In a dramatic turnaround, the South African government is to announce next month a programme that will eventually provide anti-Aids drugs free to all those who need them.
South Africa’s Finance Minister, Trevor Manuel, is expected to make the commitment in his budget speech. It will give, on average, an extra eight years of life to the country’s five million people living with Aids and HIV — the highest infection rate in the world.
At first, the antiretroviral drugs will be given in pilot schemes to new mothers. These will be expanded over the next few years and the government is still considering how they will be financed and the drugs distributed.
This is the culmination of a long, bitter war in which much of civil society, including activists, unions and churches, was pitted against the government. Although President Thabo Mbeki, who infamously declared that HIV does not cause Aids, has withdrawn from the debate, Health Minister Manto Tshabalala-Msimang dismayed doctors last month by inviting a notorious Aids dissident, Dr Roberto Giraldo, to a government-sponsored meeting where he reiterated his view that HIV is not infectious and is not spread through sex.
The health department tried to block a $70-million grant from the Global Aids Fund to the rebel province KwaZulu Natal, on the grounds that the correct administrative procedures had not been followed.
Now the government has given the grant the go-ahead on condition that the programme does not begin until March, ensuring the govern ment’s announcement of its own initiative is not upstaged.
The other powerful interest group to take a hammering in the Aids war is the pharmaceutical industry. Its attempt to take the government to court to protect its patents — and prices — ended in capitulation, in the face of worldwide revulsion.
British-American giant GlaxoSmithKline has given a licence to a KwaZulu drugs manufacturer, Aspen, to make Combivir, the pill that combines AZT and 3TC, two-thirds of the most common anti-Aids regimen. Stephen Saad, head of Aspen, is waiting for the Medical Control Council’s approval before he can release the boxes piling up in his warehouse.
What GlaxoSmithKline calls its ‘preferential pricing at cost price’ for state and non-governmental organisations will cost about R462 per person per month. Saad will sell it for about R266 per person for month — but he is restricted to supply ing the NGO/state sector. Aids and HIV are primarily the affliction of the poor, so by far the largest market will be the state.
In KwaZulu, Dr Patrick McNeil, of the Port Shepstone hospital, said the health system was overwhelmed by the epidemic: ‘Every second patient has HIV. Some days you walk through the wards and all you see is telltale gaunt faces.’
Patients are resented by staff, he said, because ‘they have constant diarrhoea, they won’t eat, they have sores and hate being moved. We can only make them comfortable and give them analgesics for the pain.’
McNeil is sceptical about success for a universal antiretroviral drugs campaign; once a patient starts on a programme of antiretrovirals, he or she has to take them every day at the same time throughout life, otherwise new, drug-resistant strains will emerge.
‘If you stop taking antiretroviral drugs, it’s only weeks till resistance develops and then there is no treatment,’ he said.
The hospital’s paediatrician, Dr Irina Andre, says her dreams are haunted by dying babies. Some 100 000 are born with HIV every year, many because their mothers refuse to be tested for HIV while pregnant because a positive diagnosis can lead to family rejection. Seventy per cent die before the age of two.
‘This means the mothers don’t get the nevirapine which could have protected their babies,’ she said. ‘They come from families affected by malnutrition. If you feed them properly, they can fight off the virus for longer.
‘The other 30% are ”slow progressors”. At six or seven, they develop continuous diarrhoea and their bodies begin to waste away. One child born with HIV lived to 13, but he was adopted by a white family who could give him good food,’ said Andre.
And that is the other difficulty with anti-retroviral drugs: they must be taken with food.
Nzimakhwe Nonjabulo (22) lies curled up on a filthy mattress in one of the poverty-stricken hillside villages where most black people live. Diarrhoea has reduced her body to a skin-covered skeleton. In acute pain, she has the rasping cough of pneumonia, one of the diseases that kills many Aids patients. Her mother has given up her job to care for her; both of them live on an HIV sufferer’s grant of R630 a month. There is no food, no electricity, no running water.
On the other side of the hill, in a larger house with electricity and a fridge, Sindisiwe Ngidi cares for her identical twin, Philisiwe. They are 27. They live with their children and mother and a third sister sends home enough for them to live on.
Philisiwe is emaciated and a large bandage covers an abscess on her chest; she is an eerie shadow of her strong, lithe twin who bustles in and out with basins and ointments.
Philisiwe is an intelligent, spirited woman who worked as an Aids counsellor until the abscess confined her to her home. She is angry with the government for not providing drugs that could have allowed her to see her son grow up. ‘I want to fight,’ she said. It may be too late for her. – Guardian Unlimited Â