- The Washington Times - Wednesday, October 15, 2003

JOHANNESBURG — With tens of thousands of South Africans dying from AIDS, Denis Matwa saw a rare glimmer of hope when his government abandoned its insistence that medicines for the disease are poison and declared them effective in treatment.

For the 31-year-old Mr. Matwa and millions of other South Africans infected with HIV, it was a sign that the government would provide the powerful medicines that have changed AIDS from a death sentence to a chronic disease in wealthier countries.

But nearly 18 months and an estimated 300,000 AIDS deaths later, the drugs still aren’t available, and many see this as yet another example of the government’s spotty history on dealing with the illness.

“I thought maybe the government had finally come to its senses. That it was actually willing to save more lives,” said Mr. Matwa, who lives in the Cape Town township of Guguletu.

The manufacturers of the drugs had offered to negotiate discounts of up to 90 percent. Boehringer Ingelheim of Germany was offering the drug nevirapine free to help prevent transmission of the human immunodeficiency virus — which causes AIDS — from infected women to their babies during labor.

Except in one case, none of the offers got any government response beyond recent requests for price lists, according to spokesmen for the five main pharmaceutical companies that produce the drugs.

Health Minister Manto Tshabalala-Msimang previously had said that South Africa lacked the health care infrastructure to deliver and monitor an AIDS-drug program. But little was done to improve the situation.

She then began touting the health benefits of olive oil and the African potato, implying that they were effective alternatives to the medicine.

“History will regard this as inexplicable,” said Mark Heywood of the Treatment Action Campaign, an advocacy group.

On Aug. 8, the Cabinet raised hopes again, ordering the Health Department to urgently prepare a plan for the introduction of AIDS medicines into the public health system.

Although wary by now, the public has greeted it as an important step.

“As much as we are happy and elated about the announcement, we are a bit cautious,” said Swazi Hlubi, coordinator of the activist group AIDS Therapeutic Treatment Now/South Africa. “We must hold them accountable to their word and make sure they really deliver this time.”

The urgency is obvious: The AIDS pandemic threatens the fabric of South African society.

About 4.7 million people, roughly 11 percent of the population, are infected with HIV. An estimated 600 to 1,000 South Africans die every day from AIDS-related complications.

So many untimely deaths will badly damage the country’s business and education systems, leave a trail of orphans, and bring down the economy in a few generations, according to a World Bank study released in July.

Well before that report, a broad coalition of South Africans had sought to force the government to change its policy and provide AIDS treatment.

Religious and businesses leaders had appealed for action on humanitarian and economic grounds. Organized labor, traditionally a government ally, had demanded protection for workers. Even officials in President Thabo Mbeki’s African National Congress had begun growing angry.

Also, doctors had become increasingly frustrated at having to watch their patients die.

“We’d like to stop fighting among ourselves and direct our energy toward fighting the virus,” said Dr. Kgosi Letlape, chairman of the South African Medical Association.

Dr. Tony Moll had watched with admiration three years ago as the government rapidly mobilized its medical forces to quash a burgeoning cholera epidemic in the KwaZulu-Natal province.

“Then one sees this incredible lethargy to move against this HIV epidemic, which has a much greater death toll,” said Dr. Moll, a doctor at the Church of Scotland Hospital in the province, which is overwhelmed by the disease.

Government spokesman Joel Netshitenzhe denied that South Africa had been lax, saying it had one of the most-praised prevention programs in the world and has been working hard to treat diseases such as tuberculosis, malaria and cholera that prey on those infected with HIV.

He also pointed to major increases in the budget to fight AIDS and said that up to 95 percent of what needed doing was being done. “In that regard, we were doing very well as a country.”

South Africa’s AIDS policies have been criticized from the time Nelson Mandela was president. His government spent millions on a contentious AIDS-awareness play and tried to pressure the Medicines Control Council to approve a locally developed AIDS drug, Virodene, made from a toxic industrial solvent.

The criticism magnified when Mr. Mbeki became president in 1999 and began questioning the causes of AIDS and the effectiveness and safety of the drugs.

Critics accuse Mr. Mbeki of frittering away time, energy and resources debating a long-settled issue while the crisis raged.

“The confusion has allowed the worsening of the HIV epidemic. Prevention programs have been stymied and undermined, and the confusion has led to massive confusion and delays in preparing for treatment,” Mr. Heywood said.

Many complained that Mr. Mbeki’s stance on AIDS have damaged prevention efforts across Africa. Health workers who had fought for years to persuade reluctant people to practice so-called “safe sex” said their work was destroyed with just a few comments of skepticism from Mr. Mbeki.

The government didn’t begin a large-scale program to provide nevirapine, which could halve the number of babies born infected, until it lost a court case last year.

Then, suddenly, there was hope.

Under intense domestic and international pressure, the Cabinet stunned many on April 17 last year with a major policy reversal. It recognized the effectiveness of AIDS drugs and pledged to use them to protect fetuses and help prevent rape victims from becoming infected.

Elsie Bogatswe was elated.

The 42-year-old has suffered tuberculosis, heart pain and back pain during her 15-year fight with HIV. Now she was certain her wait was over. “I was thinking they will bring the tablets to us,” she said.

The Cabinet had said one obstacle to providing the medicine to AIDS sufferers was the exorbitant price of the drugs, and Trade Minister Alec Erwin said in August that the government had been negotiating prices with the drug companies since that statement.

“We’ve been talking with them,” he said.

But when contacted by the Associated Press, four of the five main companies that produce the AIDS drugs said they have had little contact with the government in the nearly 18 months since the Cabinet statement.

“They did not ask for anything,” said Pat Senne, a spokesman for Roche.

The fifth, GlaxoSmithKline, sold limited quantities of drugs to the government for specialized use.

Other talks also stalled.

Last October, the government began negotiating a revolutionary agreement with business, labor and civic groups to wage a coordinated war on AIDS. It would have required the government and companies to work together to provide AIDS medicine, and unions to offer counseling and care for orphans and widows.

All sides appeared in accord in February, but the government suddenly froze the talks, saying it needed time to consider the document.

“A lot of time is being wasted where we could be doing a lot more,” said Vic van Vuuren, who negotiated on behalf of the business sector.

Also in February, the government presented a new budget, promising an extra $450 million over three years to fight AIDS, which many saw as a preparation for rolling out a treatment program.

But nothing happened.

That month, Miss Bogatswe got so sick that her weight dropped from 155 pounds to 99 pounds, though she has since regained some.

“Every day we die, and the government is thinking about this for three years or four years,” she said. “We want something now, action now. We don’t just want talking, talking, because people are dying.”

The Aug. 8 Cabinet meeting renewed hopes that the government will soon distribute AIDS medicine. But Miss Msimang dashed those hopes a day after the meeting. The medicine will not be available in the near future, she said, and the government has made no final decision on the issue.

“We’ve asked [health officials] to go back and actually work out an implementation plan, which will indicate to us exactly what are the cost implications,” she said.

Still, Mr. Heywood sees “a fundamental shift,” pointing to a report that the Cabinet released at the meeting estimating how many lives the drugs could save by 2010.

“You can’t make public a document that says you can save up to a million lives and not do anything about it,” he said.

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