.]
UGANDA: Kampala chosen for major AIDS training centre
[IRIN-CEA: Tel: +254 2 622147 Fax: +254 2 622129 e-mail:
irin-cea@ocha.unon.org ]
NAIROBI, 12 June (IRIN) - Africa's first major treatment and
training centre for HIV/AIDS is scheduled to open in the Ugandan
capital, Kampala, early next year, according to a press statement
on Monday from the Academic Alliance for AIDS Care and Prevention
in Africa.
The state-of-the-art centre would train medical personnel from
across the continent on the latest treatment options and bring
the highest standard of care to patients, the statement said.
At least 80 clinicians from across Africa would be trained each
year, according to Nelson Sewakambo, Dean of Medical Studies at
Makerere University, where the centre is to be located. "Our goal
is to strengthen medical infrastructure, replicate it across
Africa and bring the latest medicines to bear on treating this
disease so that African doctors and nurses can offer modern AIDS
care to their patients," he added.
Dr Thomas Quinn, an American doctor involved in the Alliance,
said Uganda had been chosen for the centre because President
Yoweri Museveni's leadership on HIV/AIDS had helped make it the
most successful African country in the fight against the disease.
The strain of HIV prevalent in Uganda would also respond to the
drugs used against the virus in the US, the BBC quoted him as
saying.
"This new centre is an important step for Africa as we seek to
control the AIDS pandemic and improve the quality of care," said
President Museveni. "This new approach will complement the work
our own doctors are doing and can have a positive impact across
Africa."
An estimated 820,000 people are living with HIV/AIDS in Uganda,
and there are some 25 million HIV-infected people on the African
continent.
The new clinic, to be located at Makerere University Medical
School, will be funded by the Pfizer Foundation pharmaceutical
company and operated by the Alliance in partnership with the
university, according to Monday's press statement.
"The Academic Alliance is a ground-breaking effort because it is
the first large-scale AIDS training and treatment program aimed
at improving care for patients who typically have no resources or
access to even rudimentary medical help," said Dr Merle A Sande,
co-director of the Alliance and Chairman of the Department of
Medicine at the University of Utah, USA.
One of the goals of the clinic would be to put more patients
under treatment with anti-retroviral drugs (ARVs), which are
combined with anti-fungals and other medicines that fight
AIDS-related opportunistic infections, according to Associate
Dean of the Makerere School, Dr Samuel Luboga. The centre would
use diagnostic technology to monitor patients on ARVs and
determine what kind of treatments are most appropriate for
Africa, he said.
Negotiations were ongoing with companies that manufacture ARVs so
that it would have supplies on hand when the clinic opened,
according to Monday's press statement.
The Alliance was working closely with the Ugandan medical and
public health community and would actively seek assistance from
the Ugandan Minister of Health, local organisations, the staff
and faculty of Makerere University Medical School and Mulago
Hospital, the national hospital of Uganda, the statement added.
AFRICA: IRIN HIV/AIDS Weekly issue 31, 2001, June 15, 2001
IRIN-AIDS Weekly - Tel: +27-11 880 4633
Fax: +27-11 447 5472
Email: AIDS@irin.org.za
BOTSWANA: Diamond giant leads the way
Botswana's giant diamond company Debswana has announced that all
companies wishing to do business with it will be required to
support the firm's progressive HIV/AIDS policy, the 'Botswana
Gazette' reported.
"The companies will be responsible for providing a safe working
environment both physically and mentally through empowering their
employees with knowledge to avoid risks and protect themselves
from contracting HIV/AIDS," explained Debswana's spokesman Jacob
Sesinyi. The companies will have to demonstrate that they have a
work place policy and programme on HIV and AIDS both at the home
base company and on site at the Debswana premises which includes
a statement on non discrimination based on HIV status,
confidentiality and privacy, the ability to work and criteria for
ill-health retirement.
Meanwhile, Botswana is to provide free antiretroviral drugs
(ARVs), President Festus Mogae announced on Monday. "We have not
yet started the full antiretroviral programme, but we hope it
will be running by the end of the year," Mogae told reporters.
The diamond-rich country has already begun handing out free drugs
to prevent HIV-positive pregnant mothers passing the virus to
their unborn children, AFP reported. "We have been told we have a
good chance of prevention in the majority of cases," Mogae said.
He added that a campaign would be launched soon for people to
adopt Botswana's 60,000 to 80,000 AIDS orphans, with the
government paying for the childrens' upbringing, AFP reported.
SOUTH AFRICA: Still no to ARVs
By contrast, South Africa has no plans to provide ARVs, Health
Minister Manto Tshabalala-Msimang told parliament on Tuesday. She
said her ministry's position remained unchanged, even though
pharmaceutical companies dropped a law suit against the
government in April, allowing it to import or manufacture cheap
versions of the drugs, AFP reported.
"We have no plans to introduce the wholesale administration of
these drugs in the public sector," the minister said. "ARVs are
not a cure for AIDS.In addition, the department remained
concerned about the toxicity of the drugs, the availability of
laboratory services, and "infrastructural and educational
constraints", particularly in rural areas, she said.
"I would, however, like to assure this house that this position
is not ideological," the minister said. "Obviously we will
continue to explore all the options available to us."
Tshabalala-Msimang also failed on Tuesday to give an expected
go-ahead to South Africa's nine provinces to launch programmes
using Nevirapine to reduce mother-to-infant HIV transmission. She
confirmed that 18 sites had been identified countrywide "within a
research framework" intended to answer questions related to drug
resistance and toxicity, but did not say when the programmes
would start.
AFRICA: IRIN HIV/AIDS Weekly issue 31, 2001, June 15, 2001
KENYA: Legislation promises cheaper drugs for AIDS patients
The Kenyan parliament on Tuesday unanimously passed a bill which
looks set to reduce the cost of essential AIDS treatment
significantly. The Industrial Property Bill will allow the
government to import or manufacture cheaper copies of brand-name
drugs, including the antiretrovirals (ARVs) used in the drug
cocktail used to fight AIDS, according to campaigners for the
affordable availability of drugs.
Indra van Gisbergen, a lawyer for the Kenya Coalition for Access
to Essential Medicines, told IRIN on Thursday that at least 50
percent of the antiretrovirals used in Kenya were currently under
patent. Only 1,000 to 2,000 AIDS patients were currently
receiving ARV treatment locally, but the new legislation should
lead to much wider access to AIDS drugs, she said. Although the
expected price falls were unlikely on their own to be enough to
provide ARVs to the poorest AIDS patients in Kenya, access among
the middle classes would be greatly improved, van Gisbergen said.
"This is a breakthrough," she added.
However, there has been scepticism among drugs manufacturers this
week regarding the real benefits the legislation was likely to
bring. Director-General of the International Federation of
Pharmaceutical Manufacturers' Associations (IFPMA), Harvey Bale,
was on Wednesday quoted by Reuters news agency as saying that the
legislation was "a political event that will not make any
difference to the health care being received by the Kenyans."
Bale, whose organisation represents industry associations in 60
countries, told Reuters that some 80 percent of the drugs
currently in use in Kenya to fight AIDS were unpatented, and that
the remaining medicines were being sold by the companies locally
at the same price as copied versions.
SOUTH AFRICA: Hospitals face AIDS crisis
Hospitals in South Africa's most AIDS-prevalent province,
KwaZulu-Natal, are being overwhelmed by a growing number of AIDS
patients, the country's leading medical journal said in its
latest issue. The South African Medical Journal (SAMJ) reported
that urban and rural clinics in the province were stretched to
"breaking point", with HIV-positive patients filling 80 percent
of beds in some rural clinics. SAMJ visited hospitals where
patients were forced to share beds and in some instances
compelled to sleep under beds because of shortages. Most AIDS
patients were women between the ages of 24 and 35, many of whom
had contracted the disease in the last 10 years.
KwaZulu-Natal, one of the country's most populous but poorest
regions, has more than one in three pregnant women suffering from
the disease. "People are dying prematurely because we are so
stretched. Medical patients who don't have HIV/AIDS are being
severely compromised because we have to discharge them
prematurely ... The system just can't cope," Jim Muller, acting
head of three of the province's leading hospitals, told the
journal. Drugs were in short supply or non-existent, surgical
procedures abandoned because of limited resources, and hospital
staff overworked. Based on interviews with healthcare workers,
SAMJ reported that doctors have essentially become terminal-care
workers.
HIV-positive children in need of a respirator were dying because
of pressure on resources. "If the kids are HIV-positive, we don't
ventilate and the kids die. That's become general practice," said
Kimesh Naidoo, a paediatrician at Grey's Hospital. At the remote
Hlabisa District Hospital in northern KwaZulu-Natal, 75 percent
to 80 percent of patients are HIV-positive, half of whom had
full-blown AIDS. "Nobody seems to be planning for the AIDS
epidemic ... It's a catastrophe waiting to happen," Hlabisa's
principal medical officer, Sean Drysdale, told the SAMJ.
This material is being reposted for wider distribution by
Africa Action (incorporating the Africa Policy Information
Center, The Africa Fund, and the American Committee on Africa).
Africa Action's information services provide accessible
information and analysis in order to promote U.S. and
international policies toward Africa that advance economic,
political and social justice and the full spectrum of human
rights.
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