a Metropolitan AIDS Research Communiqué - aidsinfo@metropolitan.co.za
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The views and opinions expressed in this publication do not necessarily reflect those of Metropolitan. As always, we encourage responses on any of the issues covered.
The news that President Mbeki has had a complete turnaround on the issue of providing Nevirapine to HIV positive pregnant mothers, has been received with a healthy level of optimism and applauded from all quarters of the AIDS field. Naturally, the questioning minds amongst us tend to verge towards scepticism. Could this development be the result of a new PR strategy? Are so many of our countrymen and women - many in the highest ranks of government, business and civil society - dying of ‘poverty’-related diseases such as TB and pneumonia that a new tack needed urgently (and slightly desperately) to be pursued? Whatever the reason, this turnaround has come not one moment too soon, as many babies daily in South Africa die painfully - and unnecessarily - as a result of AIDS. Moving a little farther afield and to a country that has certainly received much media attention in the past few months, Pakistan comes under the spotlight as we examine the measures being taken there to combat HIV/AIDS.
Are these measures adequate? You be the judge.
And finally, ‘In the Eye of the Storm’ features yet another success story, this time from Botswana, a country with high HIV and AIDS prevalence, but where political will has been the key to taking AIDS to task. Well done President Mogae!
Gillian Núr Samuels
Email: nsamuels@metropolitan.co.za
Tel: 021 - 940 6717
From Pulse Track www.pulsetrack.co.za
Botswana President
Festus Mogae has publicly given the lead to his nation in the fight against
HIV/AIDS,with an undertaking toprovide anti-retrovirals throughout its medical
system to everyone who needs them.
Mogae, who made his statement on 9 April 2002, becomes one of the leading African countries in attempts to combat the epidemic. "We are the most hideously affected country in the world and we had to do something about it," he told a news conference, "The pandemic is not abating."
As elsewhere in Africa, resources are limited: "We are short of doctors. We are short of nurses. We are short of pharmacists. We are short of health technicians," said Mogae.
The programme was put into place in the capital Gaberone recently, but is expected to reach an estimated 19 000 people by the end of the year, the Botswana Health Minister Joy Phumaphi said. "We do not believe it is fair to offer people prevention strategies without offering them treatment and care."
The HIV epidemic was affecting Botswana's work force in "frightening numbers" said the Minister. "The economy stands more to suffer from not having the programme than from having it."
In the eye of the storm is a segment of AIDSToday dedicated to the success stories that come to light as individuals, communities and companies continue to grapple with the challenge AIDS presents. If you would like your success story or that of another individual or organisation to be published, contact the editor via email aidsinfo@metropolitan.co.za.
Kerry Cullin
Cabinet's
surprise decision earlier this month to make anti-retroviral drugs available to
rape survivors contradicts the ANC's National Executive Committee's position
taken in March. However, it represents a victory for a number of key government
officials who have been working for months behind the scenes to improve
government's HIV/AIDS stance. These include Health Director General Dr Ayanda
Ntsaluba, head of the HIV/AIDS Directorate, Dr Nono Simelela, Joel Netshitenzhe,
head of Government Communication and Information System and Inkatha's Dr Ben
Ngubane, Minister of Arts, Culture, Science and Technology. Last month, the ANC
NEC announced that anti-retroviral drugs to prevent HIV transmission following
sexual assault or needle-stick injury "could not be provided in public
health institutions" as their efficacy was "unproven". After the
NEC decision, health officials believed their recommendation for drugs for rape
survivors would never get past Cabinet and they reported biting their nails in
anxiety while waiting for the outcome of the Cabinet meeting.
However, after Cabinet's announcement Dr Simelela said she was "very, very happy" and looked forward to the speedy implementation of the new plans.
Government has allocated a massive R1 billion to tackling HIV/AIDS for 2002/03, an increase of over R600-million in one year.
Why the turnabout? Official sources say that government has been trying to make a new start on HIV/AIDS all year.
Dissatisfaction with the government's handling of HIV/AIDS was voiced at January's Cabinet lekgotla, and Ministers Manto Tshabalala Msimang, Essop Pahad and Dr Ngubane were charged with preparing a document that could improve on this.
President Mbeki indicated in his address to Parliament in February that government was committed to "intensifying its comprehensive programme against AIDS" and had "initiated discussions with some of [the pharmaceutical companies] to examine new ways of making drugs more affordable and to strengthen our health infrastructure".
Meanwhile, Dr
Simelela's directorate and Dr Nsaluba were drawn into preparing the new document
for the three ministers. This went through a number of Cabinet committees before
finally reaching Cabinet on Wednesday. In the meantime, however, confusion with
the Nevirapine roll-out which was incredibly badly handled by Dr Tshabalala
Msimang and the subsequent court case instituted by the Treatment Action
Campaign had made government look even worse. The HIV/AIDS proposals gave
Cabinet the golden opportunity to send a message of hope to the nation
particularly on the eve of the Moral Regeneration conference, called in response
to baby rapes in the country. Strangely, some ANC NEC members had access to this
document before their meeting last month yet still resolved that drugs for rape
survivors should not be available in public health. Aside from anti-retroviral
drugs for rape survivors, other important Cabinet recommendations are:
Source: Health-e News Service
KARACHI, 10 April (PLUSNEWS)
The
HIV/AIDS epidemic threatening so many countries has not yet hit Pakistan, but
the risk of transmission remains high, experts say. Doctors and officials told
IRIN that male and female sex workers, truck drivers, unscreened blood
transfusions and needle sharing were the biggest dangers. "Right now the
prevalence of HIV is low, but there are a lot of risk factors which can
contribute to a high prevalence rate," Syed Sharaf Ali Shah, director of
the government's AIDS control programme in the southern province of Sindh, told
IRIN. "It is an opportunity for us to act and prevent it now."
The official estimate of HIV/AIDS cases in Pakistan, which has a population of about 145 million, is about 2,000. However, Shah said the World Health Organisation (WHO) believed it to be as high as between 80,000 and 100,000 across the country.
He said neighbouring countries - including India and Nepal - had missed the opportunity to halt the HIV/AIDS epidemic. "Even if they make efforts now, they cannot prevent it, but in Pakistan, we still have time, so this opportunity should be utilised," Shah emphasised.
Shah's programme is at the forefront of the government's efforts to prevent an epidemic of the deadly disease, but most doctors and nongovernmental organisations (NGOs) working in the sector believe that its spread is inevitable.
"AIDS is very much under-reported. If they say prevalence is limited, it does not mean that we should relax about it. In our country the prerequisites are there for an explosion," Saleem Azam, a medical doctor and the president of the Pakistan Society - an NGO working with drug addicts and AIDS - told IRIN. Shah said very little blood was screened before transfusion across Pakistan. In Sindh alone there was a need for up to 35,000 units of blood each month, and only 20 percent of it was being screened. "Seventy percent of the total blood is used in seven to eight major hospitals, which means if you fix these centres, 80 percent of your blood will be screened," he said.
Shah said screening was important to ensure that blood was free of hepatitis B and C, both sexually transmitted infections (STDs), and HIV/AIDS.
Another potential catalyst to the spread of HIV was the large number of drug users sharing needles, Azam said. "Injecting drug users were first discovered in Karachi. Seventy percent of them share needles, so the HIV threat is much bigger here than in other areas of the country."
Most of Karachi's population of about 14 million people live in extremely squalid conditions. Although no official estimates exist on the number of drug users in the sprawling metropolis, Azam said there were several thousand people sharing needles. According to the United Nations Drug Control Programme (UNDCP), almost half a million people in Pakistan are drug addicts.
"Different studies have found different rates of HIV prevalence in drug users. In one study of 100 people, only one case was reported. In another study, only two cases were discovered, but in our own centre we did not find a single case," Shah said.
Shah is also running a pilot
project on HIV/AIDS prevention in the poor Essa Nagri district of Karachi with
the help of the Joint United Nations Programme on HIV/AIDS and the UNDCP.
"This is Sindh's first drop-in centre for street addicts. We raise awareness and work here to prevent blood-related infections like HIV/AIDS," he said. They also carry out a needle exchange programme.
Another major source of concern for doctors and officials trying to fight HIV/AIDS are commercial sex workers and truck drivers. Both groups are considered to be particularly high-risk in that they could spread the virus widely and quickly. Richard Harrison, a coordinator for Greenstar Social Marketing, told IRIN that although there were no reported cases of HIV/AIDS among the two groups so far, there were several cases of other STDs. "We are concerned because they have a very serious risk of spreading such diseases. In other words, it is a very dry wood out there, and a match could light a very big fire," he said. Greenstar Social Marketing is a non-profit organisation which provides poor Pakistanis with cheaper medical care. Male and female sex workers operate illegally in Pakistan, where is it banned, so they are not compelled to take regular heath examinations.
"I go home every six months, but last year I went just once," said Tariq Khan, a truck driver in the Moripur Truck Station of Karachi, one of the biggest truck stops in Asia. He told IRIN that he had had sex with a commercial sex worker once, but that he was careful and used a condom. Shah said a high incidence of syphilis - an ulcerating STD, which showed that AIDS could easily spread in the group - was found in truck drivers and prostitutes.
"We found 12 percent syphilis, which is very high, and it is a marker for the HIV infection," Shah said. "Looking at the behaviour, more than 70 percent of the truckers admitted having commercial sex," he added. He noted that only five percent said they used condoms. "Ninety percent did not use condoms at all, and even the five percent said they do not always use condoms."
Source: IRIN, IRIN-Asia, Tel: +92-51-2211451, Fax: +92-51-2292918
Email: IrinAsia@irin.org.pk
A posting from SEA-AIDS sea-aids@healthdev.net.
For a complimentary copy contact Gillian Núr Samuels on 021 - 940 6717.
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