[Peace-discuss] Fwd: South Africa: AIDS Treatment Breakthrough

[Alfred Kagan]

FYI

>
>
>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+ 
>
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-- 


Al Kagan
African Studies Bibliographer and Professor of Library Administration
Africana Unit, Room 328
University of Illinois Library
1408 W. Gregory Drive
Urbana, IL 61801, USA

tel. 217-333-6519
fax. 217-333-2214
e-mail. akagan at uiuc.edu