AFRO-NETS> Kaiser Daily HIV/AIDS Report - Sat, 22 Sep 2001

[Cecilia Snyder <csnyder@ccmc.org>]

Kaiser Daily HIV/AIDS Report - Sat, 22 Sep 2001
-----------------------------------------------

* South African Health Ministry Report 'Challenges' Government's AIDS
  Policy
* Industrialized Nations 'Fail' to Show Leadership in AIDS Fight,
  UNICEF's 'State of the World's Children 2002' Report Says
* Verdict Expected Saturday in Case of Bulgarian Medics Accused of
  Intentionally Spreading HIV in Libya

--
South African Health Ministry Report 'Challenges' Government's AIDS 
Policy

A confidential document issued by the South African Ministry of 
Health "directly challenges many of" South African President Thabo 
Mbeki's HIV/AIDS policies, stating that they are "increasingly po-
litically dangerous" and encourage the country's health system to 
provide "inadequate" care for people with HIV, the London Guardian 
reports. The report, which was obtained by the Guardian, was drafted 
in July, before Mbeki wrote a "controversial" letter to South African 
Health Minister Dr. Manto Tshabalala-Msimang instructing her to "con-
sider a cut" in the country's HIV/AIDS budget. The report states that 
it is government policy to "'not provide any meaningful care' for 
large numbers of South Africans" with HIV/AIDS. The health ministry 
states that it has prevented public hospitals from "disintegrating 
under the demand for HIV treatment" through a policy of "providing 
'inadequate quality of care' for some, and 'not providing any mean-
ingful care for a proportion of those with HIV/AIDS, especially in 
areas with generally poor access to health care.'" However, the re-
port states that these policies are "'increasingly unstable' from a 
political, moral and legal perspective" as HIV infection rates rise, 
especially among the poor. "Failing to provide care for population 
sub-groups (primarily the rural poor with poor access to health care) 
will become increasingly politically dangerous as the absolute number 
of people sick with AIDS rises among poor and vulnerable groups," the 
ministry writes. Mbeki has "consistently rejected" offering antiret-
roviral drugs in public hospitals, stating that the medicines are 
toxic. However, the report refutes his statements and calls for the 
creation of trial distribution programs of antiretrovirals.

Refuting Mbeki's Other Claims

In the report, the ministry also challenges a number of Mbeki's other 
positions on HIV/AIDS, including his questioning of the causal link 
between HIV and AIDS and his declaration that AIDS-related causes are 
responsible for only a "tiny proportion" of annual deaths in South 
Africa. The report "concede[s]" that HIV causes AIDS, that antiretro-
viral drugs "extend lives" and that 3.5 to 4.5 million South Africans 
will have died of AIDS-related causes by 2010, a figure much higher 
than Mbeki's claim, based on 1995 WHO data, that AIDS-related causes 
lead to approximately 5,000 deaths each year in the country. The 
health ministry document "confirms" what the WHO has said: that AIDS 
is "the single largest killer" in South Africa. Health ministry offi-
cials urge the government to allocate "much greater funding" toward 
AIDS treatment and broaden access to antiretroviral drugs. The au-
thors of the report include health ministry officials "known to be 
unhappy" with the South African government's AIDS policies, but it is 
unclear whether the report has the backing of Tshabalala-Msimang 
(McGreal, London Guardian, 9/21).

Groups Call for Swift Release of MRC Report

A number of religious, labor and AIDS groups gathered in South Africa 
this week to "challeng[e]" the South African government to "overcome 
the denial syndrome" of HIV/AIDS and release a Medical Research Coun-
cil report that supposedly points to AIDS as the country's leading 
cause of death, Reuters reports. The Anglican and Catholic churches, 
the Congress of South African Trade Unions and the AIDS group Treat-
ment Action Campaign met on Monday to draft a statement asking the 
government to "acknowledge the scale of the HIV/AIDS epidemic" in 
South Africa. The coalition said that it has created a program to 
help government officials and others overcome their "denial" of 
HIV/AIDS. However, the delegates declined to say whether Mbeki num-
bered among those "in denial." COSATU delegate Derrick Cele said, "We 
don't want to separate the president from the government. We are mak-
ing a call on the government, led by the president." The group has 
also called for the "immediate release" of the MRC report, which, ac-
cording to media reports, states that AIDS-related causes accounted 
for 40% of deaths of South Africans ages 15 to 49 in 2000 and names 
AIDS "the country's biggest killer" (Boyle, Reuters, 9/20). The MRC 
report compiles the official South African mortality figures for 1997 
through 2000 and is scheduled to be released by the end of the year 
(Kaiser Daily HIV/AIDS Report, 9/20). Catholic Bishop Reginald Caw-
cutt said, "[The government] cannot withhold that report. It is our 
report. It was paid for with taxpayer's funds and it belongs to the 
people." TAC Chair Zackie Achmat said that his group has written to 
Tshabalala-Msimang, giving her one week to publish the report. After 
that, he said, TAC will take the issue to court (Reuters, 9/20).


--
Industrialized Nations 'Fail' to Show Leadership in AIDS Fight, UNI-
CEF's 'State of the World's Children 2002' Report Says

HIV/AIDS is one of the "cruellest political and social problems in 
the world," particularly for children, UNICEF reports in its "State 
of the World's Children 2002," released Sept. 13 in preparation for 
the U.N. General Assembly Special Session on Children. The assembly, 
originally scheduled for Sept. 19-21, has been postponed because of 
the recent terrorist attacks on New York City and the Pentagon. 
HIV/AIDS is "destroying families, communities and nations," causing 
life expectancy to "plumme[t]" while AIDS orphans "overwhelm family 
networks, social services and health care institutions," the report 
states. One of the goals set forth at the 1990 World Summit for Chil-
dren was to "improve protection of children in especially difficult 
circumstances," including children affected by HIV/AIDS. According to 
the report, the impact of the disease is "crushing the attempts of 
countries all over the world to put human development and the rights 
of women and children first," especially in Southern and Eastern Af-
rica. The poverty of the regions has exacerbated the epidemic, illus-
trating that AIDS is the "most savage index of the inequality of our 
world," the report states. Projected child mortality rates for 2000-
2005 in Botswana, Zimbabwe and South Africa are equal to or greater 
than 50%, and the southern and eastern regions of the continent had 
6,400,000 AIDS orphans as of last year. 

Leadership Needed

Industrialized nations have "markedly failed to show the requisite 
global leadership" on HIV/AIDS-related issues, responding with com-
placency once the epidemic had been contained within their own na-
tions, the report states. However, HIV/AIDS has begun to receive 
global attention, first with the U.N. Security Council recognizing in 
January 2000 that the disease poses a threat to worldwide security 
and then with the U.N. General Assembly Special Session on HIV/AIDS 
in June, which produced targets for worldwide HIV prevention and es-
tablished the Global AIDS and Health Fund to fight the disease. Lead-
ership in the most affected nations has also been "markedly varied," 
the report states. Successful initiatives in Uganda have lowered the 
HIV infection rate from 30% of adults in 1990 to 10% today, and in 
Botswana, officials have begun to implement a national program to re-
duce vertical transmission. Thailand, Venezuela and Brazil have also 
successfully implemented programs to reduce HIV transmission. How-
ever, other nations have "pursue[d] an ostrich-like approach, taking 
no account of the rising tide of infection" until the numbers were 
overwhelming, the report states. Corporations have also begun to take 
initiative, according to the report. The Coca-Cola Co. recently said 
it will use its distribution network to distribute condoms, HIV test-
ing kits and educational materials to remote areas. The company is 
part of the Global Business Council on HIV and AIDS, to which compa-
nies like AOL Time Warner, MAC Cosmetics and Unilever also belong. 
Drug companies have also begun to offer steep discounts to developing 
nations, the report notes, citing Bristol-Myers Squibb's offer to 
sell its medicines didanosine and stavudine for $1 a day to African 
nations and Pfizer's donation of fluconazole to the least developed 
nations. Pfizer is also spending $11 million on a medical training 
center for doctors treating HIV/AIDS patients in Uganda.

Children's Perceptions of HIV/AIDS

The report also includes a survey on children's knowledge and percep-
tions of the HIV/AIDS epidemic. Fifteen percent of 14- to 17-year-
olds in East Asia and the Pacific region said they knew "a lot" about 
HIV/AIDS, while more than half of those surveyed in the Baltic states 
and 40% of those polled in Western Europe said they had "very little 
or no information" about the disease. In addition, a third of those 
surveyed in the Caribbean said they felt "uninformed" about HIV/AIDS, 
sex and illegal drug use. Myths about HIV transmission also persist. 
Twenty percent of respondents in Panama, Ecuador and Guatemala 
thought that HIV could be contracted by being near an infected person 
and 4% said that the virus could be transmitted by touching an in-
fected person. Similarly, 10% of respondents in Thailand believed 
touching could infect a person. The report also includes a feature 
page describing an AIDS prevention program for children in Malawi, as 
well as quotes from children around the world on their perceptions of 
the epidemic ("State of the World's Children 2002," 9/13). The entire 
report is available online on the UNICEF Web site.


--
Verdict Expected Saturday in Case of Bulgarian Medics Accused of In-
tentionally Spreading HIV in Libya

A Libyan court is expected on Saturday to announce its verdict in the 
trial of six Bulgarian health workers and a Palestinian doctor ac-
cused of intentionally infecting 393 Libyan children with HIV, 
Reuters reports. The defendants, who worked at a children's hospital 
in Benghazi, were detained in early 1999 before being put on trial on 
June 2. Bulgarian Justice Minister Anton Stankov told Reuters he ex-
pects "heavy sentences, including the death penalty, given [the] 
heavy charges" against the medics. According to the indictment, the 
medics deliberately infected children as part of a conspiracy by for-
eign intelligence agencies to "undermine Libyan security and its role 
in the Arab world." Stankov added that the defendants will appeal if 
the Bulgarians are convicted. "We consider (the court session on) 
Sept. 22 merely as a stage in the trial which will continue," he 
added. Osman Byzanti, the Libyan lawyer for the defendants, said an 
appeal could take an undetermined amount of time under the multi-
tiered Libyan court system. Local court rulings can be overruled by 
the Court of Appeal, and in death penalty cases, defendants can lodge 
an additional appeal with the Supreme Court, which has the final say, 
he said, adding that a delay of the verdict is still possible due to 
"procedural wrangling." A spokesperson for the Bulgarian Foreign Min-
istry said that the defendants' "hopes are pinned" on the participa-
tion of Seif al-Islam, the son of Libyan leader Moammar Kadafi, who 
earlier this month had been invited to attend the trial as an ob-
server. "For us it is very important that he has expressed a positive 
attitude," the spokesperson said (Sabeva, Reuters, 9/20).

--
The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, 
a free service of The Henry J. Kaiser Family Foundation, by National 
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser 
Family Foundation. All rights reserved.

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