The 2nd South African AIDS conference opens in Durban today. The conference is organised in four tracks: basic and clinical sciences; epidemiology, prevention and public health; social and economic sciences, human rights and ethics; and best practices and programmes.
Some of the issues to be discussed are SA’s anti-retroviral plan which was implemented last year, the AIDS orphan crisis and how to deal with the stigma and discrimination that surround the illness. Also under the spotlight is the Minister of Health, Manto Tshabalala-Msimang, who is facing enormous criticism after her statement last year in which he emphasis ed the importance of the alternative treatment of garlic and lemon as a means of protecting those living with the virus.
Former health minister, Dr Trudy Thomas responded to this suggestion
To tell those who care for our children who live with the disease that raw garlic and the skin of a lemon will not only give them good complexions but will keep the terrible pain of a ravaging disease at bay, is unconscionable.
Activists are calling for Mrs Tshabala to resign and to make an "unequivocal statement that anti-retrovirals are the most effective treatment for HIV. There has been continuing controversy over the causes of AIDS and the use of anti-retroviral treatment in SA. First of all SA is one of the few governments that have not colluded with the international conspiracy of the drug companies, Western governments and money interests such as Rockefeller and JP Morgan investment groups. Secondly there was the statement by Mbeki that the most significant factor in peoples health was poverty and his supposed skepticism over the link between HIV and AIDS. Then there was the issue of generic drugs being made available following the SA government’s bill to permit importation of cheap generic drugs instead of having to pay for the high priced brand names produced by multinational pharmaceutical companies (see Doctors without Borders).
Another complication in the campaign to increase the availability and use of ARVs are the campaigns for alternative methods for treatment of HIV/AIDS such as a new campaign by a Dutch organisation, the Matthias Rath Foundation promoting vitamin supplements. The organisation "has taken out adverts in newspapers and put up posters near HIV treatment centers stressing what it says are the dangerous side effects of ARVs" and there is evidence that some people are stopping ARV treatment as a result.
The impact is being felt in places like the impoverished
township of Guguletu near Cape Town where one in every seven people is
"Our clients are very confused," HIV counselor Flora
Tabela told me as she packed ARVs into a bag before setting out on her
"I have a client who has already stopped taking the
drugs, and another client says her partner is telling her to stop ARVs
because Dr Rath has come up with something better. I’m worried because
people will die as a result."
"There are other options in delaying this disease," says Ralf Langner the foundation’s spokesperson.
"Anti-retroviral drugs have been shown to have side
effects, and doctors seem to ignore it, one has to ask whether they’re
reading the research or just accepting the spin of the pharmaceutical
There are a number of issues here. First of all it is good that there is somebody pointing out the negative aspects of ARV treatment because the orthodox treatment available at the moment is far from perfect. ARV treatment is not always appropriate for those who have not had HIV for long and who are asymptomatic meaning the virus is in your blood but is dormant ie not making you sick. This could last for 10 years so why take ARVs? Surely it is more important to support the body with good nutrition and vitamins? Secondly conventional treatment for HIV is very complicated to understand. Doctors don’t bother to explain how it works. All people know is that they take these pills everyday and then stop getting sick. They don’t understand why and this is not just in the developing world but everywhere and not just in the case of HIV.
Some years ago I had to make a choice on whether or not to take a horrendous form of chemotherapy for 6 months followed by 3 more months on a not so toxic version. It was a hard decision to make because of the side effects and because the drugs are essentially poison. Despite trying to access further information and even where alternatives were available none of them were particularly convincing. I had to end up making my decision based on my oncologists suggestions. I came to the conclusion that none of these drugs or alternatives are adequate in themselves and that it is best to combine a number of different ones. What I do know now is if I had to take chemotherapy again I would think long and hard as I was a lot more sick from the treatment than the illness and my body still suffers from the side effects 5 years on. Also if one is reliant on public health care which most of us are then there is little opportunity to take up alternative medicines. For example vitamins are very expensive and if they were proven to be a viable alternative to say chemotherapy would I have been able to afford that treatment? I doubt it.
Not understanding the illness you have or the way the medication works makes people vulnerable to others coming along and saying the drugs you are taking cause serious side effects and your doctors are doing nothing. This can encourage patients to pay attention to an alternative point of view. It is therefore the responsibility of drug treatment centers and doctors to explain how drugs work and to acknowledge that yes there are side effects to the treatment and also that treatment should include access to health care, decent housing and living conditions, and good nutrition.
According to the website, the Rath Foundation seems to be active in exposing the mulitibillion dollar drug industry and the Pharmaceutical Drug Cartel and there doesn’t appear to be anything sinister about the "Break the Chains of Pharmaceutical Colonialism" campaign. However the language used is very dogmatic and use of "sound bites" is not helpful. The site does publish a number of articles on vitamin therapy trials and so on which present some genuine and worthwhile arguments and from the brief look I have had he doesn’t seem to be selling anything. Nevertheless I believe more investigation is required on the Foundation and its motives, funding etc.
On a slightly different note I have just finished reading an article in "Femicide in Global Perspective" edited by Diana Russell and Roberta Harmes called "AIDS as Mass Femicide: Focus on South Africa by Diana Russell that highlights another side of HIV/AIDS from a gender perspective. Russell contends that
"the lethal impact of AIDS on many women and girls must be recognised as a form of femicide that is devastating women throughout the world".
She goes on to list three overlapping gender related problems that have significantly played a part in the spread of AIDS: male sexism and male dominaton, genital mutilation, and rape. Although this case study is based in Africa I have no doubt that a similar situations exist in other countries.
1) Male sexism, misogynists beliefs and behaviour towards women are a major cause of the spread of AIDS and thereby of femicide…………..
males refusing to use condoms despite having multiple partners
males who engage in sex with other female/male partners but fail to divulge their non-monogamous behaviour thus depriving their female partners of the opportunity to protect themselves or any children that may be born from contracting HIV or to save their lives by refusing to have sex
husbands who feel entitled to demand or force their partners to have sex with them
She lists certain sexual practices as being particularly dangerous for women such as the practice of "dry sex" which can cause "vaginal lacerations and suppresses the natural bacteria thus increasing the likelihood of HIV infection and gender inequalities that leave sexual decision making in the hands of men and poverty that makes young girls vulnerable to being coerced into sex by older men.
2) Genital mutilation and AIDS the roots of which lie in the patriarchal family and society at large. There are 4 types of FGM (see "Cutting the Rose by Efua Dorkenoo published by Minority Rights Group, 1994) and it is Types III and IV that are especially brutal and susceptible to AIDS. Type III otherwise known as infibulation removes the whole of the clitoris, labia monora and labia majora. The raw edges of the latter are then sewn together to form a layer of scar tissue with a small passage used to allow for the passage of menstrual blood and sex. Type IV is described as "a new category devised to cover other surgical practices", eg introduction of substances into the vagina to tighten or narrow it or burning of the clitoris and surrounding tissue. Dorkenoo estimates that 15% of FGM comes under Type III and is practiced mainly in Somalia, northern Kenya, Ethiopia, Eritrea and some areas of northern Mali and Nigeria. Women who have been infibulated are often sewn up so tightly that sexual intercourse leads to friction and bleeding and thereby far greater risk of HIV contraction. Because FGM "is designed to suit men’s sexual needs and maintain their inordinate domination over women, AIDS death resulting from FGM qualify as femicide.
3) Rape and AIDS. There are no reliable statistics on the incidence of rape in African countries except that SA has been identified as "having one of the highest rates of rape in countries in which rape cases have been estimated". The prevalence of AIDS in SA together with the high number of rape cases makes rape increasingly lethal. There is also the reported belief held by some males that HIV can be cured by having sex with a virgin and since only young children can be counted on to be virgins, then with young children. I am not sure sow prevalent this myth is and where exactly it is supposedly taking place.
Two SA NGOs (Sinikithemba HIV/AIDS Care Centre – which offers HIV-testing, counselling and ongoing support services – and HIVAN, a centre for HIV/AIDS networking) are working together to publish a book for children on HIV/AIDS written by HIV+ children. The aim is to give
HIV-positive children a scientifically correct explanation of how the virus works in the body through text and children’s drawings, but could also be used as an educational tool in schools throughout South Africa.
There are an estimated 230,000 children living with HIV/AIDS in SA
Other reports on HIV/AIDS in Africa at IRIN Plus