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Beat It! 2000 Episode 8

In this Beat It! episode the economic implications of not rolling out an antiretroviral treatment plan were looked at. In the profile section Seabelo Kgarosi pointed out how myths and disinformation around HIV/AIDS could lead to further compromised health and well-being.

Paddy Nhlapo: Njenge nhlala yenza [as usual] let me welcome come you back to this addition of Beat it! Mercy kunjani? {IsiZulu} [how are you?]

Mercy Makhalemele: Ngikhona. {IsiZulu} Paddy. Yes, Beat It! – is the guide for better living with HIV/AIDS. Each week we bring you a special report on some aspects of the epidemic, because being informed is the only way to take control of your life when you are living with HIV like ourselves. So what’s on for this week?

Paddy Nhlapo: This week sibuza umbuzo obalulekile: {IsiZulu} [we are asking a very important question:] can South Africa afford not to make antiretroviral medicines available to all of our people that need them? Antiretrovirals are the medicines which fight HIV, the Human Immunodeficiency Virus that causes AIDS, in case you were in any doubt on that subject

Mercy Makhalemele: Great. You know, I think if it were not for these medicines, you probably would not be seeing the two of us standing here right now. At the moment, the only way most South Africans can get access to these drugs is through clinical drug trials. So let’s take a look at how practical it would be to introduce these medicines more widely.

Profile - Seabelo Kgarosi

Seabelo Kgarosi: Ke mme omutjha ophelang ka lefu laAIDS. Ke diagnosed HIV ka 1996 ko Chris Hani Baragwanath Hospital February again. Ha kenne ke excpecta lastborn yaka Tsenulo. {Sesotho} [I’m a young woman living with HIV/AIDS. I was diagnosed HIV positive in 1996 at Chris Hani Baragwanath and again in February when I was expecting my last born.] The first thing that occurred to me was dying; and what about the baby that I’m carrying? The very same day I experienced abuse. By my husband, the man I loved. Then, that night, he said there is a man we have to see; a traditional healer. I went into his consulting room. After throwing the bones, he said I was carrying a snake. That was their plan to induce a traditional abortion. Then I had to take my clothes off, was put in a bath and washed. In the morning, around five, my water burst, followed by blood. The blood wouldn’t stop. It was uncontrollable. I was admitted to Ga-Rankuwa Hospital, treated for a few hours and then discharged. At Ga-Rankuwa they saved my life and the life of my child. To the extent that on 6 June 1996 I gave birth to a baby boy. Anyway, I attended the disclosure campaign run by Mercy Makhalemele. From there I was empowered and started a group of volunteers for the community. So that is how we started Sizanani, a group for the infected and affected. There are 20 women in Sizanani, including myself. It consists of ten infected and ten uninfected members. The reason is to show the community that people with HIV are accepted. Also, those who are not infected are the ones who accept them. As a result, it will be easy for them to accept their own children. Knowing that there are men who are infecting women, knowingly, as a woman I would say, give the women this advice: Let once no be no. And once yes, be yes. And, for every sexual or what … For every sexual request, use a condom. So we as women should stand up and use, practice, our rights. If he says he can’t, then I use mine. If I can’t use mine, he uses his like I’m doing now.

Special Report - Antiretrovirals

Zackie Achmat: We who have HIV cannot afford to die in silence while our disease is being denied a name. We are dying in large numbers. We are dying in large numbers and our president won’t acknowledge that we’re dying because of AIDS and HIV. That is not acceptable.

Dr Ezio Baraldi: This is a drawing of the CD4 cell, which is the primary cell in the immune system which is attacked by the virus. Our drugs work primarily here. The nucleoside analogues work here: they prevent this copying of the virus from its normal form into the human form. The non-nucleosides work here: by blocking this enzyme which is responsible for the process. The protease inhibitors work down here: this whole process has already taken place, but by blocking the protease enzyme over here, the virus can’t be assembled and it can’t be released to infect the next cell.

Dr Eric Goemaere (Head of MSF: South Africa): For one specific disease, AIDS, there’s so much of a difference between what’s happening in the north, and what’s happening in countries like this one. In my country, AIDS became a chronical disease, a bit like TB. You can give it treatment, it’s annoying still because you need to take your pills, but it’s a chronical disease. Here, to be identified as positive means a death sentence.

Dr Lawrence Bitalo (Chief Medical Officer, Khayelitsha): This epidemic is going to change the face of Africa, permanently. The economics, the cultures, the political leadership, the whole face is going to change when are talking about 20%, 30% of the population die.

Clem Sunter (Director, Anglo American Corporation): Nobody has properly costed out what not treating employees can do to their companies. The fact that employees will get sick, that they’ll absentee themselves, that their productivity will decline, that ultimately they will die and will be replaced by novices, some of whom may well be HIV positive, and you’re not allowed to pre-employment test. Those novices who are HIV positive will actually die before their apprenticeship programme ends, well there’s a large possibility. And therefore you get into a very quick cycle of replacing employees.

Dr Lawrence Bitalo: I was talking to another chap and he was telling me a story. He’s a student at UCT; he comes from one of the countries which is endemic. And he told me that in his district, the whole local government leadership passed away. And then the community chose one of the local sweepers, in the city hall, in the town hall, to become the mayor of that town. That’s what we are talking about.

Clem Sunter: What one will see is what you are seeing at the moment in places like Zululand, which is, you will see communities literally dying on their feet. And and I was taken to one or two villages, and again you don’t see any pictures in the press of this, you know, and it’s terrible, because people are dying. And you see the kids with Karposi’s Sarcoma, on their faces, and you realise it’s not a question of 10%, 20% of these communities which is being devastated, the whole community is being devastated by HIV and AIDS.

Toby Kasper (MSF, South Africa): We have to look again to an example like Brazil. Brazil is a country that is able to afford to provide its citizens with antiretrovirals because it has what are called generic medicines. Generics are drugs that are not under patent. Patents are a sort of monopoly given to a pharmaceutical company, it means that they are the only people who can sell a particular drug in are particular company, in a particular country rather. In Brazil there were not patents on the antiretrovirals until quite recently. As a result, a lot of different companies and in fact the state laboratories as well, produced antiretrovirals. This created a situation of competition between the generic manufacturers, and that reduced the prices very effectively. Over the past five years in Brazil, prices of generic antiretrovirals have fallen by almost eighty percent.

Clem Sunter: And there are those drugs available, they’re being used in Thailand fairly successfully. But it’s rather like in a Pick ‘n Pay, you have brand names versus no brand products and as I said, the problem is, with generics, is I believe that there is less quality control than there is for the brand names.

Toby Kasper: Research that we’ve conducted, talking to generic manufacturers, thinking about the size of the market, lead us to believe that it’s possible to have a triple combination, that is, taking three ARVs together, which is the recommended approach, for as little as R1500 a year, R1500 per year, much cheaper than it’s currently available.

Clem Sunter: When people say: “Oh yes, but triple drug therapies are between 35 and R50 000 a year”, my response is: “Have you negotiated with the multinational drug companies? Because they are offering deep discounts on those drugs and I believe that we could get the cost of those drugs right down to something very reasonable.”

Ahmed Lulla (Director, Cipla India): Cipla is open to any situation. Cipla, if needed, we manufacture the drugs in South Africa. If there’s advantages to manufacture them in India, we’ll do so. The focus will be on the quality, if Cipla can assure quality. Cipla does not have manufacturing plants in South Africa. But if it is important for South African authorities that the drugs are manufactured in South Africa, Cipla will do so.

Clem Sunter: The government’s got a hard problem there. They’ve got to balance their budget. And therefore, they’re going to have to take money from somewhere else in order to fund the weapons to be used in the HIV war, i.e. triple drug therapies, but equally double drug therapies, and maybe other treatment as well. So, they’re gonna have to find a way of rationalising their budget, and that could take time. But, my view is very simple: the government must actually treat this like a war, and in fact do what it would do in a normal war, which is precisely: reallocate resources from other departments to the department which is responsible for providing these treatments.

Toby Kasper: This is an epidemic that’s infecting about a quarter of SA’s Population, maybe it’s 20 %, maybe it’s even 15%. But a country has never survived having that significant a percent of its population infected with a deadly virus, without massive societal disruption. If something isn’t done to provide antiretrovirals to South Africans, a quarter of this country’s population may die of AIDS. There’s no way the society can survive that. The economy would be devastated. The impact on families, on children would be massive, if unless people receive the only treatment we know of that can stop HIV, namely antiretrovirals.

Clem Sunter: So we’re now in the middle of a war, and as I keep saying, if it was a war against a human enemy which was threatening to invade us and to kill 15% of our population, which is six million South Africans, we would have resurrected the citizen force, we would have bought tanks, aircraft, submarines. We would have bought the whole lot, and we wouldn’t have thought about the cost because we were under threat. Here you have an infinitesimal bug which is doing precisely the same, which is taking out young people because that’s what a war does, a war takes out young people, you have exactly the same here a war which is taking out young people, and we start talking about the costs of this and the costs of that, and the controversies here and the controversies there. What we’ve got to do is win the war.

Mercy Makhalemele: You are watching Beat it! So Paddy, if we could import medicines freely from Thailand, India and Brazil, we could put a basic antiretroviral cocktail together for less than R200 per month. Many of us could afford it or get the money, don’t you think so?

Paddy Nhlapo: Yoh, I would rather pay for my medication and know that I keep my viral load down and my CD4s up, than be dependent on a drug trial. I mean, what happens after the trial is over?

Mercy Makhalemele: Talking about our CD4s, and our immune system things, Dr Herman is with us in the Support Group to talk about that subject so let’s go and see what he’s got to say.

Support Group - TB or not TB…

Antoinette Fouché: Daar is baie mense wat vir my se dat almal wat rondloop in Suid Afrika of waar ook al het TB, het die TB in ons longe maar op een of ander stadium soos jou immuniteit swak raak dan sal hy uitkom. Is dit waar dat ons almal geinfekteer is met TB maar dit net nie wys nie. {Afrikaans} [There’s lots of people that say to me that all people who move around South Africa have TB in our lungs, so the moment that your immune system is damaged, it comes out. Is that true that we’re all infected with TB but that it doesn’t show?]

Dr Hermann Reuter: The history that usually leads the doctor to think about TB is a cough that doesn’t get cured easily. But if, together with the coughing, people say: “I’ve been coughing for a long time now, and I’m losing weight”, I think the losing weight part is very important to make the doctor think about TB. If you take every layer of the lung and actually put it separately, patch for patch, you would cover the whole rugby field. So as you breathing, every time, the size of a rugby field is exposed to the germs that you are breathing in. Your skin is a very small surface exposed to germs, and it’s very thick. Your lungs is a very delicate, little membrane, thin, and the germs go there, and you need an immune system to block the germs right there, before entry.

Antoinette Fouché: Sê maar as iemand nou net genies het en jy loop deur dit en daai persoon het TB en jy asem dit in of wat. Of hoe kry mens dit in presies? {Afrikaans} [Let’s say someone has just sneezed and you walk through it and that person has TB and you inhale it, does that mean you’ll get infected or how exactly does TB infection happen?]

Dr Hermann Reuter: TB germs are bacteria with a very thick cell wall, so they’re very resistant to the atmosphere. If somebody of your family members have got TB, it is likely that the TB germ is in your house. The most likely place to pick up TB is shebeens and smokkelhuise. Because, people come together, 30, 40 in one room. They spend the whole evening together, coughing, drinking, and the TB stays in there.

Dr Hermann Reuter: See the TB germs moving in? As Sipho’s breathing, the air moves into the mouth, it moves down the air pipe, the air pipes branch into the two lungs, and it moves into the lungs. And that is usually the early coughs that you get with the flu. One of the problems with TB is that it is very difficult for the doctor to make a diagnosis. You’ve all spoken about that; being sent from one hospital to another, doing one test after another. In South Africa 95% of people have TB inside. Usually the TB stays dormant in lymph nodes that are here. The same as if you got glands in your neck they either called glands or lymph nodes you’ve got them here and you’ve got big one’s here. And often the first time you get infected with TB, they sit here in these lymph nodes, just at the entry of the lungs, but they stay dormant there. And then at some later stage, they can break open and go into the lungs and cause disease. Half the people that are at the moment dying of TB, their deaths could have been prevented if they get the Bactrim, if they get the Cotrimoxazole, with their treatment. Cotrimoxazole costs R3.50 per month, and most people don’t get side-effects. So, I think it’s mandatory that every person on TB treatment asks: “Am I also getting my Cotrimoxazole?” Although we say that TB is a curable disease, we know that a half of all people living with HIV will get TB, and many of them won’t survive the TB. TB is the most common cause of death amongst people with HIV.

Faghmeda Miller: What will happen in the future? Will I get TB again, or do I just go on some medication to prevent it?

Dr Hermann Reuter: INH is the medication that can be used to treat TB, but it is also sometimes used to prevent TB. But we have to remember, the most effective prevention of TB is antiretroviral medication.

Red Ribbon and Red Noose Awards

Mercy Makhalemele: Ke nako yang haphe, ke nako ya Red Noose le Red Ribbon award. {Sesotho} [What time is this? It’s time for Red Noose and Red Ribbon award?]

Paddy Nhlapo: We give the Red Noose to someone or group who has disregarded the human rights of people living with HIV/AIDS, so let’s starts with the Noose. We’ve had the honour of giving the Pharmaceutical Manufacturer’s Association the Noose before, but did you know that they are just the local troops of the International Pharmaceutical Manufacturer’s Association led by Harvey Bail. These are the guys who co-ordinate policy to protect the profits of the big five pharmaceutical companies: GlaxoWellcome, Bristol-Myers Squibb, Boehringer Ingelheim, and Roche. These guys are so smart that they even managed to use the United Nation’s AIDS Programme to hide their profiteering from AIDS drugs. Harvey Bail is their hired gun. Their latest trick is to use promises of so-called ‘price reductions’ and offers of so-called ‘free HIV medicine’ to prevent our government from importing these same drugs at much cheaper prices. Their motto is, ‘Profit before lives’. Our motto is, ‘Health before profit’. So, in recognition of Harvey’s work, it’s the Noose for you guys! Booo!

Mercy Makhalemele: And now onto the more positive stuff. This week we recognise the work done by all those struggling for treatment access both in South Africa and in other African countries, and especially Judge Edwin Cameron who has inspired many of the South Africans with the will to live. Without a mass movement for change, we may never see the day when HIV and AIDS medication is available to all who need it. So it is Red Ribbon for all those organisations who signed the Global Call for Treatment Access, including: Agenda, AIDS Babies Fight AIDS, AIDS Care Counselling and Training, AIDS Foundation, AIDS Memorial Quilt here in South Africa, the ANC Youth League in KwaZulu Natal, and the Azanian Student Movement, Centre for Positive Care, Centre for Rural Legal Studies, Exit Newspaper… Oh my gosh, over 200 organisations both from here at home and abroad, we salute you.

Paddy Nhlapo: Asithandi ukunishiya {IsiZulu} [We don’t like to leave you] but I am afraid, that’s our programme for this week. We hope you enjoyed watching and remember we really value your feedback, comments and suggestions so please contact us at the numbers given below.

Mercy Makhalemele: Let’s beat it next week Tuesday at 18:05 and again on Sunday at 12:30. Remember together we will Beat It!

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