Treatment Action Campaign

TAC calls for further clarification of Finance Minister Trevor Manuel’s medium-term budget adjustments (released 21 October 2008, passed by National Assembly 23 October). While TAC welcomes the additional R300 million for prevention of mother-to-child transmission (PMTCT) and antiretroviral (ARV) treatment, we disagree that decisions around weak social spending, health education and laboratory services were transparent.

TAC is concerned about the budget adjustments in light of South Africa’s high inflation rates, which are eroding critical health response allocations. TAC is also alarmed by the large allocations which appear to prioritise Eskom and the World Cup over basic healthcare services. TAC demands high-level accountability in explaining the previous Ministry’s overspends. Although TAC is still awaiting details of this, the recent ARV shortage in Free State points to mounting evidence of Minister Tshabalala-Msimang’s legacy of incompetence.

Last week, TAC learnt that the Free State was experiencing critical, life-threatening shortages of ARVs and had therefore called for a stop to the provincial ART roll-out. The Manager of the province’s ART programme, Dr. Mvula Tshabalala, instructed provincial healthcare workers to stop initiating new patients on ART with the exception of pregnant women.

• To read TAC's original statement on the issue from 10 November please click here.
• To read TAC's update on the Free State ART shortages from 13 November please click here.

The alleged reasons for the shortages are a lack of funds to support the ART roll-out. The money allocated for the Free State’s ART roll-out was not sufficient to support the range of ARV regimens that healthcare clinics needed to make available to patients. Furthermore, not enough funds were allocated to support the roll-out of dual therapy for the prevention-of-mother-to-child-transmission (PMTCT). The result is that the money was quickly exhausted.

Last week it came to light that the Free State was experiencing critical, life-threatening shortages of ARVs and had therefore called for a stop to the ART roll-out. To read TAC's original statement on the issue please click here. The Manager of the province’s ART programme, Dr. Mvula Tshabalala, instructed provincial healthcare workers to stop initiating new patients on ART with the exception of pregnant women.

The reasons for these ART shortages were alleged financial mismanagement within the provincial Health Department. TAC has since received some clarity on these issues from representatives of the Free State Department of Health as well as from a range of stakeholders who are currently monitoring the situation. The findings have important implications for the national roll-out as a whole.

According to the information that we have received:

Today, Tuesday 11 November, the Treatment Action Campaign hosted a press conference to draw attention to our recent global call for affordable access to HPV vaccines for developing countries.

On Friday morning, TAC national offices began receiving phone calls from concerned healthcare workers and journalists requesting information about the antiretroviral (ARV) shortages at piublic sector health facilities in the Free State province. We have subsequently learned that healthcare workers have been instructed by senior government healthcare officials to stop initiating new patients on antiretroviral therapy (ART), and to halt baseline blood work and treatment literacy programmes in the province.

An anxious healthcare worker has since forwarded TAC a chain of emails sent by Palesa Santho, the pharmacist for the Free State’s ART programme, and Dr. Mvula Tshabalala, the head of the province’s Comprehensive HIV and AIDS Management Programme. These emails were sent to a list of government healthcare workers and focus on the province’s shortages in ART treatments, instructing the workers to stop putting new patients on ART. The subject from one of the emails sent by Dr. Tshabalala is: ‘STOP PUTTING NEW CLIENTS ON ARVS’.

TAC has issued the following global call for affordable access to HPV vaccines in non-OECD (developing) countries. Copies of the statement below will be delivered to representatives of Merck and GlaxoSmithKline, the manufactures and patent-holders of the Gardasil© and Ceravix© HPV vaccines , respectively, in the near future. We ask individuals and organisations to please add their sign-ons to this important campaign:

"This is a request to reduce the price of the vaccine to $10.00 for all non-OECD countries. It is our firm belief that in the long-run the volumes generated by global access will ensure a reasonable profit for your shareholders. But, above all, this will save countless lives of women and girls now.

We also request that your companies co-operate with the public health sector to undertake efficacy trials in men and boys with a focus on MSM.

Statistics South Africa released the Mortality and causes of death in South Africa, 2006: Findings from death notification report last week. The statistical release presents data on mortality and causes of death based on all death notification forms received from the Department of Home Affairs for deaths that occurred in 2006.

The previous mortality report included deaths up to and including 2005. This one updates that report by including 2006. The report confirms the effects of the HIV epidemic that have already been shown in previous mortality reports:

The following landmark speech was delivered this week by Health Minister Barbara Hogan before an assembly of leading HIV scientists, clinicians and activists. Her opening address to the International HIV Vaccine Research Conference, Minister Hogan’s speech below, in which she acknowledges the causal link between HIV and AIDS; commends the efforts of the scientific, medical and activists communities; recognises the depth and severity of the HIV/AIDS crisis in South Africa; commits Government to achieving the targets of the National Strategic Plan; and lauds the Cape High Court for its recent judgment against notorious quack AIDS denialist Matthias Rath, marks an historic turning point in the South African government’s response to the HIV/AIDS epidemic. TAC salutes Minister Hogan for her openness and honesty as well as for the leadership she has shown on HIV/AIDS since taking office last month.

The Advertising Standards Authority of South Africa (ASASA) has upheld a complaint by the Treatment Action Campaign against an advertisement for fraudulent treatment for HIV which appeared in the Sowetan newspaper on 6 June 2008. You can download a copy of ASASA’s ruling here.

The advert in question, placed by Gogo’s Traditional Medicines (GTM), claimed inter alia that:

• “finally we have managed to develop medicines for HIV that brings [sic] real improvement in your health.”
• GTM’s Bantam Tonic, “reduces viral load in your body and increases your CD4 count in less than 30 days” and,
• The company’s Pisces Tonic, “helps to fight other opportunistic sickness [sic].”

These products, marketed together as a package in five litre quantities, were advertised for sale “for only” R1500.

Male medical circumcision reduces the risk of heterosexual men contracting HIV. It is highly likely that the widespread introduction and encouragement of voluntary male medical circumcision (VMMC) in countries with generalised heterosexual epidemics will reduce HIV incidence substantially. There is also evidence that VMMC reduces the risk of men contracting HPV, the virus that causes cervical cancer. Therefore, there is likely a lower risk of circumcised men passing on HPV to their female partners.

Yet a number of commentators have raised objections to the introduction of VMMC.

An article by Halperin et al. titled Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics has been published in Future HIV Therapy (September 2008, Vol. 2, No. 5, Pages 399-405, doi:10.2217/17469600.2.5.399). It answers the objections raised to VMMC. Its authors include many distinguished scientists, clinicians and activists, including members of the TAC.