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Note: This document is from the archive of the Africa Policy E-Journal, published by the Africa Policy Information Center (APIC) from 1995 to 2001 and by Africa Action from 2001 to 2003. APIC was merged into Africa Action in 2001. Please note that many outdated links in this archived document may not work.


Africa: Treatment Access Update

Africa: Treatment Access Update
Date distributed (ymd): 010616
Document reposted by APIC

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide
Issue Areas: +health+ +US policy focus+

SUMMARY CONTENTS:

This posting contains several documents relating to developments on treatment access following Africa Action's letter last week protesting remarks by USAID Administrator Andrew Natsios that used racist and ignorant arguments to justify denying AIDS treatment to Africans.

Despite growing public pressure, including a demonstraton by Africa Action and colleagues outside USAID and articles in the New York Times, Washington Post, and Boston Globe (see brief quotes below), Mr. Natsios has yet made no public reply. Unconfirmed reports say that while he acknowledges "insensitivity", he has not changed his views. The e-mail address provided for Mr. Natsios on the USAID web site no longer works, but comments can still be submitted to the public inquiry address: pinquiries@usaid.gov.

Along with the refusal of some countries to include mention of specific vulnerable groups such as sexworkers, men who have sex with men and drug users in the General Assembly declaration, treatment and funding for the Global Fund will be key contentious issues raised but not resolved in the meetings and demonstrations in New York beginning next weekend.

Fortunately, there are also some signs that African countries are not waiting for "leadership" from New York or Washington, as noted in the reports below of plans for free AIDS treatment in Botswana, a new AIDS treatment facility in Uganda, and the vote by Kenya's parliament for a law making it easier to import or manufacture cheaper drugs.

NOTE: More next week on Africa Action's campaign for Africa's Right to Health. See http://www.africapolicy.org/desk for recent letters to President Bush and Secretary of State Powell.

+++++++++++++++++end profile++++++++++++++++++++++++++++++

The New York Times, June 11, 2001
"Refusing to Save Africans," by Bob Herbert

"Giving the back of his hand to the suffering of millions, a key Bush administration official is opposing any extensive use of the life-extending anti-AIDS drugs in Africa, insisting that the health care infrastructure is too primitive and that Africans, in most cases, are incapable of following the regimen."

"Africans may be dying by the millions from AIDS, but the brutal stereotyping of the Dark Continent lives on, encouraged by U.S. government officials who should know better.

Mr. Natsios's primary response to the epidemic that is roaring like a fireball across southern Africa is to just say no."

Washington Post, June 15, 2001
"Dead Wrong on AIDS," by Amir Attaran, Kenneth A. Freedberg And Martin Hirsch, all of Harvard Medical School

"As the administration's man in charge of international assistance, including helping Africans with AIDS, Natsios should know better. His views on AIDS are incorrect and fly in the face of years of detailed clinical experience.

Take the issue of whether AIDS should be dealt with by prevention or treatment. In backing prevention to the total exclusion of treatment, Natsios favors only modest changes in the strategies that USAID has relied on for the past 15 years, which by themselves have clearly failed to stem the pandemic. This is why expert consensus now agrees that prevention and treatment are inseparable."

"Harvard physicians are now treating patients in Haiti, and others are achieving similar treatment successes in Cote d'Ivoire, Senegal and Uganda."

"Two facts are clear.

The first is that, in Abidjan and Johannesburg, as in Manhattan, AIDS prevention and treatment must go hand in hand. And we can accomplish this if the Bush administration contributes adequately to an international trust fund for that purpose (it has so far promised only $200 million, or just 72 cents per American).

The second fact is that Andrew Natsios, by virtue of his unwillingness to acknowledge the first fact and his willingness to distort the true situation in Africa before Congress, is unfit to lead USAID and should resign."

Boston Globe, June 15, 2001
"Has 'The West Wing' influenced Bush Administratio policy on AIDS in Africa?," by John Donnelly

"That's the question AIDS activists are asking after two senior US officials have said that distribution of cocktails of anti-AIDS drugs would be complicated by Africans' inability to tell time. Comments made by Andrew Natsios, the head of the US Agency for International Development, and an unnamed senior Treasury official quoted in the New York Times, closely parallel an episode of NBC-TV's acclaimed 'West Wing' series aired on Oct. 25, 2000. In the episode titled 'In This White House,' a fictitious US official, involved in negotiations between an African head of state and a pharmaceutical company, asserts that taking the drugs is a 'complicated regimen that requires 10 pills to be taken every day at precise times.'

'What's the problem?' asks Josh Lyman, the deputy chief of staff character played in the series by actor Bradley Whitford. There is a long pause in the Roosevelt Room. Finally, communications director Toby Ziegler (actor Richard Schiff), says, 'They don't own wrist watches. They can't tell time.' "


Prof. Tih Pius Muffih, MPH, Ph.D.
Director of Health Services
Cameroon Baptist Convention Health Board
PO Box 9, Nso
Bui Division
Northwest Province
Cameroon
Email: hospital_banso@kastanet.org

[Posted June 15, 2001 on UNGASS-BTS listserv; archive is available at http://www.hdnet.org]

Permit me to react to Mr. Natsios' interview in the Boston Globe where he said the money raised by a new global fund to fight AIDS should be used almost entirely for prevention services, not for antiretroviral drugs, because attempting to get the drugs to Africans any time soon would not be worth the effort. Why? His answer is, "because of the difficulties posed by lack of roads, shortages of doctors and hospitals, wars and other problems." That is not all!! Probably Mr. Natsios intended to tell the whole enlightened world that human beings living in the dark continent of Africa have learnt nothing since the slave trade and of course have themselves to blame for not being among the privileged ones that were sold into slavery to America. For that helped those slaves to learn how to read western time and how to follow Western regimens. I happen to be the Supervisor of several hospitals where antiretroviral drugs have been introduced. The problem we face is not the lack of knowledge of time or compliance as it is with the cost of the drugs. Many of our patients cannot afford the cost of a year's treatment and this makes it difficult to start them on the drugs. Those who are able to pay have no problem following up the treatment. Many patients in our hospitals understand what the virus that causes AIDS is, and also understand that AIDS is a deadly disease. They take their drugs as prescribed. We have doctors, few as they are, who are not only willing to follow up the patients but also to train nurse-screeners to administer treatment correctly.

I want to assure Mr. Natsios, that Africans have been taking malaria drugs, antibiotics, etc which all need compliance. Africans are human beings with brains like Americans. Africans merit a fair treatment, equity, equality, and social justice. A second problem is that of testing and monitoring the patients for their viral load and CD4 cell counts. However, when you read the consensus statement on antiretroviral treatment for AIDS in poor countries by 128 individual members of the Faculty of Harvard University of March 2001, there is evidence that treatment in areas without access to CD4 counts or viral load testing, should be based on HIV seropositivity and AIDS-defining clinical signs and symptoms. This powerful group of intellectuals and professional giants do declare, that I quote:- "As signers of this consensus statement, we believe that the objections to HIV treatment in low income countries are not persuasive and that there are compelling arguments in favor of a widespread treatment effort." If there is compliance with the antiretroviral drug regimens in America, why does Mr. Natsios believe that Africans will not comply? Sub-humans? Prevention is highly recommended but this does not imply that effective treatment for AIDS should be denied Africans for whatever reason.


UN Integrated Regional Information Network

[The following items are from the "africa-english" service of the UN's IRIN humanitarian information unit, but may not necessarily reflect the views of the United Nations. For further information,contact e-mail: irin@ocha.unon.org or Web: http://www.reliefweb.int/IRIN . If you re-print, copy, archive or re-post this item, please retain this credit and disclaimer. Reposting by commercial sites requires written IRIN permission.]

UGANDA: Kampala chosen for major AIDS training centre

[IRIN-CEA: Tel: +254 2 622147 Fax: +254 2 622129 e-mail: irin-cea@ocha.unon.org ]

NAIROBI, 12 June (IRIN) - Africa's first major treatment and training centre for HIV/AIDS is scheduled to open in the Ugandan capital, Kampala, early next year, according to a press statement on Monday from the Academic Alliance for AIDS Care and Prevention in Africa.

The state-of-the-art centre would train medical personnel from across the continent on the latest treatment options and bring the highest standard of care to patients, the statement said.

At least 80 clinicians from across Africa would be trained each year, according to Nelson Sewakambo, Dean of Medical Studies at Makerere University, where the centre is to be located. "Our goal is to strengthen medical infrastructure, replicate it across Africa and bring the latest medicines to bear on treating this disease so that African doctors and nurses can offer modern AIDS care to their patients," he added.

Dr Thomas Quinn, an American doctor involved in the Alliance, said Uganda had been chosen for the centre because President Yoweri Museveni's leadership on HIV/AIDS had helped make it the most successful African country in the fight against the disease. The strain of HIV prevalent in Uganda would also respond to the drugs used against the virus in the US, the BBC quoted him as saying.

"This new centre is an important step for Africa as we seek to control the AIDS pandemic and improve the quality of care," said President Museveni. "This new approach will complement the work our own doctors are doing and can have a positive impact across Africa."

An estimated 820,000 people are living with HIV/AIDS in Uganda, and there are some 25 million HIV-infected people on the African continent.

The new clinic, to be located at Makerere University Medical School, will be funded by the Pfizer Foundation pharmaceutical company and operated by the Alliance in partnership with the university, according to Monday's press statement.

"The Academic Alliance is a ground-breaking effort because it is the first large-scale AIDS training and treatment program aimed at improving care for patients who typically have no resources or access to even rudimentary medical help," said Dr Merle A Sande, co-director of the Alliance and Chairman of the Department of Medicine at the University of Utah, USA.

One of the goals of the clinic would be to put more patients under treatment with anti-retroviral drugs (ARVs), which are combined with anti-fungals and other medicines that fight AIDS-related opportunistic infections, according to Associate Dean of the Makerere School, Dr Samuel Luboga. The centre would use diagnostic technology to monitor patients on ARVs and determine what kind of treatments are most appropriate for Africa, he said.

Negotiations were ongoing with companies that manufacture ARVs so that it would have supplies on hand when the clinic opened, according to Monday's press statement.

The Alliance was working closely with the Ugandan medical and public health community and would actively seek assistance from the Ugandan Minister of Health, local organisations, the staff and faculty of Makerere University Medical School and Mulago Hospital, the national hospital of Uganda, the statement added.


AFRICA: IRIN HIV/AIDS Weekly issue 31, 2001, June 15, 2001

IRIN-AIDS Weekly - Tel: +27-11 880 4633
Fax: +27-11 447 5472
Email: AIDS@irin.org.za

BOTSWANA: Diamond giant leads the way

Botswana's giant diamond company Debswana has announced that all companies wishing to do business with it will be required to support the firm's progressive HIV/AIDS policy, the 'Botswana Gazette' reported.

"The companies will be responsible for providing a safe working environment both physically and mentally through empowering their employees with knowledge to avoid risks and protect themselves from contracting HIV/AIDS," explained Debswana's spokesman Jacob Sesinyi. The companies will have to demonstrate that they have a work place policy and programme on HIV and AIDS both at the home base company and on site at the Debswana premises which includes a statement on non discrimination based on HIV status, confidentiality and privacy, the ability to work and criteria for ill-health retirement.

Meanwhile, Botswana is to provide free antiretroviral drugs (ARVs), President Festus Mogae announced on Monday. "We have not yet started the full antiretroviral programme, but we hope it will be running by the end of the year," Mogae told reporters.

The diamond-rich country has already begun handing out free drugs to prevent HIV-positive pregnant mothers passing the virus to their unborn children, AFP reported. "We have been told we have a good chance of prevention in the majority of cases," Mogae said. He added that a campaign would be launched soon for people to adopt Botswana's 60,000 to 80,000 AIDS orphans, with the government paying for the childrens' upbringing, AFP reported.

SOUTH AFRICA: Still no to ARVs

By contrast, South Africa has no plans to provide ARVs, Health Minister Manto Tshabalala-Msimang told parliament on Tuesday. She said her ministry's position remained unchanged, even though pharmaceutical companies dropped a law suit against the government in April, allowing it to import or manufacture cheap versions of the drugs, AFP reported.

"We have no plans to introduce the wholesale administration of these drugs in the public sector," the minister said. "ARVs are not a cure for AIDS.In addition, the department remained concerned about the toxicity of the drugs, the availability of laboratory services, and "infrastructural and educational constraints", particularly in rural areas, she said.

"I would, however, like to assure this house that this position is not ideological," the minister said. "Obviously we will continue to explore all the options available to us." Tshabalala-Msimang also failed on Tuesday to give an expected go-ahead to South Africa's nine provinces to launch programmes using Nevirapine to reduce mother-to-infant HIV transmission. She confirmed that 18 sites had been identified countrywide "within a research framework" intended to answer questions related to drug resistance and toxicity, but did not say when the programmes would start.

AFRICA: IRIN HIV/AIDS Weekly issue 31, 2001, June 15, 2001

KENYA: Legislation promises cheaper drugs for AIDS patients

The Kenyan parliament on Tuesday unanimously passed a bill which looks set to reduce the cost of essential AIDS treatment significantly. The Industrial Property Bill will allow the government to import or manufacture cheaper copies of brand-name drugs, including the antiretrovirals (ARVs) used in the drug cocktail used to fight AIDS, according to campaigners for the affordable availability of drugs.

Indra van Gisbergen, a lawyer for the Kenya Coalition for Access to Essential Medicines, told IRIN on Thursday that at least 50 percent of the antiretrovirals used in Kenya were currently under patent. Only 1,000 to 2,000 AIDS patients were currently receiving ARV treatment locally, but the new legislation should lead to much wider access to AIDS drugs, she said. Although the expected price falls were unlikely on their own to be enough to provide ARVs to the poorest AIDS patients in Kenya, access among the middle classes would be greatly improved, van Gisbergen said. "This is a breakthrough," she added.

However, there has been scepticism among drugs manufacturers this week regarding the real benefits the legislation was likely to bring. Director-General of the International Federation of Pharmaceutical Manufacturers' Associations (IFPMA), Harvey Bale, was on Wednesday quoted by Reuters news agency as saying that the legislation was "a political event that will not make any difference to the health care being received by the Kenyans." Bale, whose organisation represents industry associations in 60 countries, told Reuters that some 80 percent of the drugs currently in use in Kenya to fight AIDS were unpatented, and that the remaining medicines were being sold by the companies locally at the same price as copied versions.

SOUTH AFRICA: Hospitals face AIDS crisis

Hospitals in South Africa's most AIDS-prevalent province, KwaZulu-Natal, are being overwhelmed by a growing number of AIDS patients, the country's leading medical journal said in its latest issue. The South African Medical Journal (SAMJ) reported that urban and rural clinics in the province were stretched to "breaking point", with HIV-positive patients filling 80 percent of beds in some rural clinics. SAMJ visited hospitals where patients were forced to share beds and in some instances compelled to sleep under beds because of shortages. Most AIDS patients were women between the ages of 24 and 35, many of whom had contracted the disease in the last 10 years.

KwaZulu-Natal, one of the country's most populous but poorest regions, has more than one in three pregnant women suffering from the disease. "People are dying prematurely because we are so stretched. Medical patients who don't have HIV/AIDS are being severely compromised because we have to discharge them prematurely ... The system just can't cope," Jim Muller, acting head of three of the province's leading hospitals, told the journal. Drugs were in short supply or non-existent, surgical procedures abandoned because of limited resources, and hospital staff overworked. Based on interviews with healthcare workers, SAMJ reported that doctors have essentially become terminal-care workers.

HIV-positive children in need of a respirator were dying because of pressure on resources. "If the kids are HIV-positive, we don't ventilate and the kids die. That's become general practice," said Kimesh Naidoo, a paediatrician at Grey's Hospital. At the remote Hlabisa District Hospital in northern KwaZulu-Natal, 75 percent to 80 percent of patients are HIV-positive, half of whom had full-blown AIDS. "Nobody seems to be planning for the AIDS epidemic ... It's a catastrophe waiting to happen," Hlabisa's principal medical officer, Sean Drysdale, told the SAMJ.


This material is being reposted for wider distribution by Africa Action (incorporating the Africa Policy Information Center, The Africa Fund, and the American Committee on Africa). Africa Action's information services provide accessible 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 human rights.

URL for this file: http://www.africafocus.org/docs01/acc0106.php