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South Africa: AIDS Treatment Breakthrough
AFRICA ACTION
Africa Policy E-Journal
August 8, 2003 (030808)
South Africa: AIDS Treatment Breakthrough
(Reposted from sources cited below)
This posting contains a statement by the Treatment Action Campaign
in South Africa applauding the South African Cabinet decision on a
national anti-retroviral plan. Also included are the text of the
cabinet statement, and a speech earlier this month in Durban by
Stephen Lewis, the UN Special Envoy on HIV/AIDS in Africa. Lewis
noted the overwhelming demand and momentum building around Africa
to provide treatment to those who need it, regardless of the
obstacles. He also noted that a breakthrough on this front in South
Africa could provide enormous encouragement around the continent,
and build pressure for donors as well to provide the needed
resources.
The full report of the South African task force on which the
Cabinet based its announcement, is available in PDF format at
http://www.gov.za/reports/2003/ttr010803.pdf
The potential for additional obstacles, however, is apparent in a
recent announcement by the South African Medicines Control Council
(MCC) that they may prohibit use of nevirapine for prevention of
mother-to-child-transmission because of alleged flaws in the
studies confirming the drug's efficacy and safety. For more on this
topic, see
http://news.hst.org.za/view.php3?id=20030732
Webcasts from the South African AIDS Conference 2003, including
transcripts of some sections, are available at:
http://www.kaisernetwork.org/healthcast/sa-aids2003.
+++++++++++++++++end summary/introduction+++++++++++++++++++++++
Treatment Action Campaign (TAC)
http://www.tac.org.za
For Widest Distribution
TAC Response to Cabinet Statement
"DEVELOP AN ARV PLAN FOR THE PUBLIC SECTOR IN ONE MONTH"--CABINET
INSTRUCTION WELCOMED BY THE TREATMENT ACTION CAMPAIGN
8 August 2003
There is cause for celebration and optimism. Government has
decided to provide anti-retroviral therapy in the public sector in
South Africa.
The Treatment Action Campaign (TAC) welcomes the Cabinet's
instruction to the Department of Health to develop an operational
plan within one month to provide ARVs in the public sector. The
Cabinet endorsed the findings of the Joint Health and Treasury Task
Team Report that between 500,000 and 1.7 million lives will be
saved with anti-retroviral therapy. It also reaffirmed the science
of HIV/AIDS pathogenesis and treatment.
This is a critical step to develop a more comprehensive treatment
and prevention plan for managing the HIV/AIDS epidemic. Properly
implemented, this will restore hope, dignity and life for millions
of people in our country, and, hope throughout the continent. This
will also give doctors, nurses and communities the opportunity to
work together with government to build a better health care system
that meets the needs of all people in South Africa.
The TAC National Executive will formally suspend the civil
disobedience campaign and reconsider pending litigation early next
week. We welcome Cabinet's bold step today but we also remember
the anguish, pain and unnecessary loss of lives over the last four
years.
The end of policy and political vacillation reveals the real hard
work to all of us. TAC pledges to put its full weight and support
behind the successful implementation of all interventions aimed at
alleviating the HIV epidemic. We will work with government to save
lives and build a better health service. The private sector, drug
companies, civil society, international agencies and individuals
need to redouble our efforts to improve prevention, treatment and
care. We salute the efforts of every person living with HIV/AIDS,
doctors, nurses, scientists, government administrators and all
people who contributed to the report and the struggle for a
treatment and prevention plan. Let's get to work!
[END OF TAC RESPONSE TO CABINET STATEMENT]
Cabinet Statement
STATEMENT ON SPECIAL CABINET MEETING: ENHANCED PROGRAMME AGAINST
HIV AND AIDS, 8 August 2003
Cabinet today convened in a special meeting to consider the Report
of the Joint Health and Treasury Task Team on treatment options to
enhance comprehensive care for HIV/AIDS in the public sector. A
summary of the Report can be found on the government website,
http://www.gov.za. The full Report will be posted on the website
early next week.
The Report deals with various challenges, including in particular,
a programme to administer anti-retrovirals to enhance the quality
of life of those who have reached an advanced stage of the
Syndrome, and it proposes various scenarios in dealing with this
matter. The Report proceeds from the premise that new developments
pertaining to prices of drugs, the growing body of knowledge on
this issue, wide appreciation of the role of nutrition, and
availability of budgetary resources do enable government to
consider this enhanced response.
The meeting reiterated government's principled approach that
antiretroviral drugs do help improve the quality of life of those
at a certain stage of the development of AIDS, if administered
properly.
Further, Cabinet noted that, as we consider details pertaining to
this enhanced treatment programme, it is critical that we do not
lower our guard as a nation, because there is no cure for AIDS.
It also noted the assertions in the Report that a primary challenge
in our situation is to ensure that the 40 million South Africans
who are not infected with HIV stay that way; and that those who are
infected but have not as yet progressed to an advanced stage of
AIDS lead a normal life through proper nutrition, healthy
lifestyles and treatment of opportunistic infections. In other
words, not everyone who is infected with HIV would need
antiretroviral treatment.
Cabinet decided that the Department of Health should, as matter of
urgency, develop a detailed operational plan on an antiretroviral
treatment programme. The Department will be assisted in this work
by South African experts as well as specialists from the Clinton
Foundation AIDS Initiative who have not only offered to contribute
to this effort; but have also been of great assistance in
commenting on the work done thus far.
It is expected that this detailed work would be completed by the
end of September 2003.
Government shares the impatience of many South Africans on the need
to strengthen the nation's armoury in the fight against AIDS.
Cabinet will therefore ensure that the remaining challenges are
addressed with urgency; and that the final product guarantees a
programme that is effective and sustainable.
8 August 2003
Issued by: Government Communications (GCIS)
[END OF CABINET STATEMENT]
Speech by Stephen Lewis
UN Special Envoy on HIV/AIDS in Africa
At the conference of the "Centre for the AIDS Programme of Research
in South Africa" (immediately preceding the national South African
AIDS Conference).
Durban, South Africa
August 3, 2003
[excerpts only; for full text see:
http://www.sarpn.org.za/documents/d0000441/index.php]
I've been in this Envoy role for just over two years. The issues
related to the pandemic ebb and flow, but remain much the same --
care, prevention, treatment, stigma, discrimination, gender,
orphans, leadership--they all continue to reverberate,
unceasingly, as we struggle to overcome HIV/AIDS.
At this moment in time, however, no one would dispute that the
centerpiece of the debate is the quest for treatment. I recognize
that the debate has controversial edges--witness the situation
here in South Africa--but there's simply no denying that
everywhere one goes on the African continent, everyone affected or
infected by the virus is talking about or demanding treatment. And
I mean everywhere. And at every level, from groups of women at
village health clinics to the Presidents of countries. The change,
even in two years, is startling. Suddenly there is the recognition,
especially amongst People Living with HIV/AIDS, that treatment is
possible, that it should be affordable, that lives are prolonged,
and that treatment brings hope.
It is not just an idea whose time has come; it is a reality whose
time is now.
...
Happily, the imperative of treatment is spreading non-stop across
the African continent. At a recent breakfast, during the AU Summit
in Maputo, chaired by President Obasanjo of Nigeria, and attended
by the Secretary-General of the United Nations, the head of the
Global Fund, Dr. Richard Feachem used the phrase that we are "on
the verge of an explosion of treatment" throughout Africa. My
experience suggests that Dr. Feachem is exactly right.
During 2002/2003, I had the opportunity of visiting a number of
countries, all of which give credence to the powerful drive for
treatment. In Mozambique, where I was last month, the combination
of monies from the Global Fund and the Clinton Foundation is about
to initiate widespread treatment; already Medicins Sans Frontieres
has laid the groundwork with successful treatment regimens at pilot
sites. In Malawi, an appraisal of the healthcare infrastructure by
experts from WHO suggests the possibility of treating 50,000 people
in the public sector in the relatively near future. ,,,In Zambia,
the goal is to put 10,000 people into treatment as speedily as
possible--indeed treatment has begun--using a grant from the
Global Fund. In Kenya, the Government will use the force of a new
regime and a new Minister of Health, to introduce treatment at the
earliest date, relying initially on Global Fund dollars. In
Nigeria, according to President Obasanjo, the country already has
one of the most extensive public sector treatment programmes on the
continent, using--as I can personally attest--generic
antiretroviral drugs, purchased from India, and of course on the
approved list of WHO antiretrovirals. I need hardly remind you of
Botswana . everyone is surely familiar with their successful and
concerted treatment programme.
Finally, I just returned yesterday from a four-day trip to Uganda.
Uganda, as everyone knows, is the country which has had the
greatest success in countering the pandemic. If ever there were
lessons to be learned, they are to be learned from Uganda. I want
to say, without any fear of contradiction, that the country is
obsessed with treatment and is pursuing it single-mindedly. The
approach is orchestrated by the Joint Clinical Research Centre,
which offers the following information: there are well over a
million people living with HIV/AIDS in Uganda; it is projected that
some two hundred thousand would today qualify for treatment.
Seventeen thousand are currently being treated through the public
sector, civil society sector and private sector combined--and
the target is to have sixty thousand in treatment by the end of
next year, which would make it the largest public sector programme
of its kind on the continent. They are not cowed by infrastructure.
They are not cowed by human resource capacity. They are, quite
simply, determined to keep their people alive.
Perhaps I can add an encouraging footnote. The Research Centre
insists that the 17,000 people now in treatment has resulted in a
significant increase in the numbers seeking voluntary counseling
and testing. The Research Centre is persuaded that there is a
direct cause and effect relationship between treatment and testing;
that is, between treatment and prevention.
I could go on, but I trust the point is made. No matter how high
the prevalence rate in individual countries; no matter how
impoverished those countries may be; no matter how frayed the
infrastructure, government after government across the continent is
bent on treatment. They are answering the desperate call of the
people living with AIDS; they are responding to the NGO activists;
they are embracing the proposition that treatment prolongs life and
treatment brings hope.
Nor is there any naivete in any of this. The countries fully
recognize the tremendous task they face in strengthening health
infrastructures, in replenishing human capacity, in developing
laboratory technology, in training thousands upon thousands of
health care professionals and community health workers. But nothing
daunts them. Even the question of sustainability in the face of
acute financial distress--put quite simply, unremitting poverty
-- does not render them impotent. They are, in the words of
President Moghae of Botswana, "fighting for survival", and survival
does not brook delay. Happily, and this is true of almost every
country, there is, either in the private sector or amongst NGOs
like MSF, an increasing experience of antiretroviral treatment on
a small scale ... sufficient to make governments confident that
they have the rudimentary knowledge required to move to the large
scale.
It's truly inspiring to see how determined these Governments are in
the face of the state of their domestic economies and the hurdles
which must be leaped. Allow me to state the obvious: in comparison
with South Africa, they are grossly disadvantaged and their
economies are reeling. ,,,
I'm not so presumptuous as to tell South Africa what to
do. But I do feel compelled at this moment in time, when the press
for treatment is all-consuming across this, the most afflicted
continent, to make clear the position of those of us who work
within the United Nations, or at the very least, to make my own
position evident.
In so doing, I seek no confrontation. I have read the news reports:
I recognize that there are South African Government studies on
coverage, cost and sustainability which will soon be assessed by
cabinet; I recognize that there have been broad signals that the
many private sector and private hospital treatment initiatives now
in place may soon be joined by a roll-out in the public sector. My
only caveat would be that when people are dying, a signal is seldom
sufficient. Speed and action become the sine qua non. And when the
action finally happens, there will be an outpouring of relief and
exhilaration throughout Africa, akin, for many, to the emotional
catharsis which accompanied the end of apartheid. South Africa is
one of the leaders on this continent. If there is a breakthrough
here, every country will feel similarly encouraged. And there's one
other factor that must be taken into account: from the donor
community--World Bank, Global Fund, Clinton Foundation,
international NGOs, United Nations agencies, bilateral development
Ministries--I genuinely believe that resources will flow to
sustain whatever South Africa undertakes. The world,
overwhelmingly, wants South Africa to defeat the pandemic.
The welter of predictions, from the views of Professor Alan
Whiteside to the recent World Bank study, are not just sobering,
they are terrifying. I have read the World Bank study, cover to
cover. It's not an easy read, because much of the text is turned
over to algebraic equations which are, for this layperson,
indecipherable. But then you look at the narrative portion of the
text, and what it says about the prospects for South Africa is
nothing less than apocalyptic. I remind you that the Bank is given
to sober appraisal, dispassionate analysis, econometric
configurations, guarded prophecies. For the Bank to predict the
possibility of a failed state of South Africa within three
generations, based on the socio-economic fall-out from HIV/AIDS, is
astonishingly uncharacteristic. It must therefore be taken
seriously. In truth, it doesn't surprise me. While it is pleasing
and unusual to have the analysis of mortals confirmed by the World
Bank, it was surely obvious, some time ago, that the methodical
toll, year after year, exacted by AIDS would, cumulatively, cause
the unraveling of whole societies. We've never given enough
credence to that reality. It's good that the Bank has now done so.
But in a powerful way, it's the wrong reality. I, for one, am weary
of hearing new justifications for intervention from the western
world, or new reasons for declaring a state of emergency. It
apparently isn't enough to have a human catastrophe; we have to
couch it as a threat to international security; we have to imply
potential destabilization so great as to spawn breeding grounds for
terrorism; we have to wring our hands over the long-term economic
consequences, damaging to investment, trade and growth, before
we're moved to rescue the human condition.
What is wrong with the world? People are dying in numbers that are
the stuff of science fiction. Millions of human beings are at risk.
Communities, families, mothers, fathers, children are like shards
of humanity caught in a maelstrom of destruction. They're flesh and
blood human beings, for God's sake; is that not enough to ignite
the conscience of the world? Why should we have to produce all
these tortured rationales to drive home such an obvious point? This
pandemic has done something dreadful to the instinct for
compassion. I don't really understand what's happening; I don't
really understand why the simple act of saving or prolonging a
human life isn't sufficient anymore. It's irrational to need a
balance sheet of geometric calculation and economic architecture.
It's sick.
I was in Masaka District of Uganda just last Wednesday, where one
lonely NGO is dealing with three thousand, six hundred people, men
women and children, all of them HIV positive. Masaka was virtually
ground zero of the pandemic in all of Africa. I was traveling with
Ms Graca Machel, and when the people addressed us, right in the
heartland of a rural community, they talked about hearing of drugs
called anti-retrovirals, and they pleaded for the right to live.
You really have to wonder what the world has wrought: there's
something terribly degrading about people so ill, begging to stay
alive. At least it can be said that the Government is desperately
trying to respond to them. The day before, we were at the
Mother-to-Child Plus clinic at Mulago Hospital in Kampala. That's
the clinic where the mother and the infant are both on nevirapine
to interrupt transmission of the virus, and where the mother, if
her CD-4 count is below 200, can begin anti-retroviral treatment.
We met a woman whose CD-4 count had dropped to 1 (yes, 'One'), and
a month later, after ARVs, she was filled with buoyancy, energy and
an inexhaustible lust for life. And her children aren't orphans
because their mother is alive.
When Nelson Mandela spoke in Paris on July 15th, to the Conference
on HIV Pathogenesis and Treatment, just in advance of the failed
meeting in support of the Global Fund, he said, and I quote "The
world must do more, much more on every front in the fight against
AIDS. Of course, it means dramatically expanding our prevention
efforts, but the most striking inequity is our failure to provide
the lifesaving treatment to the millions of people who need it most
. the single most important step we must now take is to provide
access to treatment throughout the developing world. There is no
excuse for delay. We must start now . If we discard the people who
are dying from AIDS, then we can no longer call ourselves decent
people".
That seems to me to say it all. But I don't want to end these
remarks without acknowledging three things. First, my emphasis on
treatment is not meant, in the slightest, to diminish the need for
prevention. I well recognize that the two work, irreplaceably and
inseparably, hand in hand. Second, the question of access to drugs
in the post-Doha world, and their cost, is obviously critical, and
I shall be addressing that issue later this month in advance of the
WTO meeting in Cancun. Third, the question of resources remains
central to everything else, and I have no illusions that that
struggle over money is yet joined.
All of that notwithstanding, treatment is the current agenda. It
will remain the current agenda until the agenda is met. As Nelson
Mandela said: it is an elemental matter of human decency, and
history will judge where decency was wanting.
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Date distributed (ymd): 030808
Region: Southern Africa
Issue Areas: +health+ +economy/development+
The Africa Action E-Journal is a free information service
provided by Africa Action, including both original
commentary and reposted documents. Africa Action provides this
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
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