UNAIDS – Alex B. Hill

why there is no doctor: denial is the first step (7)

(photo: downtown Zonkizizwe, South Africa)

Since the early 1990s, Mbeki had turned his back on scientific evidence linking HIV as the cause of AIDS. Mbeki’s stance on the cause of AIDS is the largest contributing factor in the South African government’s failure to scale-up treatment. In 2000, Mbeki called together a group of scientists including a group of ‘dissident scientists’ to discuss the cause of AIDS (55). Later that year at the International AIDS Conference in Durban, he spoke publicly rejecting the accepted science that HIV causes AIDS and instead focused on the need to alleviate poverty in Africa as a way to combat AIDS (56). He said the cause was poverty, bad nourishment, and general ill health while also noting that more Western medicine was not what Africa needed (57).

Since his public statements, Mbeki and the South African government have been hit by a backlash of criticism from the international community and Mbeki has remained silent on the topic. The year 2000 was the same year that the Department of Health launched a five-year plan to combat HIV/AIDS. However, Mbeki’s statement and the lack of strong governmental support led to much “foot-dragging” (58). Mbeki had turned down grants, funding, and free medicines to scale-up the treatment program as a result of his denial. Now a recent Harvard study has placed impact numbers with Mbeki’s denial claims. The authors of the study estimate that more than 330,000 people died unnecessarily in South Africa and that 35,000 babies could have been protected from HIV-infection as a direct result of Mbeki’s HIV/AIDS policy and denial (59).

In 2002, with international pressure growing, the South African High Court ordered that nevirapine, which combats the spread of HIV from mother-to-child, be made available (60). Sadly despite offers of free and cheap antiretrovirals (ARVs), the South African government was hesitant to offer the medicines and only distributed in two test sites. In 2003, the government approved a plan to make antiretrovirals publicly available and by 2005 there was at least one service location for AIDS-related illness in each of the 53 districts (61). However the program did not reach enough people and the HIV prevalence rate among pregnant women was recorded at 30.2%, a steady increase since 1990 (62). The treatment program was beyond inadequate.

The case for HIV/AIDS treatment and prevention suffered another blow at the hands of South African government leadership in 2006. Former Deputy President Jacob Zuma went on trial for the rape of an HIV positive woman and claimed that having taken a shower afterwards protected him from HIV transmission (63). This only heightened international outrage and pressure on South Africa’s HIV treatment programs. At the 2006 International AIDS Conference in Toronto, UN Special Envoy on HIV/AIDS Stephen Lewis, called the South African government “obtuse and negligent” (64). By the end of the year the government had announced that it was drafting a framework to tackle AIDS and pledged to increase public access to antiretrovirals (65).

Mbeki was ousted from his ANC leadership position in September of 2008 and the interim president appointed Barbara Hogan as the Health Minister. Many saw this as a major turning point in South Africa’s HIV/AIDS policy, especially as the government is working to get antiretrovirals to as many people as possible. Unfortunately, Zuma is set to win the upcoming presidential election and has not made any apology for his false statement on HIV prevention.

Notes:
55. “HIV & AIDS in South Africa: The history of AIDS in South Africa.” Avert.
http://www.avert.org/aidssouthafrica.htm
56. Boseley, Sarah. “Mbeki Aids denial ‘caused 300,000 deaths.” Guardian News UK. 26 November 2008.
http://www.guardian.co.uk/world/2008/nov/26/aids-south-africa
57. Ibid.
58. Ibid.
59. “HIV & AIDS in South Africa: The history of AIDS in South Africa.” Avert.
http://www.avert.org/aidssouthafrica.htm
60. Ibid.
61. Ibid.
62. Ibid.
63. Ibid.
64. Ibid.
65. Ibid.

Coming next: What happened to Reconstruction and Development?

Access all entries in this series: Index

why there is no doctor: introduction to an epidemic (1)

Health, Research

Subtitle: The Impact of HIV/AIDS in the Post-Apartheid Health Care System of South Africa

Introduction to an Epidemic

Everyone in the car remained silent as we passed a sea of gravestones on the way to Zonkizizwe, an informal settlement south of Johannesburg (1). The cemetery seemed to extend for miles. This was the reality of HIV/AIDS in the peri-urban, informal settlements. It is a reality that is not far departed from scenes in rural homelands as well as the urban townships of South Africa. I was not new to the HIV/AIDS epidemic, but I was new to the experiences of those living in an informal settlement under apartheid, struggling with the crippling impact of HIV in an area where I never even saw a doctor. Why were there no doctors?

It is estimated that one in five South Africans aged 15-49 are infected with HIV. Since the last UNAIDS report in 2008, 5.7 million people are living with HIV in South Africa and 1000 people die everyday from HIV/AIDS related causes (2). The cause of death for 71% of people aged 15-49 is now AIDS (3). Some people have even noted that South Africans spend more time at funerals than they do at weddings. There are an estimated 1,400,000 orphans as a result of HIV/AIDS (4). The numbers of those infected does not reflect the real impact of disease because the impact of HIV/AIDS extends further into families, friends, and communities.

Life expectancy has fallen considerably in South Africa as the prevalence of HIV/AIDS spread rapidly from 1990-2003 (5). This time period is marked by violent, but positive changes in government rule and policy. The first case of AIDS in South Africa was diagnosed in 1982 among the gay population, so why was the most rapid spread during this time period (6)? Many experts and professionals posit that this rapid spread of HIV and the lack of a response to the epidemic in South Africa is due to the political turmoil of the 1980s into the 1990s. However, this represents a failure to look deeper into the history of South Africa and its health care systems.

While violent conflict had a direct effect on the response to HIV/AIDS in South Africa, a number of other factors with greater impacts based in apartheid policy led to the rapid spread and limited possibility for a comprehensive government response even if there were an absence of violence. South Africa has a difficult history of formulating a response to HIV/AIDS: from apartheid health policy to AIDS denial, from a failed treatment program to the absence of doctors and adequate health infrastructures.

In the March 2009 elections, health was a driving factor for many voters and appeared on many political party platforms. The African National Congress (ANC) ran with promises to cut HIV infections by 50%, launch a National Health Insurance program, and ensure decent wages for health workers (7). With such a far-reaching crisis at hand, politicians must formulate a better, more comprehensive plan to address the effects of apartheid history combined with the current strains on the health care system if they are to effectively combat HIV/AIDS. Why has the response to HIV/AIDS been so poor? Why was HIV able to spread so quickly in South Africa? Why is there no comprehensive treatment program? Why are there no doctors?

Notes:
1. Personal account of Alex B. Hill who interned at Vumundzuku-bya Vana ‘Our Children’s Future’ in Zonkizizwe (Proper), South Africa from May-August 2008.
2. UNAIDS 2008 Report on the Global AIDS Epidemic http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/
3. Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa (2006, November), ‘The Demographic Impact of HIV/AIDS in South Africa – National and Provincial Indicators for 2006’
4. HIV & AIDS in South Africa: The history of AIDS in South Africa
http://www.avert.org/aidssouthafrica.htm
5. UNAIDS 2006 Report on the Global AIDS Epidemic, Chapter 4: The impact of AIDS on people and societies
http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2006/default.asp
6. HIV & AIDS in South Africa: The history of AIDS in South Africa
http://www.avert.org/aidssouthafrica.htm
7. Cullinana, Kerry. “Healthy election promises.” 31 March 2009
http://allafrica.com/stories/200903310649.html

Coming next: The Health System via Apartheid

music to your ears: this year with hiv/aids

Health

This year, 2007, there is some good news about the HIV/AIDS pandemic. The percentage of people living with AIDS has leveled off and the number of new cases has fallen. This is attributed to the prevention programs. However, risk remains high in sub-Saharan Africa. Eight sub-Saharan African countries represent one-third of all new cases and total deaths around the globe. This year there are still 33.2 million people living with AIDS, 2.5 million newly infected, and 2.1 million deaths. (Read the 2007 AIDS epidemic update) As with all good reports, “much good has been done, but more is needed.” Events are happening all across the continent with dedication and promises. The theme of this year’s World AIDS Day is leadership and “Stop AIDS, Keep the Promise!” While there is a lot of talk (read the statements) already this year about what will be done about the HIV/AIDS epidemic.

It is not very often that the news of HIV/AIDS is music to the ears, but this may be one case. In Uganda, where HIV/AIDS was first discovered in the continent in 1981, there is a rising musical movement to increase education and promote prevention. Beginning to make her mark as a rising vocalist in the Ugandan pop music scene, Sylvia Nakibuule chose to go on television to declare her status as HIV positive. Sylvia gained became well known through her work with The AIDS Support Organization (TASO), which regularly puts on performances to educate people about the dangers of HIV/AIDS and how to prevent spreading the disease. Sylvia tells the youth, “I never wanted this to happen to me, so I don’t want it to happen to you. The message I want to give the youth is let us do our best to have a virus-free young generation. Be careful in the way you handle yourself.”

In Malawi, the BBC has been following the village of Njoho and their responses to the AIDS epidemic. Six months earlier one of the village elders had little hope for the people in the village to change their behavior to combat the effects. Now there is only hope. The stigma has left the village; Orphaned children are given help, there are monthly talks and support groups for people dealing with the burden of disease, and there are training programs on education and prevention. The village is fighting back. However, the recent efforts have been hindered by a lack of adequate medical facilities. The local hospital is not equipped to give HIV testing or to distribute anti-retrovirals. Patients with AIDS-related disease are instead sent to a district hospital 10 km away and most villagers cannot afford the bus fare. Yet again the lack of basic healthcare infrastructure adds another complication to an issue already too complex. But there is always hope. Njoho will be starting a clinic next year for voluntary counseling and testing, mother to child transmission prevention, and will provide bus fare for those who need anti-retrovirals.

brand of global health: gates

Health

The new major player on the global health scene is the Bill & Melinda Gates Foundation, but is it possible for two people to become a brand of global health? Is the Gates Foundation really providing aid and investment in the best possible way with their power and influence as a global health ‘brand?’

The Gates Foundation has already become one of the top players in global public health. And with last year’s gift from Warren Buffet, the Foundation is set to double its giving this year. Last year the Gates’ invested $1.36 billion in many different areas of public health, from providing childhood immunizations to agricultural research in developing countries. One of the major priorities is HIV/AIDS prevention and treatment, with over $350 million given in grants.

In June of 2006, on NPR’s All Things Considered, Thomas Quinn, director of the Johns Hopkins Center for Global Health, and Gerald Keusch, Associate Dean for Global Health at Boston University’s School of Public Health, answer questions about the practices and abilities of the Gates Foundation. They answer questions such as the Foundation’s role with the WHO and UNAIDS, its ability to make a difference, fears of responsibility and being a private foundation, and what the Foundation can do with its billions. I highly suggest checking out the link.

The two simple core values of the foundation’s work are one, that all lives—no matter where they are being led—have equal value, and two, to whom much is given, much is expected. Great values, with which great hope rests upon. Some people do not have as much hope in the Foundation as much of their practices and investment policies are out of date. I will not attempt to try and voice all of the concerns (check out the entry from‘My social life’ on 16 January 2007 Open Letter to the Gates Foundation). Has the Foundation inherited too many of the corporate practices from Mr. Gates to run effectively? Is the Foundation too big to be accountable to the people?