/ 27 September 2003

Aids: It’s about life and death

As South African President Thabo Mbeki stumbled into another Aids controversy, the horror story of the Aids pandemic in Africa has at last switched from prevention to hopes of treatment, but the groundwork that lies ahead is daunting for the goal dwarfs anything in medical history.

The International Conference on Aids in Africa (Icasa) which finished here on Friday found a consensus: the world’s poorest, Aids-devastated continent now has access to the serious money and modern drugs that it has fruitlessly sought for years.

But optimism is mixed with cold realism about what needs to be done to ensure that these long-awaited treatments are distributed quickly, safely and fairly.

If it works, sub-Saharan Africa has a realistic chance of smashing the disease which has claimed 20-million African lives in 22 years and left 30-million infected today.

But a fiasco would plunge Africa into further darkness and build drug resistance, destroying the few weapons that exist to fight HIV. A failure would resound around the world.

”The task is unprecedented, let’s all agree,” said UNAids Executive Director Peter Piot. ”This is something that has no precedents in history or development practice.”

Some five-billion dollars are needed to fund the World Health Organisation’s ”Three by Five” initiative, of providing anti-retrovirals to three-million seriously ill people with HIV by the end of 2005.

More than two-million of them are Africans. New figures released this week showed that, at present, just 75 000 have access to these drugs.

So the WHO’s goal is to multiply that number by a factor of more than 25 in little more than two years, in a continent where medical infrastructure is with rare exceptions pitiful.

There have, of course, been previous big pharmaceutical campaigns, such as smallpox vaccinations and tuberculosis treatment.

But smallpox jabs were a one-off and could be administered by mobile teams; TB treatment entails ensuring that the patient takes antibiotics and gets a followup check, and this can be administered by simple rural clinics.

Treating the human immunodeficiency virus (HIV) with sophisticated anti-retroviral drugs is a vastly different proposition.

For one thing, the drugs are ongoing rather than a one-off, for the patient has to take them for the rest of his life.

And getting the right mix of medications is vital, because some people suffer toxic side effects to some drugs and others encounter resistance. The regimen is demanding, requiring the individual to take them twice a day or more.

Lab tests and support staff are needed to check on the patient’s progress.

”We have fought hard to get anti-retrovirals in Africa,” said Papa Salif Sow, a professor at the University of Dakar and head of the infectious diseases unit at the city’s Faan hospital.

”They are coming at last, but are we completely ready for them? The answer has to be no.”

He and others outlined these nuts-and-bolts tasks in the months and years ahead:

  • Financial management Ensuring that poor countries can handle the rapidly rising inflows of donor cash without waste or corruption, a problem endemic to most of Africa

  • Human resources Training enough doctors, nurses, social workers and laboratory technicians and purchasing and maintaining test equipment

  • Preventing a black market Building networks for distributing and storing the drugs securely in order to prevent theft and the creation of a black market

  • Medical surveillance Monitoring treatment in order to ensure that drug resistance, which will inevitably happen in Africa as it has done in the West, is kept as low as possible

    Paying for all this is not included in the WHO’s five-billion-dollar estimate for the ”Three by Five” goal.

    That means the race is on to find ways of cutting costs. Existing infrastructure, such as tuberculosis clinics which are already used by many people infected with HIV, could become distribution points for the drugs.

    Expensive tests, such as monitoring the level of virus in the blood, which is routinely done in rich countries, could be reduced to a minimum.

    And cheaper, simplified types of treatment regimes are now available, such as requirements to take only two pills a day.

    One of the biggest dilemmas is deciding who should be treated first once the drugs arrive, for rationing will be inevitable in the early years.

    Countries have to set down ethical guidelines to identify clearly and fairly who would be given priority for treatment, said Piot.

    The issue ”is so visible, it’s about life and death, and it has be done right, because that could lead to real revolts,” he said. ”’Why am I not treated?’ — it’s a timebomb, a political timebomb.”

    Meanwhile, in Cape Town, SA President Thabo Mbeki’s office said on Friday it would not be diverted from the real issues of combating HIV/aids.

    This was in reaction to criticism by political parties after President Thabo Mbeki said in an interview with the Washington Post that he personally did not know anyone who had died of HIV/Aids.

    Political parties lambasted Mbeki for his statement and called for him to apologise immediately.

    In a statement on Friday, Mbeki’s spokesperson Bheki Khumalo said the president wished to clarify the situation and put the record straight.

    ”At the end of the interview the president agreed to being asked a personal question, which was whether he knew of anyone in his family or amongst his close associates who had died of Aids or was infected by HIV.

    ”It was these questions specifically about people close to him that the president answered and his negative replies do not support the broader interpretation that some media have given them.”

    Democratic Alliance spokesperson Mike Waters said Mbeki’s comments were highly insensitive.

    ”It adds insult to injury for the five million South Africans living with HIV/Aids, of which the majority cannot afford anti-retrovirals.

    ”It is clear that President Mbeki’s inner circle are rich enough to afford their own anti-retrovirals, and that the president has little sympathy or understanding of the epidemic sweeping our country,” he said.

    Mbeki should emerge from his ivory tower and see the real impact HIV/Aids was having on South African society. he said.

    Actuarial models estimated that, by the middle of July this year, a total of one million South Africans would have died from the effects of HIV and Aids.

    ”This is equivalent to the entire population of the Buffalo City Municipality (East London) being wiped out.”

    Mbeki should issue an unequivocal apology immediately.

    ”He should tell South Africans that he is committed to a national roll-out of anti-retrovirals and that neither himself nor the minister of health will try and stand in its way,” Waters said.

    United Democratic Movement spokesperson Nonhlanhla Nkabinde condemned Mbeki’s remarks ”in the strongest terms”.

    ”His utterances during this interview were insensitive, and only demonstrated to the world that he is an Aids denialist,” she said.

    It was unacceptable for the head of state, who was supposed to take the lead in the fight against the epidemic, to make such remarks on the world stage.

    ”His remarks undermine the new commitment made by his Cabinet to provide anti-retroviral drugs to HIV/Aids patients,” Nkabinde said.

    The Independent Democrats said in a statement Mbeki had embarrassed the nation.

    At a time when 600 South Africans died daily of Aids-related illnesses, Mbeki’s statement ”shows that he is detached and oblivious to the plight and sufferings of the people of South Africa”.

    ”In the face of the economic evidence that South Africa is subjected to as a result of the HI-virus, it is a shame to think that the country is run by a dissident,” the statement said. – AFP, Sapa