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Beat It! 2000 Episode 9

In this episode we again look at how access to the antifungal drug Diflucan could have saved Christopher Moraka’s life. In line with this we followed Zackie Achmat to Thailand where he bought 3000 tablets of generic fluconazole as part of the Christopher Moraka Defiance Camapign against Patent Abuse. In the profile section we also get to meet Benjamin Borrageiro who talked openly about how crack cocaine contributed to a lack of inhibitions in his life and how that ultimately led to his infection with HIV.

Paddy Nhlapo: Hello Mercy and everyone at home, welcome back to Beat It! – the programme that tells you about all about living with HIV/AIDS.

Mercy Makhalemele: Hi Paddy, so how have you been keeping?

Paddy Nhlapho: Well, I am doing well, taking my antiretroviral drugs. I only wish that everyone who needs them could have access to these medications. If our government would help us bring in cheap, generic versions of these drugs, many, many more people could have access to them.

Mercy Makhalemele: Well, maybe there is a way. As part of the campaign for treatment access Beat It! followed Zackie Achmat of the Treatment Action Campaign on his trip to Thailand, where we visited a factory making generic medicine, and brought 5 000 generic fluconazole tablets for treating oral thrush and crypto-meningitis at a fraction of a price Pfizer charges.

Paddy Nhlapho: Great so it’s off to Thailand this week but first we visit Benjamin Borrageiro. Benjamin has some really strong feelings on the importance of a positive attitude, even if you are quite ill. And also on the role of homecare in helping him live with full-blown AIDS.

Mercy Makhalemele: And after that it’s off to the support group and some more treatment literacy with Doctor Herman, so let’s go.

Profile - Benji Borrageiro

Benjamin Borrageiro: If you think about it, it was my own doing, it was my own fault, it was my own choice. Who must I be angry with? Who must I hold resentment with? Must I lay in bed and be angry that I’ve been given a disease by somebody who I found and who I loved, and be angry with that person? That person’s in the same situation that I’m in. What did make me angry was the fact that I did crack. That I allowed myself to get involved with a drug because I wanted to be part of the party, and I needed to know because I’ve got an enquiring mind, and. God it takes you, does it take you, because you don’t think about anything when you’re doing drugs you. Sex was the most important thing with the crack. And, you know, you forget, you don’t think, because of the high. I was a DJ for 26 years. I had my own nightclub so I was aware of lots of things. Then I went off the beaten track, opened up an escort agency for a while, you know, and all that kind of kak {Afrikaans} [shit]. And that’s how I got involved in the drug scene. I think God has always given me good friends. I told them immediately, I said: “Guess what, I fucked up, I got HIV.” This woman who is here helping me, she comes in at half past eight in the morning, she feeds me. Why do you think I’m so strong now? You should have seen me a month ago, I couldn’t move out of my bed, I wasn’t moving out of my bed. I was actually dying. I had given up, I was living to die, not dying to live.

Patricia Ngcobo: I’m starting on a Tuesday morning. Ooh, he was terrible.

Benjamin Borrageiro: She comes in, she cooks for me, she makes me eat. There’s a drink that I drink, and that has made me stronger in a week. She’s only been with me for a week. But I’m out of bed, as you can see, I’m ready to go and walk out into sort of Obs again.

Patricia Ngcobo: He was so sick, but I’m scared my first time when I come here, of Benji, but now he’s coming better now.

Benjamin Borrageiro: What scared me once was when I fell off the toilet, and that’s when I realized that I needed help, and I accepted the hospice, the woman from the hospice. Okay, they embarrassed me in the beginning, because I’ve always been a proud, a very proud person who wants to do things for himself, and I promise you it’s one of the best things that I could have done, was to actually accept the help.

Patricia Ngcobo: I’m not afraid at all because god was in my side, to help me, to help the people with HIV.

Benjamin Borrageiro: We all love ourselves, and I don’t think that anyone wants to get to look like that because it’s not lekker, it’s not lekker. Society shuns them to one side. Bullshit, employ people with HIV. They can still work, I can still work now. So employ me, you know what I’m saying, I’m not down yet. Employ people, make people still feel human. Because they take away that feeling of humanity, and when you take away that feeling of humanity you take away worth, life’s worth. And when that happens, you lose the will to live. I suggest to everybody, talk about it if you’ve got it. Speak about it immediately, because the longer you hold it inside, the quicker you are going to die. Because you are going to be living a lie, and when you live a lie, you have stress, and when you have stress, it eats you. And eat food, eat vegetables, eat fruit. I wasn’t doing these things until this nurse came.

Paddy Nhlapo: A few weeks after this interview, Benjamin was feeling a bit down again. People with AIDS need the support of professional healthcare workers like Patricia. This is what homecare is about, not dumping people with AIDS onto the shoulders of already over-burdened families.

Special Report – Thailand: No patience for patents

Christopher Moraka: Ja, ndizothetha nge-language yam. Ndi-HIV positive, nda-diagnoswa ngo-1996. Eh, kwi-community yam siphethwe kakubi thina bantu ba-HIV positive. Enye into endifuna ukuyichapazela, ngenye imini bendiye eCrossraods Day Hospital ndise i-rash. Ndafika pha, ibisaqala i-rash ke, ndababonisa ukuba heyi ndiphantsi ke, since ugqirha esithi mandivezi ikhadi lokuba ndiphantsi kwenatsika, kwe-trials ze-TB. Ndababonisa, abazinto. Ndabachazela ukuba ndi-HIV positive. Kwathiwa lonto leyo ungaze uphinde uyithethe. Ukusukela namhlanje ungahlali nabantu, sizaku isoleytha, ungahlali nabantu kakhulu. Kufanele ubewedwa uzihlalele wedwa endaweni, unga hlali nabantu. Mandize kwezikhampani ezenza amayeza/amachiza, iikhampani ezinje ngo-Pfizer, siyazi oo-Pfizer benza i-profiti enintsi. Ngo 1999 benze 6,5 billion rands. Besicela nakubo ke, ukuthi lamayeza makathotywe, thina abantu ba-HIV singabona abantu abasafa the rest ngoba abanye abantu abayifilishi le-pain yabona, into eyenzankalayo bayeza i-profiti yabona. {IsiXhosa} [I’m HIV positive. I was diagnosed in 1996. Let me turn to the pharmaceutical companies. Companies like Pfizer make a lot of profit. In 1999 Pfizer made R6.5 billion profit. We ask them to lower the price of drugs because we HIV positive people suffer the most. Other people don’t feel this pain. They want to make profit, you see.]

Mercy Makhalemele: Christopher Moraka died on the 27th of July this year. Those present vowed to remember him for his courageous spirit in the fight against HIV and AIDS.

Zackie Achmat: On Sunday 9^th of July we mobilized a historic coalition, we led a march to demand HIV/AIDS treatment access. More than five thousand people joined the march, representing organisations with millions of members worldwide. We will prepare a defiance campaign against drug companies by importing good quality generic medications, including fluconazole, and ensuring that they are available to healthcare facilities for appropriate use. None of us here have the intention of breaking the law, and we don’t believe that we will be breaking the law. What we will be doing is breaking Pfizer’s patent, we will be showing that Pfizer and other companies are abusing their patent. We have no criminal intention. Our only intention is to defend people’s lives. Here I have in front of me a box of fluconazole that would cost two hundred rand, but if you bought it from a South African chemist it would cost you four thousand rand. There is no doubt that we will bring large amounts and large quantities of this into the country to ensure that people have access to good quality and safe generics. We won’t stop doing it, until our government and the drug companies have brought the prices of all essential medicines down.

Bangkok, Thailand, October 2000

Rachod Thakolsri (Managing Director, Biolab Bangkok): We launched fluconazole under our own name, Biozole, for about two years now. The price was dropped dramatically in the first year. I believe that for every country generic products are a very necessary, is a fundamental for all pharmaceutical markets. Without generics, many people would have to pay a very high cost for their healthcare, which is really not necessary with a consistent quality control and with good management with production. I believe that generic products can produce high quality products just as well as original products.

Krisana Kraisintu PhD (Chem) (Head of Research & Development Institute, Government Pharmaceutical Organisation (GPO): You know that the cost of manufacturing and the cost of raw material of one capsule of fluconazole is only four Bahts (sixty six cents), only four Bahts per capsule I’m talking about two hundred and eighty seven Bahts initially of the price. So if we are selling at six Bahts (one rand). Profit two Bahts (thirty three cents) per capsule; that’s a lot.

Rachod Thakolsri: We have driven the price down for more than twenty times as well. The price situation is Thailand back then was very expensive. Of course, Pfizer doesn’t really happy about it. But we believe that the raw material that we purchase is of good quality. It match the original products and the doctor has tried our products, and liked them.

Sompong Panichpol PhD (Chem) (Technical Director, Biolab): If the fingerprints are in agreement with the standard, we accept it. If the fingerprints are not in agreement with standard, we reject it. Our activities are of a world-class manufacturing level.

Paul Cawthorne (Head of Mission, Medecins Sans Frontieres: Thailand): So this is generically made Fluconazole, made in Thailand and we use it for treatment of cryptococcal meningitis. We used to buy small amounts from Pfizer, but the prices were so outrageous that we could only buy small amounts. Now we can buy; really as much as we need.

Zackie Achmat: This at the moment is sold to the government by Pfizer for four thousand five hundred rand. A single box that we’re taking back to South Africa costs R88.50, which means basically in South Africa, they sell it to the government at R30 a capsule. You can treat fifteen people with fluconazole bought from Biolab, whereas you can only treat one person with fluconazole from Pfizer.

Paul Cawthorne: When biolab supply the fluconazole that Zackie is taking back to South Africa, they’ve also supplied with it a certificate of analysis of the raw materials inside the capsule. The fluconazole in this batch is required to have a bio-equivalent of between 90 and 100%, and this particular certificate says that the bioequivalents of the fluconazole in these capsules is 103.8%, so it means that it’s good stuff. Pfizer are offering to give South Africa fluconazole, so why are you buying it from Thailand?

Zackie Achmat: Well, there are two reasons why we’re doing that. First thing is we’re defying Pfizer’s patent, because the real problem here is not only the price, but the fact that Pfizer is giving it to the South African government in order to ensure that they retain their patent on the product for the next two years in the region. And it will only be to the government, whereas many workers in the private sector, who have medical aid, will still have to pay the excessive R100 for each capsule.

Zackie Achmat: What happened today is that the Medicines Control Council and the Department of Health will charge us with bringing generic medicines into the country illegally. They could charge us with that. What we have said is: “Our fight is not with the Department of Health, our fight is not with the Medicines Control Council, and we’re sad that they made such reactionary statements, both of them. Our fight is with Pfizer and the drug companies who profiteer at the expense of people’s lives. Our fight will continue, and we will win.

Mercy Makhalemele: You are watching Beat It! – the programme for everyone affected by HIV/AIDS.

Paddy Nhlapo: So, if in Thailand, why not here? Remember that GlaxoWellcome factory that we visited last year. Did you know that Glaxo is closing down that plant?

Mercy Makhalemele: Oh, wouldn’t it be great if the union investment companies could come together and take over that factory and produce low cost affordable antiretrovirals here at home in South Africa.

Paddy Nhlapo: This would save lives and jobs as well.

Mercy Makhalemele: Right now, on to the support group.

Paddy Nhlapo: One of our regular viewers wrote in asking if our support group was actors or real HIV positive people. I only wish we are acting, but we are not. Everyone in the support group is really living with HIV, so what’s coming up in the Support Group this week Mercy?

Mercy Makhalemele: This week we are talking about skin infection and lymph nodes, surely the most common infection affecting people with HIV.

Support Group - Shingles and Lymph nodes

Faghmeda Miller: Welcome everybody, and a special welcome to our well-known Dr Themba. I think today we are going to discuss lymph glands and skin rashes and disorders.

Paddy Nhlapo: I had a rash, right, here. It was so extremely painful, like I just wore a towel and went to the doctor, who gave me an injection and gave me some tablets to to put on and also it was again take more salt to wash, like for three days, it was unbearably painful. Painful, painful, painful, painful.

Mercy Makhalemele: Why do people living with HIV get shingles, and what makes it so painful? Because I’ve seen elderly people just with a whole arm full of shingles, and this person just screaming like a little child you know, and how can one avoid such things or treat such things?

Dr Hermann Reuter: Shingles is very common amongst people with HIV. And it’s actually not a disease of the skin, it’s actually a disease of the nerves, and that’s why it’s so painful. It’s the nerve that goes towards the skin that is infected with a herpes virus. And as the immune, it’s sitting in the nerve, and as your immune system gets weak, suddenly that virus gets very active, and as it gets active, the skin that virus gets those blisters, which later burst and then you get that rash. Shingles is characterized by being on one side of the body it doesn’t go over the midline that’s how the nerve distribution of your body works. And it affects the part of the skin that is supplied by a single nerve. With HIV, it becomes more common to get it in other body parts. Other people who are likely to get shingles are people with diabetes, people with cancer, who’ve also got immune depression. But it’s generally more on the chest or the back. It is important to get treatment as fast as possible. If you can start the treatment within the day when the rash starts, it can be treated completely with acyclovir.

Mercy Makhalemele: You know when you start getting the flu, and then you feel some pains on your throat, and every time when I touch, I mean even now I can feel round things in here, but whenever I get flu they become a bit painful, so I don’t know whether, I don’t know what that means. So that’s one thing that I would really like to find out.

Dr Hermann Reuter: Yah, I think if you speak about swollen lymph nodes today, that’s probably the first thing that most people notice about living with HIV. And, I think that what that means, is that even though you’re in a very early stage of HIV disease, the lymph glands can be swollen. And although it’s irritating for you as a person it’s actually a good sign for the doctor because it shows that your body has got an immune response against the virus. However we mentioned some cases where swollen lymph glands are also dangerous or are a sign of a more serious disease. Mkhanyiseli was talking last time about the lymph glands he had under the arm, and the doctors had to take a syringe and, instead of injecting something, they actually took something out to do tests on it for TB. And, that sometimes if you can’t cough up properly, if you’ve got a dry cough, or if the TB isn’t just in the lungs, it’s in the glands, it’s the only way to diagnose TB, is to take a syringe and actually suck some lymph gland out and test it for TB. Usually, as a doctor he can try to see whether it’s just lymph glands related to the HIV, or lymph glands related to TB. With TB, usually you’ve got other symptoms, like sweating at night or losing weight. And usually the lymph glands are bigger than two centimeters. With just HIV related lymph glands, they should be smaller than two centimeters.

Faghmeda Miller: Okay, well, I think that’s it for Dr Themba, and we really must say thank you for coming out and speak to us about all these issues of HIV and AIDS and all that. I think we can all give the doctor a hug.

Red Ribbon and Red Noose Awards

Mercy Makalemele: Re yale amohela haphe ko Beat It! {Sesotho} [Welcome back to Beat It!]

Paddy Nhlapo: Njengoba nazi, sekwiyisikhathi se {IsiZulu} [As you know its time for] our weekly Red Noose and Red Ribbon Award. Each week we give the Noose to someone or group that has disregarded the human rights of people living with HIV/AIDS.

Mercy Makhalemele: Red Ribbon, he yona {Sesotho} [is the one that], goes to someone or group who has made a contribution to the struggle against HIV and AIDS.

Paddy Nhlapo: Let’s start with the Noose. Bristol-Myers Squibb have the patent on ddI and d4T, two of the most important antiretroviral drugs. BMS did not invent these medications. They bought a license to produce and sell these medicines from the US government after a university research lab developed the formula with government money. They have made billions of dollars off these medicines that cost them nothing. Their license agreement stated that they should charge a fair price for these medicines. They think they have a license to charge as much as they like for ddI and d4T. Meantime, their CEO takes home about $120 million a year which is about R800 million. Our advice to Bristol-Myers Squibb: grant a voluntary license so that we could make affordable medicines available to people with HIV here in South Africa. Until then, it’s the Noose for you guys.

Mercy Makhalemele: Having flushed that capitalism away, this week we would like to award the Red Ribbon to Patricia Ngcobo from Red Cross, the Dream Centre in KwaZulu Natal, and all AIDS service organisations providing home-based care. I was really moved by Patricia’s work with Benji. Just having someone to help with food can make a huge difference to someone with AIDS. If more people were trained to do this work, it would help ensure that home-based care is not just one way of dumping sick people onto shoulders of poor households who can’t afford to look after them. So showing us what home-care is all about, it’s Red Ribbon to you guys.

Paddy Nhlapo: Hayi ke. {IsiZulu} [Well]That’s our programme for this week. We hope you enjoyed watching. We really value your feedback, your comments and your suggestions. So please, every time, contact us at the numbers of your screen.

Mercy Makhalemele: Ke jwalo he bahesu. {Sesotho} [That’s all we have for you] and if you have any medical enquiries, please contact the National AIDS Helpline on the number given on your screen now.

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