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Beat It! 1999 Episode 4

In this episode of Beat It! the team interviewed a whole spectrum of people with experiences around the prevention-of-mother-to-child-transmission and with their help debunked the argument that the roll-out of PMTCT would be economically impractical. The episode actually arrived at the exact opposite conclusion: by not rolling-out PMTCT AIDS sick babies will place bigger strain on the healthcare system. The episode also addressed the differences between HIV and AIDS.

Mercy Makhalemele: Hi, my name is Mercy Makhalemele. Welcome back to Beat It! – your guide to better living with HIV/AIDS.

Sipho Nhlapo: Hi, I’m Sipho Nhlapo, in case you are wondering about this T-shirts yes, Mercy and I are both positive. Not so bad hey?

Mercy Makhalemele: Abakithi ngenke nikolwe basixoshile kulela bonda eGlaxoWellcome, {isiZulu} [Guys you wont believe it, we were kicked out at GlaxoWellcome,] but you know Sipho its hard for grown ups to have HIV but for babies it’s even worse because their systems are even weaker.

Sipho Nhlapo: Last week we saw that there are new medicines that will prevent HIV mothers from transmitting the virus to their babies however government says that they can’t afford this medicines because they are too expensive.

Mercy Makhalemele: Kulele viki bakithi I [This week the] Beat It! Team report back on how much it’s going to cost to treat babies in the hospital, kimi [to me] it looks as if it is cheaper to provide the medicines in order to prevent infecting their babies akuzibonele wena [see for yourself]. {isiZulu}

Special Report - Prevention-of-mother-to-child-transmission Part 2

Narrator: In South Africa sixty thousand babies are born HIV positive every year. These children will fall ill much more frequently than uninfected children, some mothers might be healthy enough to take care of their babies, other mothers will become too ill while yet another will die and leave their children orphaned. Finding someone to care for these orphans is not an easy task. Until recently Nazareth House in Cape Town was the only children’s home specialising in the care of HIV positive children.

Jane Payne (Social Worker, Nazareth House): We are Nazareth we are only looking after children that nobody else will look after.

Narrator: The larger community is generally unwilling to look after these children.

Jane Payne: There is a lot of stigma attached to being HIV positive in the black community particularly they don’t understand the disease, the illness, they fear it themselves. Many women are ostracised if the family knows that they are HIV positive.

Narrator: Also caring for these children is not easy.

Jane Payne: HIV infected children often become, get quiet ill, they suffer from diarrhoea, they have sores, they get pneumonia, flu and so they need a lot of medical care. Once they get the first signs, we see them getting sick they must be treated pretty quickly, otherwise they get ill very quickly, we have to admit children in hospital a lot, we back and forward to the hospital; regular clinic check ups.

Seabelo Kgarosi (Person Living with HIV): I see how the children with HIV related diseases look like and how they suffer.

Rachel Pelo (Person Living with HIV): There was this research that was taking place at Chris Hani Barangwanath Hospital; the AZT they were giving to mothers who are infected then I thought let me have a chance; let me go for it, it might help, it might not help but the chances are there. I had this picture I might be one of the people who would be lucky and bring a health baby to life.

Narrator: UNAIDS estimates that in five years time 61 out of 1000 babies in South Africa will die before the age of one. Without any intervention about 30% of all HIV positive pregnant women who transmit the virus to their babies. However it is possible to stop this tide. Studies have shown drugs like AZT and Nevirapine can bring the percentage of babies’ infected by HIV virus down to 15%.

Rachel Pelo: His happy and his HIV negative through the help of AZT.

Narrator: Some feel the state should not intervene to prevent the transmission of HIV virus from mother-to-child. They say if the state intervenes and healthy babies are born to HIV positive mothers, these babies will put a burden on the state once they become orphaned. Is this a defensible argument? Professor James McIntyre who sees increasing number of HIV positive pregnant women at Chris Hani Baragwanath Hospital disagrees.

Prof. James McIntyre (Co-Director of the Perinatal HIV Research Unit): I think it was put very strongly to me by somebody in government in Mozambique when we were discussing and she said you know, in this country we have a lot of orphans from the war and they are a real problem and yet I’ve never heard someone suggest that we should go out and kill them to solve the problem. The treatment is not creating all the AIDS orphans they are going to exist anyway. I think that the answer is to move on those services. It is also very much easier to find foster homes and services for HIV negative orphans than for HIV positive orphans.

Rachel Pelo: We the Africans we have a big family whereby before we used to know that auntie can take care of the kids, so we need to go back to ubuntu, [I am, because we are,] our culture and see how can we accommodate that, so that we are not left with kids that will give the government problem. {isiZulu}

Narrator: The majority of HIV positive infected children will live beyond their first year. Experts like Prof. Greg Hussey of UCT says, taking care of HIV ill infected children will have serious implications for the public health services.

Prof. Greg Hussey (Head of Paediatric Infectious Diseases at UCT): 15 to 35% of all the paediatric beds are full with HIV children. Those beds could be freed up for other children who need admission to hospital. The whole services are in a crisis I mean beds are being cut through out the country.

Narrator: At the moment it costs R400 per women for AZT needed to bring down the transmission of HIV between infected mothers and their babies from 30% to 15%. However government says it cannot afford this price.

Prof. James McIntyre: Manufactures of AZT have already brought the price of AZT down by 70 to 75% for the public sector. We believe, and we told them we think they can do better than that.

Narrator: HIV activists like the Treatment Action Campaign say although GlaxoWellcome reduced the price of AZT it will still make large profits on sales. However drug companies like GlaxoWellcome are not solely to be blamed, government should also be held accountable.

Prof. James McIntyre: I haven’t had a firm price form the government as to what they say is affordable. We asked for this before the election, I think there was a meeting with the Treatment Action Campaign they were told that they will be given a price in June but of course the change in Minister and the change in approach this has not happened. We are really in the little bit in the dark. Nobody said get it down to this price and we can do it and I think that that is one of the problems we don’t know what we are fighting against.

Narrator: Currently the AZT needed to bring down the rate of HIV transmission form mother to babies costs R400. Although government says they can not afford this price, researches say caring for these babies will even be more expensive.

Prof. Greg Hussey: Children get sick quicker; they tend to develop more severe diseases and they tend to have frequent admission to hospitals for severe illnesses. Many children have repeated admissions to hospital and we had cases where children come back five, six, and seven, eight…ten times a year.

Narrator: Children with HIV also take time again.

Prof. Greg Hussey: A child with pneumonia without HIV will spend five days in hospital and a child with pneumonia and HIV will spend ten days in hospital. And if you just look at the basic cost for example of admission to hospital, like Somerset Hospital just for a bed it works out to be R400 a day. So ten days for HIV positive child with pneumonia is about R5000. Compared to two thousand R500 for a non HIV positive child; we really save a lot of money. That’s besides the saving on the treatment with antibiotics and the other medications that are needed to treat pneumonia.

Narrator: Even those who don’t need hospitalisation need a lot of constant care which comes at a price.

Jane Payne: It costs Nazareth House R2500 a month to look after each child in our care. Just bear in mind that we have to have 24 hours staff all the time. We get a government grant which is the third of what it cost to look after a child and the rest is fundraising. Our children only have normal medication; antibiotic, vitamins they don’t have fancy drugs there isn’t any money for that.

Narrator: Studies like the Wilkinson study undertaken by the South African Medical Council and another done at the Baragwanath have definitely shown that it will be cheaper to provide mothers with anti HIV drugs like AZT, to prevent their children from being infected than treating HIV positive babies.

Prof. James McIntyre: We believe strongly that an AZT programme will be cost effective and it will be cost saving. In other words what it will cost you to implement you will save in the long run because to treat infected children, and regardless what you do to infected children, they are a drain on health systems.

Narrator: But trying to justify intervention programmes where you have long term benefits could be tricky.

Prof. James McIntyre: It’s difficult sometimes to argue with government about things that are cost effective because they have to spend money up front now and is not that easy for a politician to be able to justify saving money later if they don’t have money now.

Narrator: However for those working with HIV positive children the benefits are clear.

Jane Payne: If the mothers received, when they were pregnant received the drug to prevent the baby to being born then we wouldn’t have to look after these children, they wouldn’t suffer so at Nazareth House we see the end result if it can be stopped it should be stopped.

Joy Shezi: Okay ngizizwa ngijabulile ngoba bakwazi ukuthi banginikeze amapilisi i AZT. Ngakwazi ukuthi umtanami a phume right anganalo igciwane futhi ngiyathanda bayephambili banike nabanye abantu abakhulelwe. Kwazi abatwana babo baphile. [Okay, I feel very glad that I was given AZT and that I gave birth to a child who is HIV negative. I wish that they must go on giving other pregnant mothers to save their children.] {isiZulu}

Narrator: A recent Ugandan study done with the drug called Nevirapine showed that a single dose of this drug to mother and baby costing about R40 can also reduce the percentage of infected babies being born to HIV positive mother from 30% to about 13%. A complementary trial involving Nevirapine is currently run in South Africa. Whether the government will implement an intervention programme if this drug proves to be successful remains to be seen.

Prof. James McIntyre: I think we are seeing a change in that, I think we are seeing the Treatment Action Campaign holding alliances at the gates of Baragwanath Hospital with lots of people there. We are seeing the pickets at the American Embassy about drug prices, I think I am perceiving a ground swell of support that really is starting to mobilize the community, I think that’s how it should be.

Narrator: As for Jane Payne the case for providing medicine to prevent mothers to child transmission is clear cut.

Jane Payne: They have a lot of arguments on why they shouldn’t give mothers the AZT and various drugs but I don’t think that we got a moral right to make that judgment. The drug that exist we should stop a baby being born HIV infected. The cost of looking after a sick child is enormous, hospital cost, cost in a place like Nazareth House the money can be found I’m sure and it should be found.

Sipho Nhlapo: Last month the drug companies temporarily suspended their legal action against the government from importing AIDS medicine from the countries where it is sold at a cheaper price. They also don’t want our government to give permission to local companies to manufacture the medicine here in South Africa at a reduced price.

Mercy Makhalemele: Sipho I could do the award ceremony this week because those people who don’t know anything about treatment; thinking it would be better for children to die rather than be born healthy deserve the noose.

Sipho Nhlapo: I kinda agree with you Mercy, but we have to wait for Marc to give out the nooses. Now first it is time to move on to information for better living with HIV and AIDS. This week Luanne and Adeline are making some kind of power drink it sounds interesting, but first we drop in on Faghmeda and Steve.

Treatment Literacy

Faghmeda Miller: Last week doctor we discussed the difference between HIV and AIDS because a lot of people believe HIV and AIDS is the same thing. We have discussed the HIV virus that causes the illness called AIDS. So what is AIDS actually?

Dr Steve Andrews: Faghmeda, I’m glad you ask me that. It’s a common problem to distinguish HIV and AIDS and it cause many difficulties both for the person who is HIV infected and for the people who have to deal with him or her. Essentially the difference is a simple one. As you said HIV is the virus itself, it is the thing that causes the illness AIDS or the Acquired Immuno Deficiency Syndrome, the name we give to the last stage of HIV illness.

Faghmeda Miller: So what you are actually saying is that someone who are HIV positive does not have AIDS?

Dr Steve Andrew: That’s exactly what I’m saying. Most people who have HIV do not have AIDS. This can be a bit of a problem because a lot of people who are HIV infected do not have any symptoms at all and can be unaware that they have an illness at all. This can mean while they are HIV positive they can pass the illness on to their sexual partners.

Faghmeda Miller: How long does it actually take before you develop AIDS?

Dr Steve Andrews: Different people will progress to AIDS on a different rate. On average HIV can progress to AIDS in anything from 7 to 12 years. The majority of people they are going to fit to that but some people will even progress more rapidly and there was a very small percentage of people who we call the long term non progressors who will live even longer.

Faghmeda Miller: There’s quite a big difference. So how do I know that I’m going to live longer or am going to get ill right away?

Dr Steve Andrews: The big difference here is the immune system, in general if the immune system is stronger the person will live longer. What it implies to people who are HIV positive is living healthy and as we’ve already discussed eating, exercising well, it also means treating illnesses rapidly so they do not lower the abilities of the immune system to defend the body.

Faghmeda Miller: Are there any other things that can cause for an HIV positive person to get sick quick?

Dr Steve Miller: Faghmeda, in parts of Africa we see people progressing from infection to AIDS in under five years. There is a sharp distinction between the first and the third world in this case. People who have access to quality healthcare, who have access to good running water, who eat well do better than people who don’t have these things. Even our country in South Africa there is a sharp distinction, between people with access to good nutrition and good quality healthcare and those people who do not, in terms on how rapidly they will progress to AIDS. This is a matter of enormous importance and one that we need to raise more frequently, more forcefully.

Faghmeda Miller: I understand when you are HIV positive it takes quite a while for you before you develop full blown AIDS. Now myself what would you say, were do I stand in this, will I get sick now or in the future. How do I find this out?

Dr Steve Andrews: There are ways of finding out and your doctor can actually measure your immune system by measuring your T cells or CD4 cell this gives a good idea where you are now with your illness. Sometimes your doctor will also measure the amount of HIV in the blood and this can also help not only in showing where you are now but in showing were you going to go and how fast you going to go there.

Faghmeda Miller: Well doctor I am very glad that we have sorted out this difference between HIV and AIDS ’cause now I’m also clear about it. We will be back with discussing other treatment issues that we need to be aware of.

Dr Steve Andrews: It’s a pleasure.

Food for life

Marc Lottering: Wait a minute girl watch it nê? [right?]. I told you last week to watch already. Ja, man the cooking is surprisingly basic for TV, but is nogal [rather] interesting. Okay call you back. Call you back. {Afrikaans}

Luanne Epstein: Hello, I’m Luanne, welcome to food for life.

Adeline Mangcu: Hello, I’m Adeline. I know this programme is all about garlic. Could you explain what you are wearing around your neck?

Luanne Epstein: It keeps you in your spirits Adeline. I’m not sure if I believe that, but I can assure you that garlic will frighten away germs and diseases. Garlic is one of the best food essences we got because it strengthens the immune system. If you are living with HIV/AIDS that’s important because your immune system needs all the help it can get. Today we are going to show you the recipe for our power drink that can really help to fight those bugs.

Adeline Mangcu: Let’s just call it the garlic gladiator

Marc Lottering: Adeline you’re a stouter [joker], now South Africa finally gets to see gladiator on e(TV) and on garlic of course. {Afrikaans}

Adeline Mangcu: One large clove of garlic chopped, a table spoon of ginger, if you don’t have fresh ginger then we can use half a teaspoon of ginger, one teaspoon of turmeric also known as borrie, add half a cup of water and another cup of milk. If you are struggling with diarrhoea do not use the half cup of milk, instead add another cup of water.

Luanne Espstein: Now we boil this together and we let it simmer for ten minutes. I always use real spices instead of flavouring cubes; flavouring cubes contain flavourants, colourants and preservatives which upset the immune system and weaken the ability to fight diseases.

Marc Lottering: Oh dear, some pot for the pot, ag nie [oh no], I’m joking. It’s the colonel’s herbs and spices. It’s just a storage space. Luanne ek gooi sommer alles in [I just through everything in]. {Afrikaans}

Adeline Mangcu: Now here is another safety tip a wooden board and a plastic board. Now which one is better? I say the better one is the plastic board because you can wash it with hot soapy water and then rinse it in warm water but do not wipe it with a dishcloth because the dish cloth might leave some germs on it. So this can be thoroughly clean but with the wooden one some of the germs might be stuck in between the wooden pieces that make up of the wood, so it’s better for us to us this plastic board instead of the wooden one.

Marc Lottering: Ja, so what? My cutting board is not exactly cutting?

Adeline Mangcu: The recipe is also easy to remember, one clove of garlic, one sprig of parsley add oil, freshly ground black pepper and amasi or Plain yoghurt. And it becomes a beautiful vegetable dip or spread for the bread.

Luanne Epstein: By eating yoghurt, amasi every day, one can prevent diseases like thrush and diarrhoea which people with HIV and AIDS often get. Antibiotics can be a real life saver because they kill bad bugs, but they also wipe out the good bugs that live in your body, good bugs help to keep the bad bugs away when buying yoghurt look for the AB Mark this means that the yoghurt contains the good bugs. Also it’s better to buy plain yoghurt without sugar.

Marc Lottering: I think I will have a teaspoon of brandy with mine, would you believe it I’m all out of teaspoons… well I’ll pour.

Adeline Mangcu: How is the brew coming up Luanne? A cup of this a day is excellent for strengthening your immune system you should take four cups of this when you are feeling ill.

Marc Lottering: Not bad at all; ek lieg nie vir jou nie [I’m not lying too you]. {Afrikaans}

Luanne Epstein: It’s not exactly a milkshake, but it will give you a boost.

Adeline Mangcu: Bye everybody see you next week.

Marc Lottering: I hope this works. Bye.

Sipho Nhlapo: You know Mercy it’s like Steve said there are treatments available for HIV and AIDS but it is up to us to fight for them.

Mercy Makhalemele: Ma Africa it doesn’t seem right to be worrying about money when people are dying in their thousands.

Sipho Nhlapo: Treatment Action Campaign is saying; TAC wants our government to be able to buy medicine at the cheapest price.

Mercy Makhalemele: Well if that is what Treatment Action Campaign is doing then it deserves our support.

Sipho Nhlapo: Well talking about our kind of people, let’s see who Marc is giving the Positive Person Award too.

Mercy Makhalemele: And who gets the Noose too.

Positive Person and Red Noose Awards

Marc Lottering: Hello, this is me Marc again amazing nê, ek wil net ook nie change nie [right, I just don’t change]. Now this week the Red Noose goes to all those who support what must be the most ridicules argument I’ve heard in my entire life. There are people out there who believe it or not, who argue that unborn babies should be allowed to get HIV from their mothers because their mothers will die while they’re still young; they also argue that the society can’t afford to look after these AIDS free orphans. Well to all of you, may you have many bad hair days, I know what that feels like, and afterwards go and hang yourself. Now the Positive Person Award is shared by a number of people this week, it goes to all those marvellous people at institutions were AIDS babies are cared for. Some of those that we can think of include Nazareth House, Beautiful Gates in Crossroads, Sparrow Rainbow Village in Roodepoort and the Diana Princess of Wales Mohau Children Care in Pretoria and also to individuals like Pat van Rensberg and her husband who are caring for abandoned HIV positive children; vir julle gee ons ‘n hart [to you we give the heart], and this is me, Marc, saying until next week, please take heart and watch out for that Red Noose. {Afrikaans}

Sipho Nhlapo: Okay ke bakwethu {isiZulu} [yes my people] that’s what we have time for this week. We have enjoyed ourselves we hope you did too. Until next time from Mercy and myself remember that we can Beat It!

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