Healthcare News Snippets

Hogan praised for AIDS policies

WHEN Health Minister Barbara Hogan closed the 4th SA AIDS conference in Durban last week she delivered a powerful, sober speech but she did not grab headlines like her predecessor, Manto Tshabalala-Msimang. "Dr Beetroot" made headlines for all the wrong reasons at four previous AIDS conferences in Durban and at two international ones, - in Thailand and Canada - during her term from 1999 to 2008. Since her removal, and that of her boss, Thabo Mbeki, the implementation of South Africa's national strategic plan for HIV/AIDS has progressed under a revamped National AIDS Council. About 700 000 South Africans are on antiretroviral drugs. In July 2000, at an international AIDS conference in Durban, health professionals and activists demanded access to treatment and were forced to unite against AIDS denialism. More than 5 000 scientists signed the Durban Declaration in July that year, affirming that HIV is the cause of AIDS. Three years later, at the 1st South African AIDS conference, delegates - led by the Treatment Action Campaign - were still fighting for medicines, and protests echoed around the convention centre. That conference ended with a victory on August 8 2003, when the Cabinet announced that the government would rollout antiretroviral drugs in public hospitals. In 2005, at the 2nd South African AIDS conference, Tshabalala-Msimang was divisive and disruptive. She did not confirm her attendance but pitched up for the opening ceremony anyway and attacked keynote speaker Mamphela Ramphele in her speech. She also attacked HIV/AIDS scientists and promoted traditional medicines on and off the stage. Between 2000 and 2005, about 330000 people died of AIDS as the government stalled its ARV rollout. In 2007, at the 3rd South African AIDS conference, Tshabalala-Msimang failed again to provide leadership. Instead, she and her director-general, Thami Mseleku, tried to sideline Deputy Health Minister Nozizwe Madlala-Routledge, who was taking the lead on HIV/AIDS. Another two years have passed and South Africa has the world's largest treatment programme, but it is buckling under the load and inadequate funding. At this, the 4th South African AIDS conference, the TAC led a small protest on the funding crisis and problems with antiretroviral access in the Free State. Hogan tackled the "very serious financial crisis in the Free State late last year" by saying she hoped the Health Department would be able to address many of the issues but there were no quick fixes. She added that health services should not be cut but sustained. In contrast to Tshabalala-Msimang, she picked up the priorities of the delegates, from TB to the prevention of mother-to-child HIV transmission. She thanked the scientists and conference organisers for their contribution to stopping HIV. Hogan also thanked international donors - such as the US, for its Pepfar programme - and called on them to sustain funding. Francois Venter, president of the HIV Clinicians' Society of Southern Africa and chairman of the next South African AIDS conference, in 2011, said of Hogan's speech that it was good to have an honest appraisal of the successes and failures of the healthcare system. He said Hogan understood the complexity and challenges, and had empathy for patients and professionals, and added that her comments on Zimbabwe and on preventing another Free State were heartening. But it is unknown whether Hogan will be reappointed after this month's election. She is under fire for criticising the government on the Dalai Lama issue.

Claire Keeton: The Times, 5 April 2009

Coming to their AIDS

THE FOURTH South African AIDS Conference, held last week in Durban, once again shone a necessary spotlight on the progress of the epidemic. The statistics are appalling. In South Africa almost 1 000 people die every day from diseases associated with AIDS. Some 5.5 million South Africans live with the virus - a significant portion of the 39.5 million people worldwide who bear the disease. South Africa's epidemic has now reached the stage where increasing numbers of people are dying of AIDS. Official mortality data show that the total number of deaths from all causes in South Africa increased by 79 percent between 1997 and 2006. Much of the rising trend in death rates can be attributed to the AIDS epidemic, and the increasing death toll has driven average life expectancy below 50 years in three provinces: Eastern Cape, Free State and KwaZulu-Natal. The virus continues to spread at a frightening rate. For every new person receiving antiretroviral treatment, another 10 become infected. In this context it is heartening that during the conference, celebrities such as film producer Anant Singh, Springbok captain John Smit, filmmaker and writer Jann Turner, the legendary Sipho "Hotstix" Mabuse, soccer star John "Shoes" Moshoeu, and Tendai Mavundla, the brave Idols contestant who disclosed her HIV status on that show, all joined in to try to destigmatise the pandemic and to persuade people at all levels of society to get tested, an important prerequisite for dealing with the disease. But unless those going for a test have reason to believe that adequate and affordable treatment will be available if they need it, many will shun the test which could save their lives.

Editorial Comment: The Cape Times, 6 April 2009

'Health sector needs to work with scientists'

HEALTH Minister Barbara Hogan is considering setting up an advisory committee to bring politicians and scientists together after the breakdown of relations during the Thabo Mbeki era. Hogan told the scientific advisory board of the Centre for the Aids Programme of Research in SA (Caprisa) that it was very important that there was a respectful relationship between government and scientists and that government needed a more structured relationship with scientists. She said the Health Act made provision for a consultative forum. Hogan warned that policy-making was "messy" and appealed to scientists to consider financial constraints when making recommendations to government. She said that while some researchers believed the antiretroviral treatment programme was sub-optimal because treatment should be started when the CD4 count was 350 and not 200, this had enabled almost 700 000 people to be put on treatment in five years. Caprisa, one of South Africa's foremost research institutes, comprises scientists from the universities of Cape Town, KwaZulu-Natal, the Western Cape, Columbia in New York, and the National Institute of Communicable Diseases. For the first time, Caprisa gave special awards to three scientists for their outstanding contributions to HIV/AIDS research in the country. Professor Bruce Walker, director of Harvard University Centre for AIDS, was recognised for his exceptional contribution to building research capacity and infrastructure in South Africa. Last week, at the closing ceremony of the 4th SA Aids Conference in Durban, Hogan raised concerns about the health crisis in Zimbabwe, saying the country's deteriorating health system could no longer be dealt with by that country alone. Hogan said it needed to forge partnerships with South Africa that could provide expertise to help improve their health system. Hogan raised concerns about inadequate drug supply problems in Zimbabwe - which had a direct impact on the success and strengths of South Africa's antiretroviral therapy (ART) programme.

Kerry Cullinan & Sipokazi Maposa: The Cape Argus, 7 April 2009

Major breakthrough in TB research

THE world's deadliest strain of tuberculosis - extremely drug resistant TB (XDR-TB) - may soon be curable. In a discovery that could mean the difference between life and death for people infected with XDR-TB, scientists from the US's Albert Einstein College of Medicine and the National Institute of Allergy and Infectious Diseases (NIAID) have shown in laboratory experiments that two antibiotic drugs working in tandem can kill laboratory-grown strains of the bacterium that causes TB. The breakthrough is published in the latest issue of SCIENCE. Locally, Dr Lindiwe Mvusi, TB manager at the Department of Health, hailed the discovery as significant. The drugs - meropenem and clavulanate - are already used to treat bacterial diseases like E.coli. According to an NIAID report, researchers, in a series of laboratory experiments, determined how the drugs inhibited the growth of Mtb strains. In addition to killing drug-susceptible strains of Mtb, the combination also worked on strains of XDR TB. The study found that clavulanate inhibited a bacterial enzyme that normally shielded the TB bacteria from the other antibiotic, meropenem. Now researchers from the Nelson Mandela School of Medicine at the University of KwaZulu-Natal, led by dean and interim director of the KwaZulu-Natal Institute for TB and HIV Research, Professor Willem Sturm, are testing the potency of the drug combination in a small number of TB patients. If the tests prove successful, the study will be expanded to include more TB patients. In 2006, the World Health Organisation announced that a deadly new strain of XDR-TB had been reported from the Tugela Ferry district in northern KZN. Of the 544 patients studied in the area, 221 had multi-drug-resistant TB. Of the 221 cases, 53 were identified with XDR-TB while 44 of the 53 were tested for HIV - all were found to be positive. Within 16 days of first being diagnosed through sputum specimen collection, 52 of the 53 patients died. Currently in South Africa, one in every four cases of TB is XDR-TB. There are no reliable drugs to treat the strain, and treatment involves being hospitalised for close on a year.

Jillian Green: The Star, 23 April 2009