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Beat It! 2002 Episode 12

This episode, the last in this series, covered the TAC COSATU Treatment Congress that was held in Durban from the 27^th to the 29^th of June 2002. The Support Group prepared a healthy yet inexpensive meal for themselves and discussed nutrition and HIV. Dr Nombulelo in turn discussed the symptoms of and the treatment for oral thrush.

Nombeko Mpongo: Namkelekile kwis’qendu sethu sok’gqibela sikaBeat It! NdinguNombeko Mpongo. {IsiXhosa} [Welcome to our last Beat It! episode. I am Nombeko Mpongo.]

Vuyani Jacobs: NdinguVuyani Jacobs. {IsiXhosa} [I am Vuyani Jacobs.] We hope you have benefited from all these programmes.

Nombeko Mpongo: Treatment literacy is essential to taking control of your virus. This week Doctor Nombulelo talks to us about oral thrush.

Vuyani Jacobs: And our Special Report is on the call for National Treatment Campaign at the recent COSATU/TAC National Treatment Congress.

Nombeko Mpongo: But first, let’s go to the Support Group where we are talking about the most important topic of nutrition and how to stay healthy with HIV.

Beat It! Support Group - Balanced diets

Mathew Damane: Apha sine-balanced diet ne esithe say’pheka for i-lunch ye-support group and kubalulekile ke singabantu abaHIV positive batye i-balanced diet kwenzel. Ba ufumane yonke into. Okokuqala like ekutyeni kwethu sinepapa, ipapa esinika i-carbohydrates, enika i-energy, ikwasiso ne starch. Sibene khaphetshu. Ja, kwikhaphetshu ufumaniseka ba ine-roughage. Sibenenyama enika ii-proteins ne and also there are fats pha kwinyama. Then sibene-carrot, carrot that helps emehlweni ethu sibone kakuhle and also there are vitamins ezikhona pha. {IsiXhosa} [Here’s a balanced diet that we’ve cooked for the Support Group’s lunch. It is important as HIV positive people that we eat a balanced diet so we can get everything. First in our food we have maize meal, which gives us carbohydrates. It gives us energy and it has starch. We have cabbage, which has roughage. We have meat that has proteins and fat. We have carrots which help our eyes see well and they also have vitamins.]

Busisiwe Maqungo: Akunyanzelekanga ngoku ngenxa uyi-PWA funeka utshintshe uyotya okona kutya kwakhe kwa-expensive. Utya the normal food oqhele ukutya. Qha make a point uba ku-preparishwe kakuhle. Umzekelo jonga le-carrot asiyiphekanga ikrwada, you get all the vitamins kula-carrot. Ikhaphetshu yethu i-half cooked, zonke i-proteins are there. Uyanqonda, so.{IsiXhosa} [It is not compulsory for a PWA to eat expensive food. We eat normal food that is just well prepared. Look at the carrots we haven’t cooked, it’s raw and you get all the vitamins from it. Our cabbage is half cooked and all the proteins are there.]

Sindiswa Godwana: Umntu xa e-HIV positive, ayithethi ukuthi angehla e-weightini ngenxa yokuhambisa abene-diarrhoea qha. Nokungatyi kuyamenza umntu o HIV positive ba ehle e-weightini. So into ebalulekileyo, yitya kakhulu lonto ikhoyo uyifumanayo aph’endlini. Qha qwaba. {IsiXhosa} [When a person is HIV positive, they don’t lose weight through diarrhoea only. Not eating can also cause weight loss. What’s important is to eat a lot of whatever you can find in the house. That’s all.]

Busisiwe Maqungo: Bendisithi abantu basez’lalini ngabona bane-lucky because they get ezizinto for free. Umzekelo, these natural kutya okuz’khulelayo njenge mbuya elirhal’jane onomdlomboyi, iinto ezinjalo. They grow their own food. Bayazilimela their own imbotyi for prolteins imimbhona for carbohydrates, their own small vegetable gardens. Nalapha kuthi ibingekho ndzima lonto leyo even if we have small yards. [People in the rural villages are the luckiest because they get everything for free. For example the natural vegetables that grows in the veld. They grow their own food, they grow their own beans for proteins, maize for carbohydrates. That is not difficult, even if we have small yards.]

Nontsikelelo Zwedala: Bedizaw’thi nalaph’ezdolophini akhonto inzima because abantu abasebenza emaplaasini bayazithengisa ezizinto, le yasemaxhoseni. And ne-vegetables ezi, ii-carrots iintoni, zonke ziyafumaneka nge-price ephantsi. {IsiXhosa} [Even here in the cities, nothing is difficult because people who work on farms do sell these vegetables, these natural ones. They also sell carrots and other vegetables at low prices.]

Nomandla Yako: Futhi enye indaba kulendaba ye-breakfast bethunana. Akubalulekanga umntu athenge i-pro nutro nepapa eziduru. Ipronutro yi-R!7 i-one kg, omaaKellog’s Corn Flakes. Umntu angazenzela ipapa ka-mealie meal ugalele noba licephe le-oil or ugalele i-peanut butter, utye ipapa yakho. Uzozifumana ii-vitamins zakho, izakha mzimba. Uyabo. {IsXhosa} [And also about breakfast guys, it’s not important to buy these expensive porridges. ProNutro costs R17 per kilogram. A person can cook maize meal porridge and add a spoon of oil or peanut butter. You get all the vitamins from that.]

Corné Fourie: Garlic is one of my main things that I take. I take garlic twice a day; that is not the garlic that is included in my meals. I take a teaspoon of crushed garlic every morning and a teaspoon at night. And I can feel all those small sicknesses like flu and colds, you don’t them that often.

Nombeko Mpongo: Igarlic iduru xa uyithenga kwezinye iindawo okanye iduru xa uyithenga njengayo nay’phi into xa uyithenga iduru. Kodwa ungayithatha igarlic njeng’ba iyilamicwe nje, ungay’lima noba kusebhaketini noba kusebhafini evuzayo endala, ufake lamicwe phayana, ugalele amanzi. Iyakhula igarlic yakho oyilime kwakho instead of going to the shop and buy garlic, you plant your own garlic and it grows everywhere, ebhafini, ebhaketini, endaweni nje encinci. {IsiXhosa} [Garlic is expensive when you buy it from anywhere just like everything. It’s best to take the leaves and plant them even in an old bath. Put the leaves in a bath and water them. Your garlic will grow and you’ll have your own garlic instead of going to the shop to buy garlic, you can plant the garlic. It grows everywhere, in a bath, in a bucket; ust a small place.] You’ve got the garlic, you’ve got the veggie you want, so it’s just to make life easy.

Mathew Damane: Liquor is the most common thing that is being used by our people, you know, to relieve their stresses and all those things, you know. Of which, to us it’s not good because if you drink liquor and you are HIV positive, you are just killing your immune system and your viral load will get a way of shooting up. All I want to say is that don’t take liquor trying to relieve stress and you try to cope with your HIV status. That will never work out for yourself.

Busisiwe Maqungo: Abantu banala-bvelief yoba iswekile irongo. Nyani ke sikhule noomakhulu bethu besithi masitye i-teaspoon elinye leswekile. I eat a lot of sugar bethunana ufumene nje konke ukutya oku-right. Utye isonka esi-brown emveni koko neti because kulati there is sugar, i-sugar ezakunika nje amandla. {IsiXhosa} [People believe that sugar is wrong. We grew up with our grandmothers telling us to take one spoon of sugar. You get all the right nutrition by eating a slice of brown bread and tea because the sugar in the tea will give you energy.]

Sindiswa Godwana: Kulendaba yeswekile, abanye abantu iyababhida lendaba yeswekile. Ewe kuthi Bantu banentsholongwana kagawulayo funeka siyitye iswekile ngoba kwelinye icala isinika amandla njenoBusisiwe ebesetshilo. Kwe4linye icala xa na une-thrush, zinike ithuba ungayityi iswekile ngoba kaloku iyenza worse i-thrush iswekile. Ngoba kaloku apha kuthi emzimbeni thina Bantu sine-yeast. So ke ngoku xa na usitya iswekile eninzi u-HIV positive, idibana nale-yeast ilapha kuwe emzimbeni yandisa i-thrush. {IsiXhosa} [About sugar, some people are confused. Yes, we with the virus must eat sugar because on the other hand it gives us energy, like Busisiwe said. On the other hand, when you have thrush, you mustn’t take sugar because it worsens the thrush. Because in our bodies we have yeast, and when you take a lot of sugar and you are HIV positive, it mixes with the yeast and worsens the thrush.]

Bongiwe Mkhutyukelwa: Buthunana ndinikvile niyathetha ngentlobo ntlobo zokutya but mna yazi ndi-believa too much kwi0-exercise like not about kufuneka ndi-join uHealth and Racquet but ujogga. Like xa ndisiya emsebenzini inot endiyenzayio everyday, mele ndihamba about 15 minutes walk from endlini ndisiya e-station apho ndizaw’khwela khona i-train. Instead of ubhatala la R3 yetaxi, ndivele ndizibalekele usuka endlinini ukuya e station. And kufumaniseke uba ndithathe only five minutes. I believe ba i-exercise ikugcina u-active and it’s good for your health. Enye into eyingoza xa ungumntu ophila neHIV/AIDS si-stress. I try by all means uku-avoida i-stress. I always try to look at the funny side of izinto. Like ukuhleka nako kuyasi-relieve i-stress. Ndiyathandu ukuhleka, ndihleka a lot guys. So I believe maybe zezinye zezinto ezindincedayo mna.{ IsiXhosa} [I’ve heard you talk about the various kinds of food, but I believe a lot in exercises. I don’t have to join clubs like Health and Racquet; just jogging, like when I’m going to work. Maybe it takes 15 minutes from home to the station. Instead of paying R3 taxi fare, I just run to the station. And it only takes me 15 minutes. I believe exercise keeps you active and it’s good for your health. Another thing that’s dangerous if you’re HIV positive is stress. I try by all means to avoid stress. I always try to look at the funny side of things; like laughing. Laughing does relieve stress. I love laughing, I laugh a lot. So I believe those are some of the things that help me.]

Busisiwe Maqungo: Emfuleni siyi-group yamantombazana amahlanu. Siyesidibane mhlawumbi uba ngaba sifuna upheka loo lunch yethu. Omnye azene mealie-meal endlini yakhe ne-rice okanye omnye aze neembhotyi, njalo njalo. Sithathe yonke lonto leyo sidibanise sitye kubemnandi, ubone nje uba silibele noba sineengxaki zethu uba sinengculaza. {IsiXhosa} [At Emfuleni, we are a group of five positive girls. We often get together for lunch and a person would bring maize meal, another with rice and so on. We take that, cook and eat and chat and forget our problems, that we have AIDS.]

Vuyani Jacobs: You are back with Beat It! Coming up is Dr Nombulelo talking about oral thrush.

Nombeko Mpongo: Did you know that this common fungus can be killer? But with proper treatment, it should not be a problem. Let’s listen to the doctor.

Dr Nombulelo Madala's consulting room

Dr Nombulelo Madala (HIV/AIDS community doctor): NdinguDoctor Nombulelo, iHIV doctor yenu. Sanibonani kwakhona ekhaya. {IsiXhosa}[I am Doctor Nombulelo, your HIV community doctor. Greetings again at home.] Recently Mandla, an HIV patient of mine came to see me complaining that his mouth was painful and he had pain when he was swallowing and had a poor appetite. When I looked inside his mouth, I discovered white plagues and some red areas. It was oral thrush. Oral thrush is a fungal infection. It is caused by a fungus called candida which is present in the gut of most people. This is oral thrush, this is the white plagues that cover the person’s mouth. If you can remove the plagues, you can see the redness underneath. This is Nystatin, it’s the first line drug in oral thrush. It’s in liquid form, you use a dropper and suck it in; you drop the medicine in the mouth and you switch it around for quite a while and then you swallow. The correct medication for oesophagal thrush is fluconazole. Most tablets that contain fluconazole are very expensive. The state was unable, for many years, to make this drug available to all the clinics that look after HIV positive people. Diflucan is one of the tablets that contain fluconazole. In what is called the Diflucan partnership program, the company that makes Diflucan made it available free of charge to government in order to make sure that all clinics and hospitals that look after HIV positive people have this drug. Since that has happened we are now able to treat all HIV positive patients who develop oesophagal thrush with Diflucan. This has tremendously cut down the number of people dying because of oesophagal thrush in HIV/AIDS. This drug, Diflucan, can also be used in cryptococcal meningitis, which is another big killer in HIV/AIDS. That is all from me today, until I speak to you next time, stay healthy.

Vuyani Jacobs: The COSATU/TAC Treatment Congress held in Durban in July was a turning point in the campaign for treatment. COSATU, the churches and many NGO’s committed themselves to the development of a National Treatment Plan. The National Treatment Plan set out timelines and budgets for the establishment of ARV pilot sites and the scaling up of ARV treatment programs as well as proper treatment of opportunistic infections.

Nombeko Mpongo: Government needs to support the calls for a National Treatment Plan.

COSATU/TAC Treatment Congress

Willie Madisha (COSATU President): Welcome, I hope you’ll be able to participate and ensure that indeed by the end of this conference we have been able to do something. We owe that to the people of our country.

Zwelinzima Vavi (COSATU Secretary General): This conference we look at options to ensure that our people have access to affordable and effective treatment.

Mark Heywood (TAC National Secretary): We are aiming to develop a South African National HIV/AIDS Treatment Plan. But in our minds is the belief that if we can succeed in this southern part of the African continent, we’ll inspire other African countries to try to follow the same path.

Professor Malekgapuru Magoba (Former Head of the Medical Research Council): We have no public health policy and we have been bickering and debating and wasting time. We have spent ten years of that in this country to allow an infectious epidemic to entrench itself within our society.

Winston Zulu (HIV/AIDS Activist, Zambia): I’m a person living with HIV, I’ve been living with HIV for the last 12 years, since 1997 I was on antiretrovirals. Until one of the greatest people that I respect very much, one of my heroes Thabo Mbeki made me start doubting, well he didn’t make me start doubting. I’ve always wanted to be HIV negative and he sort of encouraged me to think in those lines. I decided to drop my drugs in the year 2000 and just wished HIV away. And it was kind of very stupid for someone to do but I think you will understand if you are living with HIV and you really want to live, say up to the age of Madiba and someone comes and say HIV has nothing to do with AIDS. It’s very attractive and I got very attracted and decided to start denying that HIV caused AIDS. And that denial has been very costly to me and I’m very lucky to be alive now at least on a wheelchair because some of the people, I was with in the panel, I’m a member of President Mbeki’s Presidential Panel, some of them are dead now. I think about three people, we were together, are dead. And my CD4 count plummeted from 500 when I stopped taking the medications to 36 in February this year, until I restarted and I’m able to stand now and speak to you.

The Most Reverend Njongonkulu Ndungane (Primate of the Anglican Church of Southern Africa): I must apologise for all people of faith. The church has committed the great sin of silence in the face of such discrimination and fear. And when it has spoken out all to sadly, it has spoken out on judgement upon the sick. We now wish to make it clear and for all to hear that HIV and AIDS is not a punishment from God. We would remind both governments and pharmaceutical companies that it is a basic human right that all who require treatment have access to that treatment.

Dr Zweli Mkhize (MEC for Health, KwaZulu Natal): That was quite intimidating. The seriousness of HIV/AIDS is actually well understood by everybody both in the ANC and government and as of my personal feelings that I have had the experience of relatives who are HIV positive, who are being looked after, who are being cared for and those who have actually passed away, I’ve had friends, I’ve had members of staff. So we are not really discussing an issue which is of a theoretical or academic nature. If out of this meeting we come out with a resolution to say in this province and any other province we want to come into partnership and work together on the programs in the community on mobilizing people to fight against HIV together with government departments, I would be with you. Thank you very much.

Thabo Cele (NAPWA & TAC Activist): I lost a partner due to HIV. It is because the treatment is very expensive. I knew that if we had money we could save that life. When we are speaking about treatment we are not only speaking about the antiretroviral drugs, it must be clear comrades. Natural people who are HIV positive, we need to use the antiretroviral drugs.

Dr Des Martin (HIV/AIDS Clinicians’ Society): In days gone by, we used to treat very early. The philosophy of ‘hit early hit hard’ no matter at what stage of the illness, no matter what the CD4 count, we would commence treatment. We realise we made mistakes there because we found when we looked at the date that the deferred treatment, to deferred treatment and that is a fine line, the results were just as good in terms of survival et cetra. And by starting late you minimise toxicities, you minimise chance of resistance, resources are sped, and so the evidence based data showed that deferred treatment is the way to go.

Mark Heywood (TAC National Secretary): We have crossed from having an HIV epidemic where many people are being infected with HIV, having both an HIV and an AIDS epidemic; asituation where many people still infected with HIV on a daily, on a weekly basis, but also a situation where now many people are beginning to show illnesses that are caused by HIV and are beginning to die.

Sister Edna Bokaba (Chris Hani Baragwanath Hospital): Today we find an increasing number of opportunistic infections being admitted in the hospital with limited human and material resources. How do you provide the services? You can’t. So we need to talk the truth and we need to work hard to change the present situation.

Mark Heywood (TAC National Secretary): People with HIV who are developing signs of AIDS related illnesses are crowding out other people in the public health system. Beds are being taken up by people who have HIV/AIDS so allowing the HIV epidemic to continue uncontrolled impacts negatively on the management of non-HIV related illnesses. We are saying focus on HIV, not to the detriment of other illnesses. Focus on HIV in addition to other illnesses in order to allow us to manage other illnesses properly.

Zackie Achmat: Saadiq Kariem from the ANC’s health desk.

Saadiq Kariem (ANC Health Secretary): I wasn’t going to say that, I was going to say I’m Saadiq coming from Western Cape because I’m not officially meant to be here. But be that as it may. It’s confusing to see the various structures of government operating not talking to each other; the left arm doesn’t know what the right arm is doing first of all.

Dr Nono Simalela (Head of HIV/AIDS unit, Department of Health): I want to pledge the commitment at least of the National Department of Health HIV/AIDS Unit to work in partnership, as Zackie says it’s been heavy, it’s been hard. The stackes are very high, the pain sometimes unbearable but we see people here working towards finding solutions. I’m always optimistic, some of us do have ears to listen. Sometimes we might not be able to say we are hearing but we’re there and I think it’s good to have some people inside to do the ugly work as you do the work outside that is easier to push. Remember we are out there working for the same goals and I wish you well and we’re here, still working together.

Mark Heywood (TAC National Secretary): Some medical interventions are prevention. Access to mother-to-child-transmission programmes, access to AZT and Nevirapine is preventing HIV infection. Access to post exposure prophylaxis is prevention, it prevents people who have been raped from being infected with HIV; reduces the risk.

Dr Hermann Reuter (MSF, Doctors Without Boarders): People have got a right to treatment and if it’s HIV that needs to be treated then people have a right to that treatment. If you don’t provide antiretrovirals, society will decay and we can’t afford that so we have to pay for those medicines.

Mark Heywood (TAC National Secretary): In September 2001, a document produced by the Department of Health; it’s anticipated that by 2004-5 the government will be spending R7 billion a year on managing AIDS in the hospital sector. We want to show that if we spend money on antiretroviral treatments as well as on the other interventions, then you will reduce some of the other costs.

Professor Jerry Coovadia (School of Medicine, University of Natal Durban, UND): My view is we have three opportunities and three entry points to treatment of our subjects who are HIV infected. The first one is, the commonest complication of HIV is tuberculosis. And here’s a system where you can provide antiretroviral care, you can ameliorate the TB, you can treat the TB and there’s a lot of good you can do and you can do a lot of good for a lot of people because that’s the commonest complication. The second entry point would be people who are employed and I would ask the corporate sector to assume a large part of the responsibility for provision or prevention and care including antiretrovirals for that group of people. And then the third group would be mothers of children who’ve been born from HIV positive mothers.

Mark Heywood (TAC National Secretary): After two days of deliberations, the congress came to the following conclusions: The HIV epidemic has created an emergency in South Africa. This emergency threatens South Africa’s future by creating more poverty and impacting negatively on our ability to reconstruct and develop South Africa to the benefit of all its people. A national HIV/AIDS treatment plan is needed to combat this emergency. A treatment plan will strengthen the existing five year strategic plan which concentrates mainly on prevention.

Zackie Achmat (TAC National Chairperson): The Treatment Action Campaign and COSATU (Congress of South African Trade Unions) hosted the largest and the most representative congress on treatment for people living with HIV/AIDS. All of us agreed that our public healthcare service needs to be restructured, there has to be additional resources put in to making sure that poor areas, rural areas are resourced and we have access to treatment in there. By access to treatment we mean we want the government to implement its National Summit Proposal, to implement antiretroviral pilot projects in every part of our country. We also want the government to immediately consider the implementations of its guidelines on opportunistic infections throughout the country in a proper manner to ensure the key drugs that we need are there and that most importantly, health workers are trained. For us this has been a remarkable congress. We believe that creates the basis for a treatment plan that we, Treatment Action Campaign, COSATU and all of civil society will put to NEDLAC (National Economic Development and Labour Council) and we hope it will be taken forward from there and to the government and we will have access to antiretroviral therapy and the proper treatment of HIV in our country.

Vuyani Jacobs: So Saadiq Kariem from the ANC Health desk was there as well as Doctor Zweli Mkhize, MEC for Health in KwaZulu Natal.

Nombeko Mpongo: Dr Nono Simelele, Head of the HIV/AIDS unit at the Department of Health was also there.

Vuyani Jacobs: So there are many people who support the call for a National Treatment Plan. The plan will show how antiretroviral treatment plan will be extended starting with those most in need.

Nombeko Mpongo: This is really our best hope for getting life-saving treatment to millions of people who will otherwise die. We must all urge government to implement the National Treatment Plan.

Vuyani Jacobs: We hope that you have enjoyed being with us for the past 12 weeks and that you have found the series of benefit to you.

Nombeko Mpongo: Please contact us with your thoughts and ideas for future programmes. We’d like to be back with you again next year. Khumbula, sisonke sizonqoba! {IsiXhosa} [Remember, together we can Beat It!]

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