Waterfall, South Africa -- Lulgile Dmani is sitting on a pile of old tires,
in the shade of a jacaranda tree, brooding, as a dozen children play nearby
with a ratty tennis ball.
The 13-year-old has big, sad eyes and does not crack a smile, even when the
others collapse in laughter into a dusty heap. She is slouching, as though
the weight of the world is on her shoulders.
Lulgile has already buried her father, her mother and baby brother.
She was the sole caregiver for more than a year as her parents suffered from
ingculazi, the Zulu word for AIDS.
Death brought no respite. She was left with four younger siblings to care
for, all of them likely infected with the deadly virus.
For more than four months, Lulgile rose at dawn to do chores and go off to
beg for bread from the local Catholic mission to keep her family from
starving. But in March, driven out of the house by relatives, she sought
refuge at Agape Child Care and Support Centre, a daycare and makeshift
orphanage for children with AIDS in Waterfall, South Africa.
Lulgile's story is becoming increasingly commonplace. As the HIV-AIDS
epidemic grows, one of its most dramatic social impacts is the creation of a
generation of orphans. Already, according to UNAIDS, there are 13.2 million
of them around the world.
Yesterday, two groups argued that the figure was a significant underestimate
and predicted that the number could reach at least 40 million within a
decade, and maybe even as high as 100 million.
"This is an earth-shaking catastrophe," Countess Albina du Boisrouvray,
president of the François-Xavier Bagnoud Foundation, a charity that supports
research and development related to HIV-AIDS and human rights, said
yesterday at the 13th International AIDS Conference in Durban.
"There will be 100 million children abandoned, sometimes infected at birth,
sometimes in good health, left to fend for themselves or die because their
families have been wiped out by the epidemic. We must do something about
this," she told reporters, with Hollywood actor Danny Glover at her side.
Earlier, John Williamson, a senior adviser with the U.S. Agency for
International Development, made the same point with a new demographic study
entitled Children on the Brink.
"AIDS is literally changing the social landscape of the planet," he said.
"Family is the primary social safety net for children and AIDS is tearing
huge holes in that net."
The report noted that because HIV-AIDS is a sexually transmitted disease
with a long latency period, it tends to hit people hardest in their prime
parenting years. That not only creates orphans but also places an undue
burden on children to earn a living and care for their siblings. They also
tend to drop out of school, almost guaranteeing themselves lives of poverty.
"On top of that, children of people with HIV-AIDS lose the ability to be
children," Mr. Williamson said.
Lulgile left school at age 10 because her father needed full-time care. Then
her mother, pregnant again, fell ill, and so did her baby. Now, the teenager
has returned to school because the drop-in Agape Centre can care for her
brother and three sisters, putting a roof over their heads and feeding them
basic meals.
"I want to be a teacher when I grow up," Lulgile said. "But every day I
worry that I will get sick, that my brothers and sisters will get sick and I
will have to leave class again to care for them."
None of the 91 children cared for by the centre has been tested. There is no
point, said centre director Zodwa Mqadi, because there is no treatment
available to them.
The centre concentrates on getting the orphans fed and clothed and, above
all, educated. "The only way to break the cycle is to get the children in
school so they will learn to protect themselves," Ms. Mqadi said.
The orphans sleep 20 to a room at the tiny centre. She has to negotiate with
schools so they will forgive their school fees, and she begs for donations
of uniforms.
As the epidemic grows, orphans are being created more quickly than room can
be found for them in orphanages and in family homes. The preference of
governments is for children to be adopted by their relatives, because it
costs about $1,600 annually to care for a child in an institution.
"But if you are a grandmother with five children who are unemployed, maybe
some of them with HIV-AIDS, and you have only 220 rand a month [about $45],
how are you going to take in the children also?" Ms. Mqadi wondered.
What happens, increasingly, is that children are abandoned to the streets,
where they often end up in the sex trade. More often than not, they end up
infected with HIV-AIDS and passing on the virus to others.
"What we have to aim for is preventing orphans from ending up on the streets
because then this thing will get much worse," said Shirley Pretorius, head
of The Ark Christian Ministries Church, a social-service agency in Durban's
impoverished port area.
The agency has a new program that targets secondary breadwinners, offering
education and training so that, when the family's main income earner dies,
the family will not be left destitute.
"This is a good investment. If we train one of the older children, we can
often avoid having six to 10 new orphans," Ms. Pretorius said.
But with 4.2 million people in South Africa infected with HIV-AIDS -- almost
10 per cent of the country's population of 46 million -- there is often a
sense of desperation in dealing with orphans.
"Because of the AIDS epidemic, we've got a problem with murdered and
abandoned babies. Babies are picked up, dead and alive, in toilets and on
public beaches, almost every week," said Beverley Lambrechts, a drug and
alcohol counsellor.
She adopted an infant boy who was found in a graveyard on Christmas Eve,
1996. He had been stuffed into a plastic bag, his umbilical cord intact and
a rope around his neck. Police believe his mother was an HIV-infected
prostitute who tried to strangle him to spare him the suffering of the
disease.
Yesterday, Ms. Lambrechts tickled and hugged young Christopher, now 4 and
HIV-negative. "I think Christopher was sent to us as a symbol of what could
happen if we all reached out and rescued an AIDS orphan."
Like most policymakers, she knows the orphaned children may prove to be a
bigger social and economic problem than the tens of millions of parents who
have died.
"If I had the ability, I would adopt all these children myself. But I can't.
I just pray that somebody can," she said grimly.
As for Lulgile Dmani, she hopes her siblings will end up in a good family,
and in good health. She also has a modest dream for herself, to marry and
have a family, one with "children who can laugh and play, children who never
have to care for me when I'm sick."
**********
Global pressures building for low-cost AIDS drugs
Monday, April 16, 2001
ANDRÉ PICARD
PUBLIC HEALTH REPORTER; With reports from freelance journalists Rama
Lakshmi; in New Delhi and Karen MacGregor in Durban
When Maria Musamba was living in Uganda, the only AIDS treatment she could
afford was a strange herbal concoction whose side effects were as bad as the
disease itself. Sophisticated drug cocktails, costing more than $1,000
(U.S.) a month, were far beyond her reach.
But after she came to Canada as a refugee in 1998, she began treatment with
antiretrovirals immediately, for free.
"It was like a miracle. My situation was very, very desperate -- I had only
months to live, but today I'm doing so well, I forget that I'm sick," the
38-year-old Toronto resident said in an interview.
Her experiences embody the gaping disparity in the treatment of HIV-AIDS
patients -- one standard in the developed world and another standard in the
developing world.
"I cry sometimes when I think of all the people who would be alive today if
they had the opportunities I did. Every day, I see how blessed I am. But
every day, I realize just how unfair the situation is for those who are
denied these life-saving drugs," said Ms. Musamba, a student who asked to
remain anonymous.
More than 36 million people around the world are infected with HIV, 25.5
million of them in sub-Saharan Africa. Yet twice as many people are treated
with the vital drug cocktails in Canada as on the entire African continent.
Such inequities are spurring demands that treatments for HIV-AIDS be made
available at low cost, or no cost, in developing countries. Enormous legal
and political pressures have come to bear on multinational drug companies,
putting the $350-billion-a-year (U.S.) industry on the defensive.
The push began last summer at the International AIDS Conference in Durban,
South Africa, where delegates embraced the campaign for access to essential
medicines.
The campaign is led by the Nobel Prize-winning humanitarian group Doctors
Without Borders.
The group is known internationally as Médecins Sans Frontières, MSF.
International patent agreements, which limit competition and keep drug
prices high, are now under the microscope -- and being seriously questioned.
The international Agreement on Trade Related Aspects of Property Rights, for
example, obliges countries to grant 20-year patent protection to new drugs.
"People around the world are asking themselves, 'How much power are we going
to allow multinational drug companies to have when people's lives are at
stake?' " said Marie Hélène Bonin, Canadian co-ordinator of the MSF
campaign.
"If we accept these patent agreements as they are, we are accepting that our
governments are no longer sovereign in public health. That is a grave
situation, an undermining of human rights, of democracy," she said in an
interview.
With millions of people infected with HIV-AIDS clamouring for treatment,
countries as diverse as Brazil, South Africa and India are openly defying
patent laws and producing generic drugs. A year's supply of the generic drug
cocktails sells for as little as $350; those marketed by brand-name
companies in North America and Europe cost $10,000 to $15,000 a year.
In response to the campaign, makers of AIDS drugs have begun slashing prices
by as much as 98 per cent in parts of the developing world. But they are
also aggressively pursuing a court case in South Africa that has become a
lightning rod in the debate.
The Pharmaceutical Manufacturers Association, which represents 39 of the
world's biggest drug companies, is suing the South African government in an
effort to strike down a law that permits the import of cheap drugs and
allows the manufacture of much cheaper generic versions of patented drugs.
The government argues that under World Trade Organization rules, it can do
so in the case of a "national emergency," which it considers the HIV-AIDS
epidemic to be. With 4.7 million citizens infected -- one in nine -- South
Africa now leads the world in HIV-AIDS victims.
The drug industry sees South Africa's move as a threat to global
intellectual-property rights, and warns that it will undermine research and
development. The companies also argue that they are being made scapegoats
for South Africa's inaction on the disease, and that in a world where
billions do not have access to clean water or adequate food, low-cost drugs
are not a panacea.
"When people are angry and dying out there, the government mustn't accuse us
of delaying their treatment," said Mirryena Deeb, head of the PMA.
The court case, which is to begin in earnest on Wednesday, is not the only
battlefront in developing countries. Economically strapped Brazil, for
example, has created a network of AIDS clinics and is offering sophisticated
treatment to everyone who needs it. Brazil has also shown that widespread
use of drug cocktails is cost-efficient.
Last year, it spent $444-million on the drugs (4 per cent of the national
health budget) -- but it saved $422-million in hospitalization and treatment
costs. As well, the AIDS death rate has fallen by more than half and the
transmission rate is dropping sharply.
"What we need now is a Brazilian program on a global scale," said John
Foster, a researcher at the North-South Institute and an expert on AIDS as a
development issue.
"I don't think that genocide is too strong a term to use for what is going
on with HIV-AIDS," he added. "Millions of lives are at stake, so we can no
longer tolerate this attitude that patents are more important than people."
Activists want an approach like the global child-vaccination program, in
which governments of developed countries buy huge quantities of drugs at low
cost and distribute them free in developing nations.
The World Health Organization estimates that at least five million HIV-AIDS
patients in the developing world could benefit from drug cocktails, which
have only been in use for about four years but have already cut the death
rate by 70 per cent in the West.
Fewer than 10,000 people with HIV-AIDS in Africa have access to the drugs --
1/25th of 1 per cent of those infected. In Canada, about 16,000 of 50,000
people with HIV-AIDS are using antiretrovirals. In Africa, only the elite
can afford the treatment, even at reduced costs. In Canada, no one pays for
the cocktails out of pocket.
With tough questions being raised in international meetings, in
universities, in legislatures and at protest rallies all over the world,
drug companies are scrambling to improve their public image.
The antiretroviral drug Zerit is a striking example. It was invented by
William Prusoff of Yale University, which patented the drug and licensed it
to Bristol-Myers Squibb. Yale students began protesting against the
university's role in denying access to drugs, prompting Dr. Prusoff to speak
up and say Zerit should be available at low cost to everyone who needs it --
a move that could cost him millions of dollars in forgone royalties. Within
two days of his comments, Bristol-Myers cut the price from $1.50 a pill to
15 cents.
Bristol-Myers vice-president John McGoldrick issued a statement saying: "We
seek no profits on AIDS drugs in Africa, and we will not let our patents be
an obstacle."
A competitor, Merck & Co., has also vowed to sell two popular components of
HIV-AIDS drugs at cost, slashing the prices of Crixivan and Stocrin in
Africa to 10 per cent of what they sell for in North America.
But critics such as Mr. Foster argue that these price cuts are essentially
meaningless, because the major companies sell virtually no HIV-AIDS drugs in
the developing world.
"The question of this drug company making this or that product available
more cheaply to this or that group is trivial -- it's straws in the wind.
The reality is that the drugs are still out of reach."
In contrast to the brand-name AIDS drugs, which can cost thousands of
dollars for a year's supply, a generic drug cocktail produced by an Indian
company sells for as little as $350 a year. The company, CIPLA, is able to
sell its drugs legally because although India has signed an international
agreement on patent rights, it doesn't take effect until 2006.
Yusuf Hameid, president of Bombay-based CIPLA, is viewed as a pariah by the
brand-name companies, but he dismisses them in turn as greedy and
exploitative.
"If I am called a pirate, then I should have broken some law. But I live in
India and I abide by the Indian laws," he said. "I represent the Third
World, the needs and aspirations of the Third World."
Dr. Hameid said India is precisely the type of place where drug cocktails
should be widely and cheaply available. There are an estimated 3.9 million
people with HIV-AIDS in India, but there are fears that it could reach the
infection-rate level of some African countries -- catastrophic in a country
of more than one billion.
Ms. Bonin believes that countries like Canada -- with its reputation for
embracing human-rights issues -- should support access to essential
medicines.
"Canada should play its traditional role as a leader. We should not satisfy
ourselves with being puppets of multinationals," Ms. Bonin said. "This is
not a debate about patent rights, this is about the right to life for
millions of people around the world."
***********
AIDS summit convenes at ground zero
Meeting in S. Africa to dwell on global inequities
of epidemic once called 'soft nuclear bomb'
Saturday, July 8, 2000
ANDRE PICARD
DURBAN, SOUTH AFRICA -- On June 4, 1989, Zambian President Kenneth Kaunda
stood on a Montreal stage and solemnly pleaded with the world to recognize
the gravity of the AIDS epidemic, particularly in Africa.
"AIDS is here. It is killing us. It is hitting us where nothing has hit us
so accurately before," he told the International Conference on AIDS.
Calling HIV-AIDS a "soft nuclear bomb on human life" that was exploding with
increasing ferocity each day, Mr. Kaunda said only a vast international
mobilization could prevent a disaster unprecedented in human history.
At the time, an estimated five million people worldwide were infected and
epidemiologists were predicting that number could double by the turn of the
century.
How wrong they were. And how cruelly prescient were Mr. Kaunda's words. An
estimated 53 million people worldwide have been infected with HIV-AIDS, and
the number-crunchers are now saying the epidemic is still in its infancy.
The wily little virus continues to defy the world's greatest scientific
minds, infecting more than five million people a year. It also is destroying
communities, ravaging economies and threatening political stability.
Tomorrow, South African President Thabo Mbeki will mount the podium at
Kingsmead Cricket Stadium in Durban and, like Mr. Kaunda, implore
politicians, corporations, researchers and community activists to do more.
With thousands of locals mingling with dignitaries, it will, no doubt, be a
politically charged address. HIV-AIDS, because of its devastating social
consequences, long ago ceased being a medical issue alone. This week at the
13th International AIDS Conference, it will move firmly into the political
and economic sphere.
Mr. Mbeki has, in the past, had harsh words for pharmaceutical companies,
calling them "profit-takers benefiting from the scourge of HIV-AIDS." At the
meeting, pricing of drugs will overshadow any talk of medical breakthrough.
The South African President has also flirted openly with so-called
HIV-deniers. They argue that AIDS is not caused by HIV but by a combination
of recreational drug use and malnutrition, and they contend that
conventional drug therapies exacerbate the disease.
How much of Mr. Mbeki's interest in fringe groups is a ploy in his battle
with drug makers is open to debate. But the fact that two decades into the
epidemic these picayune arguments stand in the way of taking concrete action
goes a long way toward explaining why the epidemic continues unchecked.
Despite being the continent's financial powerhouse, South Africa has more
cases of HIV-AIDS -- 4.2 million -- than any other country in the world. In
KwaZulu-Natal province, where Durban is located, life expectancy has dropped
to a mere 28 years, a chilling figure for those who wonder just how bad the
epidemic can get.
HIV-AIDS, which preys on the poor and vulnerable, this week will officially
become the world's new shame, the new apartheid. Nelson Mandela, who will
give the closing address, will ensure that is understood. It is he who
coined the phrase "breaking the silence" -- the conference theme -- and his
remarks are being nervously anticipated by many political and corporate
leaders.
By bringing 12,000 scientists, clinicians, community activists, politicians
and journalists to witness the epidemic firsthand, and topping it off with
the words of Mr. Mandela, organizers hope to shame world leaders into
action, into finally heeding Mr. Kaunda's words.
The reason it may actually work this time around is self-interest. There is
a growing realization that HIV-AIDS threatens the economy of many countries
and, in turn, the profitability of corporations.
In ever-larger areas, HIV-AIDS is wiping out the work force, causing
manufacturing plants to close for lack of workers and hindering the ability
to harvest crops.
In Zambia, there is a shortage of nurses and doctors because so many have
died. Health-care systems in areas with high HIV rates are teetering on the
verge of bankruptcy. In Burundi, 70 per cent of hospital beds are occupied
by people with HIV.
In recent months, both the president of the United States and the head of
the World Bank -- not exactly Battle of Seattle radicals -- have stated
publicly that the HIV-AIDS epidemic has reached such catastrophic
proportions that it could lead to war and topple governments.
Pharmaceutical companies, fearing boycotts, have taken pre-emptive action,
promising to slash the prices of HIV-AIDS drugs by 70-85 per cent. What they
will hear at the conference is that these gestures are not enough.
There will also be calls for debt relief. The countries that are home to 95
per cent of cases of HIV-AIDS owe, collectively, more than $2-trillion. They
pay four times as much for debt servicing as for health and education.
The virus is far more deadly than war. Ten times as many people died of
HIV-AIDS in Africa last year as in armed conflict.
It is, the Durban conference will make clear, war, and AIDS is winning. And
while combat strategies are plotted this week in Durban, 100,000 more people
will be infected.
Another soft nuclear bomb.
THE HUMAN COSTS
Number who have contracted HIV-AIDS to date: 53.1 million. Number who have
died: 18.8 million.

Number of people living with HIV-AIDS, 1999: 34.3 million. Number of people
living with HIV-AIDS, 1989: 5 million.

New cases of HIV in 1999: 5.4 million. Number of new cases in 1989: 500,000.


Number of people infected daily: 16,000. Percentage of newly infected under
the age of 15: 40 per cent.

Number of AIDS orphans: 13 million. Estimated number of AIDS orphans in
2010: 40 million.

Number of babies born with HIV-AIDS last year: one million. Percentage of
cases involving mother-to-child transmission that can be prevented with
drugs: 90-95 per cent. Cost of drug treatment for expectant mother: $50
(U.S.).

Country with the most infected: South Africa, 4.2 million. Country with the
highest rate of infection: Botswana, 36 per cent of adults.

Number of sexually active adults infected worldwide: 1 in 100.

Percentage of global HIV-AIDS infections in the developing world: 95 per
cent. Percentage in sub-Saharan Africa: 70 per cent.

Annual spending on HIV-AIDS: $18.8-billion (U.S.). Percentage of spending in
developing world: 3 per cent. Daily health-care spending in the U.S.:
$3-billion.
**********
AIDS in Africa 'greatest disaster' since slavery
Monday, July 10, 2000
ANDRÉ PICARD
Public Health Reporter; Source: United Nations Program on HIV/AIDS
Durban, South Africa -- AIDS has already decimated the population and
economy of Africa more than the slave trade, and there is no end in sight to
the devastation wrought by the disease, an international conference heard
yesterday.
"AIDS is clearly the single biggest issue facing sub-Saharan Africa and
represents the biggest health crisis the world has ever known," said Dr.
Kevin De Cock, director of HIV/AIDS prevention at the U.S. Centers for
Disease Control in Atlanta, Ga.
"It is the greatest social disaster since slavery."
More than 34.3 million people worldwide are living with HIV-AIDS, 24.5
million of them in sub-Saharan Africa, and 4.2 million in South Africa
alone. It is now estimated that hundreds of millions will be infected before
the epidemic peaks.
Dr. De Cock said that, by the end of this decade, some countries will lose
40 years of life expectancy. A whole generation of breadwinners and parents
are being plucked from society and the economy, just as happened when slave
traders raided the continent.
Yesterday was the opening day of the 13th International AIDS Conference,
under the theme Breaking The Silence, and was ushered in with the largest
AIDS protest ever on the African continent.
Thousands of South Africans, along with activists from dozens of other
countries, took to the streets of downtown Durban to demand better access to
drugs and lower prices for treatments.
Winnie Madikizela-Mandela, head of the African National Congress's Women's
League, told the crowd that AIDS is a "social holocaust" that poses a bigger
threat to freedom than did the apartheid system of white supremacy.
The ex-wife of former South African president Nelson Mandela said the world
must do what it did when it united to demand an end to South Africa's racist
government, and must mobilize to ensure cheap, accessible drugs for all
people infected with HIV-AIDS. With that commitment, Ms. Madikizela-Mandela
said, millions of lives could be saved.
Wearing a T-shirt reading "HIV Positive," she lashed out at South Africa's
ANC government, which has been reluctant to fund even the most basic and
inexpensive drug regimes that can prevent pregnant, HIV-positive women from
passing the virus on to their children.
"We are marching to demand that a government which we have elected put the
interests of its people before the profits of drug companies" Ms.
Madikizela- Mandela said.
She also warned that, when the conference wraps up Friday, the protests will
not end. "If this march doesn't turn the tide, we will march again and again
until our voice is heard," she told the cheering crowd.
South African President Thabo Mbeki has been criticized around the world
since he convened a panel of scientists to investigate whether the human
immunodeficiency virus causes AIDS, something long accepted by most experts.
He has also been taken to task for his refusal to provide medicine to
pregnant women to reduce the risks of mother-to-child transmission of the
disease.
In his speech to the opening session of the conference, Mr. Mbeki defended
his policies, saying he is looking for a solution to the scourge that would
deal with Africa's social and economic problems.
Kate Thomson, founder of the International Community of Women Living with
HIV-AIDS, said the disease used to be a great equalizer, infecting young and
old, rich and poor, men and women alike. But now that the wealthy in
developing countries have access to life-prolonging treatments, "we're no
longer in the same boat any more.
"The United Kingdom has fewer new infections in one year than Africa has in
two days. . . . We must not be silent witnesses to this humanitarian
crisis," Ms. Thomson said.
Calls for international mobilization and attacks on the international
pharmaceutical industry were not limited to community activists.
"We have called on the pharmaceutical companies to put humanity ahead of the
balance sheet and dramatically lower their prices -- and the companies are
beginning to respond," said Dr. Peter Piot, executive director of the United
Nations AIDS agency UNAIDS.
Recently, a group of five pharmaceutical companies announced they would cut
prices by 70 to 85 per cent on some drugs used to treat HIV-AIDS and, in
recent days, there have been a number of announcements of drug-donation
programs.
But Dr. Piot said industry and governments must do more. He said $3-billion
(U.S.) is needed annually for basic care and prevention of HIV-AIDS in
Africa. That is 10 times what is being spent today, without even considering
the cost of drug cocktails that are widely available in developed countries.
(A recent Canadian study said that would cost $56-billion in South Africa
alone.)
Dr. Piot said that one of the most effective measures that wealthy countries
can take is to offer debt relief to poor countries. He said African
countries alone make $15-billion in debt repayment annually, money that
would be better spent on providing health care and HIV-AIDS prevention.
A GLOBAL VIEW OF HIV
AIDS has already caused 18.8 million deaths and orphaned 13.2 million
children. In 1999, 2.8 million people died of AIDS. Currently, it is
estimated that 34.3 million people around the world are living with
HIV/AIDS.
Number of adults and children living with HIV/AIDS:
North America 900,000


Caribbean 360,000


Latin America 1.3 million


Western Europe 520,000


Eastern Europe and Central Asia 420,000


South and Southeast Asia 4.6 million


East Asia and Pacific 530,000


Australian and New Zealand 15,000


North Arica and Middle East 220,000


Sub-Saharan Africa 24.5 million
********
The changing face of AIDS in Africa
Increasingly, those infected are young, female and black -
with 4.2 million people HIV-positive in South Africa alone
Thursday, July 13, 2000
ANDRÉ PICARD
Cato Crest, South Africa -- Thandi Celwe sits on the side of the bed in her
one-room, cinder-block home, pondering the question at length. The
22-year-old woman stops coughing, and now starts rubbing and pinching her
hands as she struggles to find the words.
"My future?" she whispers, not able to lift her gaze from the floor. "My
future is nothing. I am going to die."
Ms. Celwe, like 10 million other young people in the world, has the
HIV-AIDS. Her face -- young, black, female, frightened -- is the new face of
AIDS. Every minute, six more people under the age of 25 are infected with
the deadly virus. Four of them are female.
Virtually all of them live in the developing world, and virtually none of
them has access to any treatment.
Ms. Celwe, who believes she has been infected for about four years, takes
only one drug to ward off tuberculosis, the disease most likely to kill her.
A former hotel worker, she lives in Cato Crest, a former squatters' camp on
the outskirts of Durban that is slowly being transformed into a town as the
government builds basic housing.
At least 45 per cent of Cato Crest's 15,000 residents are infected with
HIV-AIDS, including Ms. Celwe and her 42-year-old boyfriend, who has gone
off to the hospital to die.
She doesn't know the status of her two children, aged 4 and 8. "I don't want
them to have tests. It will only bring them misery."
Instead, Ms. Celwe has sent them to her mother's to live, but she is afraid
that if her family finds out she is HIV-positive, she will be shunned and
the children sent to an orphanage.
"I love my children very much," Ms. Celwe says, unable to stop the tears
from flowing. "But I had to abandon them so they would have a chance."
Makhosi Mkhize, a nurse who runs the Philangezwe AIDS Care and Support
Program, a volunteer agency that provides home care, says Westerners do not
understand the stigma and discrimination that flow from having a positive
AIDS test in sub-Saharan Africa.
She says the result is a strange silence that allows government to play down
the extent of the epidemic. "Everyone is suffering but no one is
disclosing," Ms. Mkhize said.
The United Nations estimates 4.2-million people have HIV-AIDS in South
Africa, more than in any other country in the world.
Zwelihle Dube, a commercial photographer, has all the outward symptoms of an
untreated AIDS sufferer: the disfiguring scars of Kaposi's sarcoma, the
wasting that has brought his weight down to about 40 kilograms, and a
crushing weight on his chest indicative of pneumocystis carinii pneumonia.
The 28-year-old is so weak that he can barely sit up in bed, but insists
that a visiting delegation of health professional come in to see him. Asked
directly if he has AIDS -- something not normally done in these parts -- he
shifts uncomfortably and gives a vague answer.
"I know there is something poison in my body, but I don't know the cause of
this sickness," he says. He has heard on the radio that there is a
conference in Durban -- the 13th International AIDS Conference, with the
theme Breaking the Silence -- and that scientists have drugs to treat "that
disease."
He wonders if the visitors can provide him with some. Disappointed, he
reaches into a drawer and pulls out the only medication available to him --
a potion with a fancy name that is essentially a cough syrup.
The father of three young boys stares at the box, then swears that, as soon
as he can raise the money, he will go to hospital and "they will take care
of me." "I'll be back soon to take care of my wife and children," he says.
At King Edward VIII Hospital, a sprawling 1,600-bed facility in Durban,
there is far less optimism.
"Almost all patients with AIDS end up at King Edward," says director
Archibald Mhlambi. "We are the last port of call."
KwaZulu-Natal is the hardest hit by the epidemic in South Africa, with an
estimated 40 per cent of working-age adults infected. A report released this
week predicted that AIDS will devour about 20 per cent of South Africa's
gross domestic product, reduce life expectancy to below 40 years, and put a
crushing burden on the healthcare system.
In the halls of the hospital, it is easy to see why. The last time they
counted, more than 30 per cent of patients were HIV-positive. Dr. Mhlambi
stresses that those are only the patients who asked to be tested for the
virus.
"In most cases, this is not the most appropriate place to be if you're a
patient with HIV-AIDS. What most of them need is tender loving care, or
hospice care," he says.
Anti-retrovirals, drugs that can keep AIDS at bay for years, are not
available here because, at about $5,000 (U.S.) per patient annually, they
are too costly. (The hospital treats infections the patients contract --
tuberculosis, meningitis, bacterial pneumonia -- and then, if they survive,
discharges them.)
And while it costs as little as $8 (U.S.) to prevent a pregnant,
HIV-positive woman from passing on the infection to her baby, that treatment
is not available either. About 34 per cent of mothers who give birth at King
Edward are known to be HIV-positive.
Zama Shangase, 23, gave birth to her son Emmanuel in January. Within a
couple of weeks, the baby was admitted to hospital with severe diarrhea. The
boy is HIV-positive, and so is his mother. She says she knew her husband had
other sexual partners, likely including prostitutes. She was vaguely aware
of the dangers of AIDS but never thought of using condoms.
"I heard about this killer disease, but I thought it was a fairy-tale story
that they made up so young people would not have relations and get
pregnant," Ms. Shangase says candidly.
Three of her friends died of AIDS, but she remained convinced there was no
real risk to her -- until she saw her infant son wasting away and the nurse
explained the grim reality of her positive test. When Ms. Shangase told her
husband the diagnosis, he beat her and left. He hasn't returned.
She decided then not to tell anyone else. "No, no, no, my mother doesn't
know. She will never know," Ms. Shangase says. Her mother has been caring
for her three other children, and been told that Emmanuel has pneumonia.
Ms. Shangase, who worked in a shoe factory, has given up her job to live at
the hospital, where she breastfeeds her son. "I breastfeed because that's
what a mother does," Ms. Shangase says, speaking in Zulu. Then, with a big
smile, she adds in English: "Breast is best."
Her words underscore the challenges that exist in trying to stem the spread
of HIV-AIDS. For years, breastfeeding has been touted as the best protection
against childhood diseases. Now, with 16-million women in the world
infected, their milk can transmit the deadly virus, and a new education
campaign is needed urging them not to breastfeed.
With a vaccine a long way off and treatments limited by cost, prevention and
education campaigns remains the best hope. Still, millions more people will
end up with HIV-AIDS. But Ms. Shangase prefers not to think of such things.
"I tell myself that maybe Emmanuel can continue to live, that maybe God will
not call him until he's a man," she says, stroking his back as he sleeps.
Carol Bellamy, executive director of UNICEF, said yesterday that the manner
in which HIV-AIDS is felling young people makes it one of the greatest
threats the world has ever faced. She said it should spur a global war
against the disease.
"Virtually every society understands what it means to wage a struggle for
liberation," she said yesterday in Durban. "It means sparing no effort."
*********
Worldwide killer no longer the great equalizer
Third World has little reason to celebrate medical
advances in battle against AIDS as gap between haves
and have-nots grows, MDs say
Saturday, July 4, 1998
BY ANDRÉ PICARD
The Globe and Mail
GENEVA -- Toyi-toyi, the hypnotizing freedom dance that South Africans
performed in marches against apartheid, means, literally, "moving forward
while remaining in one place."
As researchers, clinicians, activists and sufferers look ahead to the next
World AIDS Conference, a millennial gathering in Durban, South Africa, there
is no more apt description for the battle against AIDS than toyi-toyi --
moving ahead while standing still.
With at least 40 million infections expected worldwide by 2000, there is no
better analogy for what needs to be done than toyi-toyi -- a plea for
revolutionary change.
The scientists are jubilant with the breakthroughs, the advances, the
promise. People benefiting from the drug cocktails and state-of-the art
medicine have reason to celebrate, too: freedom from immediate death.
But most of the 30.6 million people infected worldwide are on the outside.
The greatest contributing factor to their infection is the biggest
impediment to their getting help: economic marginalization.
Not long ago, HIV-AIDS was called the great equalizer. Unlike other
worldwide killers -- malaria, measles, cholera -- it killed rich and poor
alike, black and white.
Today, the epidemic is a barometer of inequality. In the United States, it
has become a disease of blacks and Latinos; in Canada, natives. As economic
grief spreads across Asia, HIV spreads faster. In parts of Africa, one in
four adults has AIDS.
"With this disease, we are seeing a repetition of our history, one of
colonization, of apartheid. . . . We are once again being subjected to the
worst and most vile forms of discrimination," said Dr. Hoosen Coovadia, a
pediatrician from Durban, and chairman of the next conference.
On the cusp of the 21st century, AIDS has become not so much a medical
challenge, but a human-rights one.
"I'm a scientist, but I've become an activist. I think we all have to," said
Mark Wainberg, president of the International AIDS Society. "It's time for
the world to realize that the fight against AIDS is as important as the
fight against apartheid."
Dr. Wainberg noted that, during the week the world's top scientists
discussed HIV-AIDS developments in Geneva, at least 100,000 more people
became infected.
Jonathan Mann, a professor of health and human rights and dean of Allegheny
University in Philadelphia, said AIDS has demonstrated that the commonly
accepted public-health model is fundamentally flawed because it emphasizes
the collection of information, not action.
He said the fact that, two decades into the epidemic -- one that rivals the
Black Plague -- rates are still rising, underlines this failure. A new
approach is needed, Dr. Mann said, "one whose starting point is asking:
'What are the social preconditions to ensure human well-being?' "
In other words, the HIV-AIDS crisis will not be solved in a world where 1.1
billion people live in absolute poverty -- and where 800 million do not have
access to clean water, let alone health care.
"There are many, many challenges," said Winstone Zulu, a community activist
in Zambia. "But one of our biggest achievements at this conference is that
people are now willing to talk about these gaps."
That awareness is essential, said United Nations Secretary-General Kofi
Annan. "Remember, this epidemic feeds off inaction."
A total of 13,375 delegates from 177 countries attended the 12th World AIDS
Conference in Geneva, and 1,334 journalists from 73 countries.
The theme was Bridging The Gap, but what was revealed was more of yawning
chasm: on one side, developed countries, which have treatments and care, and
infection rates well under 1 per cent; on the other, the developing world,
where HIV-AIDS is tearing families and economies apart, and where 90 per
cent of the total number of infected people live, with access to little more
than prayer.
"The paradox is that the greater the advances in research, the greater the
number of people suffering from HIV-AIDS in the world," said Ana Luisa
Liguori, an anthropologist who works for the McCarthy Foundation in Mexico
City.
And, in that sense, the gap actually grew during the conference, because it
featured promising developments for those who can afford them.
On the medical front, the focus shifted back to the immune system, with
important discoveries about reservoirs where the virus hides in the body and
much greater understanding of the life cycle of HIV.
Four new drugs that will simplify and expand drug cocktails were also
unveiled. This means that the United States now will have 204 potential
triple therapies and 1,028 quadruple ones. (Canada has approved only seven
drugs.)
The biggest clinical breakthrough was news that mother-to-child transmission
of HIV can now be prevented almost 100 per cent of the time. Unfortunately,
the gains are offset by the fact that many HIV-positive women must
breast-feed.
On the down side, there were troubling revelations about the dangers of drug
resistance and disfiguring side effects of antiretroviral drugs. Most
dispiriting, however, were the continued woes, scientific and financial, in
trying to create an AIDS vaccine.
On the prevention front, there was more proof of the effectiveness of
needle-exchange programs and sex education. There was also news of growing
acceptance of the female condom and advances in the development of
microbicides.
But Montreal epidemiologist Catherine Hankins said "governments are not
learning any lessons from our successes." She said that for every $100 spent
on "scientific wizardry," only $1 goes to education and prevention despite
the fact that, in Canada, each case prevented saves $154,000 in treatment
costs.
As delegates left the Bridging The Gap conference, they were left to ponder
two contrasting images: a big screen featuring a slick promotional video for
Durban, bursting with colour and blaring with sound; and beside it, a bit
off in the corner, the "AIDS clock" of the International AIDS Society, its
red lights quietly ticking away a new infection every five seconds.
It read: 33,5346,757.
Toyi-toyi.
************
AIDS fight would cost $26-billion, study says
Friday, June 22, 2001
ANDRÉ PICARD
PUBLIC HEALTH REPORTER
If the world wants to take control of the HIV-AIDS epidemic, an additional
$26-billion (U.S.) needs to be invested for the battle by the year 2005, a
study warns.
Two-thirds of the money should be spent in Africa and almost one-third in
Asia, according to scientists from some of the top governmental,
not-for-profit and private research institutes in the world.
The researchers said more than half the money, up to $4.8-billion a year,
should go to prevention and $4.4-billion on care.
"Over two decades of experience, we have developed effective tools for
prevention, treatment and support," Dr. Bernhard Schwartlander, senior
epidemiologist at UNAIDS and one of the study researchers, wrote in today's
edition of Science.
"Many countries, including some of the poorest, have shown political
commitment and developed plans to scale up treatment and prevention
programs. "What they need now are resources."
The researchers estimated that one-third to one-half the new spending could
come from domestic sources, but the balance needs to come from the
governments of developed countries, big business and charitable foundations.
Dr. Schwartlander said the goal, to raise an additional $9.2-billion a year,
is realistic. International donors such as Canada would need to increase
their foreign aid budgets by only 10 per cent, he said.
Under the model used by the researchers, the extra funding would mean an
additional 35 million pregnant women would undergo prenatal testing for the
AIDS virus, and 900,000 of them would receive drugs to prevent
mother-to-child transmission.
And there would be enough money to buy and distribute six billion condoms --
one for every person on the planet.
On the care side, more than half the new money would provide so-called drug
cocktails to people with HIV-AIDS.
The researchers called on employers and insurers to extend health coverage
to ensure access to the drugs, which delay the onset of AIDS. Coca-Cola,
Africa's largest employer, made such a pledge this week, and a number of
other international companies are expected to follow.
The United Nations General Assembly will hold a special session on HIV-AIDS
next week and hopes to approve a global plan for fighting the epidemic.
Yesterday, the president of the World Bank said doing so is essential to the
world's economy and to ensure peace.
"HIV-AIDS is no longer just a health problem but a global development
problem, threatening to reverse many of the gains made over the last
half-century," James Wolfensohn said.
"AIDS is an international security problem and, as such, it needs a war
chest and a rigorous strategy for achieving results."
More than 36 million people worldwide live with HIV-AIDS. There are 15,000
infections daily. died in the 20 years of the epidemic.
According to the report, only $1.8-billion is being spent annually on
HIV-AIDS in the developing world, where more than 90 per cent of the
infected live. By contrast, the U.S. spends about $20-billion domestically
on HIV-AIDS each year, and it has fewer than one million sufferers.
"There is scope for considerably more funding from all major donors," Dr.
Schwartlander said.
The researchers said the additional spending on prevention could fund
programs that reach 22 million young people, and testing and counselling for
nine million more. There would be targeted prevention programs for high-risk
groups, including 28 million men who have sex with men, six million sex
workers and three million injection-drug users.
In the Science article, the researchers estimated the cost of HIV-AIDS
prevention and care in 135 low- and middle-income countries.
They concluded that $3.2-billion more is needed next year, $4.7-billion in
2003, $6.8-billion in 2004 and $9.2-billion in 2005. Dr. Schwartlander said
those are conservative estimates and more money is probably required.
The researchers were unable to estimate how many cases of HIV-AIDS could be
prevented or how many deaths could be delayed or prevented. There were 5.3
million people newly infected with HIV last year, and about three million
who died of AIDS.
Dr. Schwartlander cautioned that the epidemic cannot be tackled in
isolation. Another $1.3-billion to $2.6-billion a year is required to tackle
malaria and tuberculosis, two of the other big epidemics in the developing
world.
On the
Web:<http://www.sciencemag.org/sciencexpress/recent.shtmlwww.unaids.org>
***********

RETURN TO SELECTED TAINTED BLOOD STORIES