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17 March 2005

A challenge greater than apartheid

by Feroza Master
The London Globe

A 77-YEAR-OLD man stands tall behind the podium at Chatham House in London, his hair untouched by grey. He looks out at the packed room. His serious deep brown eyes hidden behind his black wire-framed glasses suddenly turn sad and teary. There is one thing that stands in his way of a sense of peace.

“AIDS has struck down two members of our family – two of our beloved children. There are no ways to convey the pain of watching your child lose their life,” he says.

This is no easy confession for Chief Mangosuthu Gatysha Buthelezi. The South African home affairs minister is a prominent figure in South African politics. As President of the Inkatha Freedom Party, he pushed for the end of apartheid a decade ago. He is about to start a new fight – eliminating the stigma associated with HIV/Aids.

There is a culture of silence around the disease in South Africa. A prejudice exists that only poor people get it. The government denied the existence of Aids for years, only recently admitting it was a problem. President Mbeki has been slow to accept its prevalence. Former president Nelson Mandela admitted last year that his son died of Aids. Now other politicians, including Buthelezi, are trying to break the silence surrounding the disease by exposing Aids deaths in their own families

“We live in a time of great adversity,” Buthelezi said. “One in 10 South Africans is infected by HIV/Aids. That means one in 10 people who work in your office or sit next to you in a taxi or your Sunday church service have HIV/Aids.”

He sighs when he says, “We face a challenge ever greater than apartheid.”

Buthelezi says HIV/Aids thrives on a cycle of poverty. Those who are poor cannot afford antiretroviral drugs – medicine that can slow the progression of the disease. Parents die young, leaving orphans to grow up on their own.

“It has created brand new levels of awfulness. Child-headed households. Terminally ill parents who cannot perform their daily tasks at home. We have funerals every weekend,” Buthelezi said.

By slowly eating away at its people, the disease threatens the economy. “HIV/Aids is depleting our workforce by thousands, frightening away foreign investment,” Buthelezi said.

Medecins Sans Frontières (MSF), an organisation committed to improving the health of people around the world which also works in South Africa, says stigma has caused the government to act slowly.

This is because Aids targets the poorest and most marginalised people such as prostitutes, drug addicts, children born with HIV and children who lost their parents to Aids.“These people are at a compromised level of access to healthcare and are perhaps at the bottom of the list of people who are receiving government support,” says Nathan Ford of MSF.

Ford works for MSF’s Campaign for Access to Essential Medicines, which pushes drug companies and governments to provide more Western medicines for those in developing countries.

He says the problem is bigger than stigma. He wants the governments of the developed and developing world to force pharmaceutical companies to lower the price of antiretroviral drugs – essential medicines to the fight against Aids.

Antiretroviral drugs are the main treatment for HIV. It’s a cocktail – a mixture of three drugs – usually two drugs from the nucleoside family and one drug from the non-nucleoside family. Patients take more than one drug at a time in order to keep their system from getting resistant to it too quickly. The treatment can keep a person from becoming ill for years at a time.

However, since millions of people in Africa have HIV, pharmaceutical companies have to try and meet the corresponding demand for pills. This business could also be very lucrative for them. In order to keep the money coming in, they have to make sure no other company can replicate their drug. This is done through patents and other forms of intellectual property rights.These are a thorn in the side of the fight against HIV/Aids. Patents give the pharmaceutical company the right to prevent other companies from selling the same drug for 20 years from the filing date of the patent application. This allows the pharmaceutical company a monopoly over the drug, charging as much money as it wants for it.But developing countries can’t wait 20 years for a patent to expire and prices to come down. South Africa took 39 pharmaceutical companies to court in 2001 over the right to buy and use generic drugs in the country.

South Africa has 5.5 million people with HIV/Aids. About 500,000 urgently need antiretroviral drugs.Former President Nelson Mandela passed a bill in 1997 that allows the health minister to import generic versions of patented drugs. These are usually bought from companies in India, Thailand or Brazil. Drug companies argued that this violates their patent, which allows drug companies to have a monopoly on the drug formula for 20 years after the drug is made.

HIV/Aids affects some of the poorest people in developing nations. Most make less than $1 a day. Antiretroviral drugs cost as much as $1,000 a month.South Africa eventually won the case. During the trial, the pharmaceutical company Merck reduced the price of one of its Aids drugs by 90 per cent, and another by 50 per cent. GlaxoSmithKline also slashed prices by 90 per cent, to encourage Africans to buy their drugs instead of generic ones produced elsewhere.“Unfortunately the debate around intellectual property rights thatdetermine what medicines a country can and can’t buy is still a verysignificant debate and for a long time to come,” Ford says.

“MSF and others will have to keep fighting pharmaceutical companies,the World Trade Organisation, and some powerful Western governments –particularly the US – to ensure that African governments canpurchase the most affordable medicines they need which right now.”

Developing countries can only afford to buy generic drugs. So,pharmaceutical companies use “voluntary licensing”, where they allowAfrican companies to make generic versions of antiretroviral drugs.This way the pharmaceutical companies get to keep their intellectual propertyrights.

GlaxoSmithKline disagrees with MSF that pharmaceuticalcompanies only act in their own interest when it comes to fightingAids. “We have a good record in this area,” says GlaxoSmithKline spokesman David Mawdsley.

“We’ve done four or five licensing agreements withgeneric companies. We give the voluntary license to generic producersin Sub-Saharan Africa which is the poorest region. We see this as apart of the solution.”

He says that GlaxoSmithKline always tries to keep their drug prices low.“We sell our key drugs for HIV at not-for-profit prices in the verypoorest areas of the world already” he says, adding that genericsaren’t always the cheapest way to go.

“Drug companies aren’t to blame. No one is to blame. What we’re trying to do is break down the stigma,” Buthelezi says. Ford says that while pharmaceutical companies may be allowing the production of generic drugs, they are not doing anything to produce the new drugs fast enough.

More than two million children live with Aids in Africa. Because of costs and doses for children, parents end up cutting an antiretroviral drug in half.

“You can’t break the pill in two and know that half of that pill is going to contain exactly half of theactive ingredient that you need,” Ford says. “It might contain muchmore of those elements that lead to severe side effects.”

The World Health Organisation (WHO) is concerned with preventing thetransmission of Aids from an infected pregnant mother to her child. They say 15 to 30per cent of pregnant women with HIV will pass on the disease to theirbabies. It is also estimated that another 10 to 20 per cent will pass it on through breast milk.

The WHO’s guidelines recommend using Boehringer Ingelheim’s drugViramune (nevirapine). It’s been used for this purpose since 1996. BIhas donated the drug to 57 developing countries.

An American NationalInstitute of Health study recently found that the drug can curb transmission of HIV from mother to child.So, while drug companies can be criticized for not providinggeneric drugs, thereis also the issue of stigma.

“Aids is not just a medical problem, it’s an economic problem, it’s asocial problem, and it’s a problem of stigmatisation,”Ford says. “And all of these issues need to be addressed.”

Buthelezi agrees. “We have to treat every individual like our own family members and tear down the walls of silence.”

ferozamaster@gmail.com

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