A Deadly Cocktail in South Africa

Richard Tren | 10 Jan 2005
TCS Daily

On Thursday Nelson Mandela's eldest son, Makgatho died tragically from an AIDS related disease. Mandela has been widely hailed for being open about the cause of his son's death. In a country where the stigma of AIDS forces people to lie every day about the disease, Mandela's move was indeed brave and is another example of his extraordinary moral courage and leadership. Right now, South Africa is in desperate need of more leadership of this nature. The same week that Makgatho Mandela died, controversy rages about the safety of the AIDS drug Nevirapine. The South African government, far from providing balance and reason, seems to be creating confusion and adding to stigma. The acrimonious relationship between the South African government, NGOs and the drug developers does untold harm to the effort to roll out essential treatment. All of this confirms the opinion that we have held for many years; that the simple message that drug patents block access to treatment is wrong.

Nevirapine is a non-nucleoside reverse transcriptase inhibitor, and is known to be highly effective at preventing mother-to-child transmission of HIV and is also used in triple therapy for people living with HIV/AIDS. When used to prevent mother to child transmission, a single dose is given to the mother when she begins labour and a single dose is given to the infant.

Despite the fact that the drug works and can save thousands of lives, the South African government had to be taken to the highest court in the land, the Constitutional Court by the AIDS activist group Treatment Action Campaign (TAC) before it would provide the therapy. Cost cannot have been an issue as Nevirapine's producers, Boehringer Ingelheim, offered the drug for free. The government's reluctance to provide treatment probably has more to do with its own AIDS denialism than sound medical or economic policy.

In September 1999 a study, known as HIVNET 012, was published on the use of Nevirapine in Uganda by, among others, the National Institutes of Health (NIH) and Johns Hopkins University. Subsequently some deficiencies in the documentation of the study were reported and even though the NIH has clarified the deficiencies, the ANC and South Africa's Minister of Health claim that the drug is unsafe. This is despite the overwhelming evidence that the drug is safe and effective. Thousands of pregnant women have been given Nevirapine without a single life threatening adverse effect being recorded.

Shortly before Christmas, an ANC newsletter accused TAC of "discounting the lives of Africans" and questioned the US government's motives in providing Nevirapine to Africans. For those South Africans that are taking Nevirapine as part of ongoing antiretroviral therapy and for those HIV positive pregnant women, the controversy has been confusing and frightening. There is a great deal of stigma attached to HIV/AIDS and so people are reluctant to be tested for the disease. The last thing that South Africa needs is for people to stop their treatment or to refuse to be tested for HIV in the first place because they think the treatment is harmful.

To add to the confusion a new body known as The Traditional Healers Organisation (THO) has added its somewhat dubious voice to the debate. In a large advertisement placed in South Africa's Mail and Guardian newspaper, the THO claims that it comprises more than 20,000 members and "reaches out to a total of almost 200,000 Traditional Health Practitioners" whatever that may mean.

Many South Africans consult traditional healers who treat them with the leaves, bark and roots of numerous plants, following generations of handed-down advice. Although many South Africans trust traditional healers implicitly, THO is attempting to promote its craft by making some ludicrous (and I would think libellous) claims. For instance it states that:

"The fatal side effects of prescription drugs have become the hallmark
of modern pharmaceutical-based medicine. In the United States and the
industrialised world the epidemic of deadly side effects from pharmaceutical
drugs have become the third largest cause of death."

Without bothering to substantiate its claims, the THO goes on to state that:

"Currently the pharmaceutical industry is being exposed globally as an
investment business that is responsible for the premature death of millions
of people."

The THO states that Africans are being used as guinea pigs by the international drugs industry because they are taking Nevirapine -- a claim also made by South Africa's Minister of Health. Bizarrely, the traditional healers then accuse TAC of being a pharmaceutical interest group and of greedily trying to destroy humanity. The THO then appeals "to all Health loving individuals and institutions to further investigate the TAC's intentions to disturbalize the country's peace, justice and stability" (sic).

In a moment of nauseating sycophancy, the THO then commends the "efforts of OUR Government through the office of the Minister for putting up a committee that will further investigate this deadly deeds." (sic)

The THO doesn't seem to have a website (perhaps that wouldn't be traditional enough) and the number provided for their spokesman is never answered and so it hasn't been possible to get clarification on their many mysterious statements.

One thing we can be sure of however is that the TAC is not a pharmaceutical interest group. They have conducted a successful and often acrimonious campaign against the research based drugs industry for many years. Their chairman, Zacchie Achmat has accused the drugs industry of having blood on their hands for defending their drug patents. He even accused me of endorsing genocide for daring to suggest that patents were not the problem in AIDS drug access. While I consider the TAC to have got it wrong on drug patents, they have played an invaluable role in challenging the stigma of HIV/AIDS and in forcing the South African government to roll out desperately needed AIDS medicines.

The attacks on the drugs industry and TAC by government and the traditional healers show how far South Africa has to go in order to roll out a comprehensive AIDS treatment programme. South Africa could learn a great deal from its neighbour to the north, Botswana which has been running an excellent AIDS treatment programme for several based upon cooperation and partnership between government, the drugs industry, academia and NGOs. It is shameful that South Africans will die needlessly because the government prefers to play politics and ignore good science and medicine. Our sympathy goes out to the Mandela family and we hope that Nelson Mandela's leadership and courage will somehow rub off on the ANC government that he used to lead.

Tren is a director of the health advocacy group Africa Fighting Malaria and is based in Johannesburg, South Africa.