Saturday, October 28, 2006

South African Government Announces Shift in ARV Drug's Policy

SA government ends Aids denial

Johannesburg, South Africa
28 October 2006 08:04

The South African government on Friday announced a dramatic reversal of its approach to the country's HIV/Aids crisis, promising increased availability of drugs and endorsing the efforts of civic groups battling the disease.

"We must take our fight against Aids to a much higher level," Deputy President Phumzile Mlambo-Ngcuka told a conference of Aids activists, who until recently had been ignored and even denounced by the government.

"We must tighten up so that ARV [antiretroviral] drugs are more accessible, especially to the poor. Education and prevention of HIV infection must be scaled up. Our people want us to unite on this issue in the best interests of the health and wellbeing of our nation. Working together we can defeat this disease," she said to cheers from a crowd of health professionals, church leaders and labour officials.

Experts said the government's policy change could save thousands of lives. An estimated 5,4-million of South Africa's 47-million people are infected with HIV, one of the highest ratios in the world. "This is a sea change," said Mark Heywood, director of the Aids Law Project. "We're not across the ocean yet, but now the government is sailing in the right direction."

Activists fought a prolonged legal battle that forced President Thabo Mbeki's government to distribute the life-saving ARV drugs through the public health services. "The government is finally acknowledging that Aids is a serious national problem and is taking a scientific approach to tackling it. It's long overdue, but it is worth celebrating," said a senior doctor working in a government hospital.

Mbeki had questioned that Aids was caused by HIV and said it was not certain that ARV drugs were safe and effective. He denied knowing anyone who had died of Aids, despite several prominent South Africans succumbing.

After a 2003 court ruling, the government reluctantly rolled out a public programme to make ARV drugs available to people with Aids. About 200 000 people receive the government drugs, making the public programme one of the biggest in the world. But they are reaching just one quarter of the estimated 800 000 in need.

Confusion over what is effective Aids treatment was spread by Health Minister Manto Tshabalala-Msimang, who adamantly promoted a diet of beetroot, lemons and garlic as an alternative treatment. At the Toronto Aids conference in August, she sparked an uproar with a South African government display of the fruits and vegetables but no ARV drugs.

The South African government's position on Aids was denounced as "wrong, immoral and indefensible" by the United Nations's top official on Aids, Stephen Lewis.

Mbeki has been silent on Aids issues recently and has not sacked Tshabalala-Msimang as demanded by international and domestic Aids campaigners. But significantly, the president marginalised the health minister by making his deputy president the head of an Aids taskforce and it appears he authorised her to change government policies.

In recent weeks the soft-spoken but savvy Mlambo-Ngcuka had signalled the change by privately meeting Aids specialists whom the government had previously refused to consult. She has accepted that Aids is caused by HIV and emphasised that ARV drugs are central to fighting the disease.

A month ago, Aids activist Zackie Achmat and 40 members of the Treatment Action Campaign (TAC) were arrested for demonstrating in government offices for the sacking of Tshabalala-Msimang.

On Friday Achmat, in his trademark "HIV-positive" T-shirt, walked arm in arm with the deputy president and was kissed and hugged by other top officials.

"This is a serious, significant change. The government wants to work with us, not against us," he said. "By increasing the availability of drugs, particularly for preventing mother to child transmission, the government is going to save lives."

'Tremendous efforts'

In her speech, Deputy Minister of Health Nozizwe Madlala-Routledge was frank about the government's progress on fighting the disease. She said while "tremendous efforts" are being made and resources invested to fight HIV/Aids, there are still unacceptably high levels of new infections and deaths.

While a lot of money has gone into condom distribution, the impact this is making is not known. The implementation of programmes to prevent mother-to-child transmission has been "most uneven". Some provinces showed positive trends while others had performed dismally, she said.

A high teenage pregnancy rate also reveals the "huge challenge" of changing the behaviour of young people.

The strain resulting from a growing burden of disease and staff shortages will require honesty in speaking about problems. These include a shortage of doctors, nurses and pharmacists, infrastructure problems and collaboration with other departments -- particularly correctional services. The Traditional Healers' Council has also not been established and marketing the "comprehensive plan" is inadequate.

A recent study by the Health Systems Trust also showed a very low level of HIV treatment literacy among South Africans.

In a briefing after her speech she told journalists that her ministry has had an "up and down" relationship with the TAC. "We cannot afford to antagonise anybody and are taking steps to improve relationships with civil society."

She said the government is "very clear" that nutrition could not replace medicines, but is interested in learning how alternative remedies could help fight opportunistic infections. "We have started the process of putting these so-called remedies under scientific scrutiny."

Cosatu's general secretary, Zwelinzima Vavi, said Madlala-Routledge's speech was "brilliant". Although the country is now "marching behind a single message", he said the days of toyi-toying are not over.

He said the union federation will no longer hold marches complaining about "potatoes and other matters", but will instead focus its public actions on greater access to Aids treatment and cheaper medicines.

Mbeki's U-turn

Several factors convinced Mbeki to change his policies. Official statistics show an alarming rise in deaths among South Africans in their 20s, 30s and 40s.

Supporters of the ruling African National Congress such as trade unions have criticised his policies and the resulting shortages of antiretroviral drugs. Civic groups were joined by 81 leading scientists in demanding the sacking of the health minister who suggested eating beetroot as a cure. And South Africa has fallen behind its neighbours in cutting the infection rate.

Guardian Unlimited

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