Three HIV-positive prisoners are known to have died in Durban’s Westville Prison since the Department of Correctional Services was challenged in the courts over its antiretroviral (ARV) treatment programme, the Treatment Action Campaign (TAC) said on Friday.
TAC secretary general Sipho Mthathi said one of the prisoners had died two weeks ago. She said the TAC had been informed on Friday that another two HIV-positive prisoners had died.
Correctional Services spokesperson Manilisi Wolela said the two inmates had died on Friday.
Wolela said he could not comment until he had all the information, including whether they were receiving ARV treatment.
News of the deaths came as the Department of Correctional Services filed an affidavit in the Durban High Court on Friday, mapping out its plans to speed up ARV treatment in compliance of a court order.
The department was criticised on August 31 by Judge Chris Nicholson, who said government’s failure to abide by court orders posed a ”grave constitutional crisis” for the country.
The department said in a statement on Friday that its legal team had filed an affidavit ”on its interim intervention plan to deal with the HIV and Aids pandemic and a report on progress made in the implementation of comprehensive HIV and Aids programmes and services in Durban Westville Correctional Centre, in compliance with a court order”.
The government was ordered by Judge Thumba Pillay to comply with the interim execution order pending an appeal against his ruling on the provision of ARVs to offenders at Westville.
Nicholson set the new compliance date of September 8 when he upheld Pillay’s interim execution order on appeal.
The TAC called the submission of the affidavit ”real progress”, but said there were ”shortcomings” in the plan detailed in the affidavit.
The TAC’s KwaZulu-Natal organiser Mihle Dlamini said: ”There is no mention of nutrition and there is no mention of how they will monitor side effects.”
Mthathi said one of the big concerns was the numbers of inmates authorities said had CD4 counts below 200 — the point at which ARV treatment should begin.
Jonathan Berger, a lawyer for the Aid Law Project, which brought the initial action to court, said: ”We’re not satisfied. There is progress but there are real gaps. It doesn’t go far enough.”
He said the affidavit was being studied and a full response would be included in the affidavit that would be submitted to the Durban High Court next Friday in compliance with Pillay’s order.
When Nicholson gave his judgement, he said: ”If the government of the Republic of South Africa has given such an instruction [not to comply with the execution order] then we face a grave constitutional crisis involving a serious threat to the doctrine of the separation of powers.
”Should that continue the members of the judiciary will have to consider whether their oath of office requires them to continue on the bench.”
The government responded by saying there was no constitutional crisis, but that its appeal against Pillay’s execution order had been ”an attempt to alert the court to the administrative burden that would arise as a result of the decision of the court”.
In May, 15 inmates of Westville Prison and the Treatment Action Campaign (TAC) made an urgent application to compel the department to speed up ARV treatment.
On June 22 Pillay ordered the department to speed up ARV treatment to the 15, and to all inmates requiring the treatment.
On July 25 the department was granted leave to appeal against the order, but Pillay made an execution order compelling the department to carry out his order pending the outcome of the appeal.
In its statement on Friday, the department said that its plan included increasing the number of accredited public health ARV sites to which inmates would have access.
HIV-positive inmates who did not have identity documents could not receive ARVs. The department said it was implementing a ”waiver of the ID requirement for accessing treatment from health facilities, provisional free processing of ID applications for offenders who qualify to commence with the ARV treatment programme”.
The respondents in the case are the government, the head of Westville correctional centre, the minister and area commissioner of correctional services, and the minister and KwaZulu-Natal provincial minister for health.
Minister committed to plan
Despite calls for her removal, Health Minister Manto Tshabalala-Msimang has reaffirmed her commitment to implement the country’s HIV/Aids plan.
She has also welcomed the Cabinet’s moves to tackle a ”campaign” to deliberately misrepresent the plan and ”undermine” SA’s response to the pandemic at home and abroad.
Under her leadership, the health department would ”intensify its efforts to ensure that everyone progressively realises the right of access to all the elements of the plan”, her spokesperson Sibani Mngadi said in a statement on Friday.
In a letter to President Thabo Mbeki on September 4, 81 international scientists called for the immediate removal of Tshabalala-Msimang, describing her policies as ”ineffective and immoral”.
They also called for and an end to ”the disastrous, pseudo-scientific policies that have characterised the South African government’s response to HIV/Aids”.
It was an embarrassment to the South African government to have a health minister who ”now has no international respect”, they wrote, adding that ARVs were presently the only medication available to alleviate the consequences of HIV infection.
Tshabalala-Msimang came under fire at the International Aids Conference in Toronto last month for promoting the use of garlic and beetroot against HIV/Aids.
While Mbeki has yet to respond to the letter, he has previously said he will not fire his health minister.
Briefing the media on Thursday’s Cabinet meeting, the government’s spokesperson Themba Maseko said it was not the Cabinet’s responsibility to discuss the future of a minister. He also did not know of any talks about sacking Tshabalala-Msimang.
It was wrong to create the impression that axing her would make the problem of HIV/Aids go away.
”We need to shift focus from saying the problem in the programme is the minister of health,” he said.
While Tshabalala-Msimang had made it clear the government’s HIV/Aids plan included ARVs and nutrition, she might have given the impression that its focus was on nutrition and specific nutrients, said Maseko.
Although the government did believe nutrition was important, ”it should never be seen as an alternative” to other forms of treatment, but as complementary, he said.
In its statement on Friday, the Health Ministry said the Comprehensive Plan for Management, Care and Treatment of HIV and Aids focused on prevention, but made available other interventions to maintain optimal health of those infected.
These included prolonging the progression from HIV infection to Aids through healthy lifestyles which involved good nutrition and physical activity, and not smoking, alcohol abuse and unsafe sex.
Treatment was provided for opportunistic infections, cognisant of the role of traditional medicines, which the World Health Organisation found were used by 80% of people in Africa. – Sapa