After months of official indecision over how to confront the epidemic ravaging South Africa, the government announced today that it would make critical drugs available to people who have H.I.V. or AIDS. In a deal signed today, World AIDS Day, the government agreed to accept a $50 million donation of the drug fluconazole from the pharmaceutical giant Pfizer. The drug, which treats a deadly brain inflammation and other AIDS-related maladies, will be provided free in public hospitals and clinics for two years.
Earlier this week, South Africa's government gave conditional approval for a drug for pregnant women that reduces the risk of transmission to the fetus of H.I.V., the virus that causes AIDS, according to officials at Boehringer Ingelheim, manufacturer of the drug, nevirapine. Dr. Nono Simelela, who heads the H.I.V./AIDS unit in the Ministry of Health, confirmed today that nevirapine would be distributed to pregnant women soon. Details about the drug distribution were sketchy, but they were welcomed by advocates and experts, who have criticized the government's lagging response to the virus, which has infected more people in South Africa than anywhere else.
During the last year, President Thabo Mbeki has confounded scientists by questioning the safety of commonly prescribed anti-AIDS drugs and the widely accepted causal link between H.I.V., the human immunodeficiency virus, and AIDS. Prominent doctors, researchers and advocates around the world have accused the president of wasting time while people were dying. In October, Mr. Mbeki acknowledged that his public statements were hampering efforts to curb the spread of the virus. Today, however, the government won praise for its efforts to provide expensive drugs free. In local pharmacies, one tablet of fluconazole costs about $17. ''Until now, it has been accessible only to people who could afford these extremely high prices,'' said Morna Cornell, director of the AIDS Consortium, which represents dozens of groups fighting the disease here.
This week, the United Nations reported that 25.3 million people in sub-Saharan Africa -- the bulk of the world's infected -- have H.I.V. or AIDS. This year alone, 2.4 million people in the region died of AIDS. The good news is that the number of new infections seems to be stabilizing. In 1999, four million people became infected with the virus, the United Nations said. This year, the figure is expected to be 3.8 million. But there is still a desperate need for affordable drugs. In South Africa, about 20 percent of adults -- about 4.2 million people -- are believed to have H.I.V. or AIDS.
Today, government officials pledged to continue to pressure pharmaceutical companies to lower prices for the developing world. The Pfizer drug fluconazole is the only outpatient treatment for cryptococcal meningitis, the brain inflammation that affects 1 in 10 AIDS patients, officials said. It is also highly effective in treating a fungal infection of the esophagus that afflicts about 20 to 40 percent of AIDS patients. The infection makes it painful to swallow and can result in severe weight loss and death.
Health officials said the drug would be available to all poor patients for two years. And even afterward, they said, Pfizer will continue to provide the drug to patients already taking it. Sputnik Ratau, a government spokesman, said it was unclear when fluconazole would start appearing in public hospitals. Some advocates for AIDS patients criticized Pfizer and the government for not providing the drug to the minority of poor patients who are treated in private clinics. Even less is known about how widely nevirapine, the drug that reduces H.I.V. transmission from mother to child, will be distributed.
Officials at Boehringer Ingelheim said the government offered only conditional approval of the drug on Thursday. Kevin McKenna, the technical director at Boehringer Ingelheim, said he was optimistic that final approval would come quickly. The company has offered to provide the drug free for five years. Mr. McKenna said he hoped that distribution would start by February or March.
Source: New York Times
Showing posts with label AZT. Show all posts
Showing posts with label AZT. Show all posts
Saturday, December 2, 2000
Monday, May 15, 2000
AIDS in South Africa; A President Misapprehends a Killer
THE tone and substance of the letter was so peculiar that some officials in Washington thought it was a hoax. In a five-page letter to President Clinton last month, South Africa's president, Thabo Mbeki, argued that his country had to chart its own course in dealing with AIDS, including consulting those who challenged prevailing views on the causes and treatments of the disease. A ''campaign of intellectual intimidation and terrorism'' akin to ''medieval book-burning'' was keeping such voices from being heard, Mr. Mbeki wrote.
The letter was no hoax, and it touched off an uproar, in part because South Africa's democratic politics and advanced industry make it the natural leader in the fight against a disease that has devastated Africa. This status was acknowledged in the nation's selection to sponsor this year's international AIDS conference. Yet here was Nelson Mandela's anointed successor questioning many years of scientific research. Never mind that Mr. Mandela hardly mentioned the disease during his presidency. In the weeks since, many South Africans have engaged in a kind of psychoanalysis of the 57-year-old president they elected last year. Why did this cultured man, educated as an economist at Sussex University in England, take such a position? What does he gain from it?
Mr. Mbeki is the only African leader to have questioned the consensus theory on AIDS. He has, moreover, an embattled history with the disease, having first become embroiled in the scientific debate three years ago, when Mr. Mandela's cabinet backed research into Virodene, a supposed cure developed locally that turned out to be carcinogenic. Attacked by scientists, the health minister in Mr. Mandela's government, which Mr. Mbeki was virtually running, refused to back down, and it later turned out that stock in the company set up to make Virodene had been given to the ruling African National Congress. Virodene was discredited long before Mr. Mbeki began publicly questioning the causes of AIDS, so there seems little reason to believe that led to his present position. But it helped create the ill-will that exists between the scientific establishment and the A.N.C.
Last year, Mr. Mbeki stunned experts by questioning the safety of the standard anti-AIDS drug AZT, which the government has declined to distribute to pregnant women despite studies indicating that it could greatly reduce the transmission of the virus to newborns. Still, AIDS activists are shocked by Mr. Mbeki's refusal to accept the standard scientific model of the disease. Political analysts, meanwhile, say they can see little political gain for him or for his party (which took 66 percent of the vote in the 1999 elections) in his stance. Most see it as a personal decision from a man who, since his teens, has lived largely in exile, petitioning world leaders to help fight apartheid. They say that Mr. Mbeki's desire to reject Western thinking -- and condescension -- is strong, and his speeches have repeatedly called for an African renaissance. ''He is very keen on doing things in an African way and not just accepting the gospel from the West,'' said Raymond Louw, editor of the weekly newsletter Southern Africa Report. ''You hear this all the time.'' Wishful thinking about a cheap cure may also have played a part, some say, since South Africa isn't nearly rich enough to afford $15,000 AIDS cocktails, (or even $3,000 ones, if drug companies cut prices, as they indicated they might last week) for the 13 percent of the population that is infected.
Others believe that Mr. Mbeki simply couldn't help himself. He has repeatedly displayed a stubborn inclination to master technical issues in his own way, and in a highly personal speech recently he told of Internet searches with dictionaries at his side as he looked for information that might help him formulate his country's AIDS policies. Whether his current approach -- convening a ''What Causes AIDS?'' panel divided between orthodox AIDS researchers and those who believe it is caused by malnutrition and parasites -- will help or hurt his country is an open question. Heading the panel of 33 experts is William Makgoba, who runs South Africa's equivalent of the National Institute of Health. Mr. Makgoba strongly supports the standard model of AIDS, but said that bringing the dissidents ''into the tent'' will be a good thing.
MR. MAKGOBA believes Mr. Mbeki to be a ''very intellectual person'' who is trying to inform himself on a disease that is ravaging his country. He wishes, however, that Mr. Mbeki had informed himself in private, fearing that he will be classified ''as one of those African leaders who doesn't care about science or technology.'' Tom Lodge, a professor of political science at the University of Witwatersrand, says that Mr. Mbeki shows the personality traits of what he calls ''an interferer, not a delegater.'' It is a trait that has come up in other arenas as well, he says.
At the moment, Professor Lodge points out, Mr. Mbeki is shuttling back and forth to Zimbabwe, trying to ease the tensions over the violence that has broken out as supporters of President Robert Mugabe have seized white-owned farms. But Professor Lodge says Mr. Mbeki should let his foreign minister do the traveling. ''He is running up to Harare every two minutes like an office boy,'' Professor Lodge said. ''The AIDS issue is the same. Maybe he will learn the lesson that a head of state does not busy himself with details.''
Source: New York Times
The letter was no hoax, and it touched off an uproar, in part because South Africa's democratic politics and advanced industry make it the natural leader in the fight against a disease that has devastated Africa. This status was acknowledged in the nation's selection to sponsor this year's international AIDS conference. Yet here was Nelson Mandela's anointed successor questioning many years of scientific research. Never mind that Mr. Mandela hardly mentioned the disease during his presidency. In the weeks since, many South Africans have engaged in a kind of psychoanalysis of the 57-year-old president they elected last year. Why did this cultured man, educated as an economist at Sussex University in England, take such a position? What does he gain from it?
Mr. Mbeki is the only African leader to have questioned the consensus theory on AIDS. He has, moreover, an embattled history with the disease, having first become embroiled in the scientific debate three years ago, when Mr. Mandela's cabinet backed research into Virodene, a supposed cure developed locally that turned out to be carcinogenic. Attacked by scientists, the health minister in Mr. Mandela's government, which Mr. Mbeki was virtually running, refused to back down, and it later turned out that stock in the company set up to make Virodene had been given to the ruling African National Congress. Virodene was discredited long before Mr. Mbeki began publicly questioning the causes of AIDS, so there seems little reason to believe that led to his present position. But it helped create the ill-will that exists between the scientific establishment and the A.N.C.
Last year, Mr. Mbeki stunned experts by questioning the safety of the standard anti-AIDS drug AZT, which the government has declined to distribute to pregnant women despite studies indicating that it could greatly reduce the transmission of the virus to newborns. Still, AIDS activists are shocked by Mr. Mbeki's refusal to accept the standard scientific model of the disease. Political analysts, meanwhile, say they can see little political gain for him or for his party (which took 66 percent of the vote in the 1999 elections) in his stance. Most see it as a personal decision from a man who, since his teens, has lived largely in exile, petitioning world leaders to help fight apartheid. They say that Mr. Mbeki's desire to reject Western thinking -- and condescension -- is strong, and his speeches have repeatedly called for an African renaissance. ''He is very keen on doing things in an African way and not just accepting the gospel from the West,'' said Raymond Louw, editor of the weekly newsletter Southern Africa Report. ''You hear this all the time.'' Wishful thinking about a cheap cure may also have played a part, some say, since South Africa isn't nearly rich enough to afford $15,000 AIDS cocktails, (or even $3,000 ones, if drug companies cut prices, as they indicated they might last week) for the 13 percent of the population that is infected.
Others believe that Mr. Mbeki simply couldn't help himself. He has repeatedly displayed a stubborn inclination to master technical issues in his own way, and in a highly personal speech recently he told of Internet searches with dictionaries at his side as he looked for information that might help him formulate his country's AIDS policies. Whether his current approach -- convening a ''What Causes AIDS?'' panel divided between orthodox AIDS researchers and those who believe it is caused by malnutrition and parasites -- will help or hurt his country is an open question. Heading the panel of 33 experts is William Makgoba, who runs South Africa's equivalent of the National Institute of Health. Mr. Makgoba strongly supports the standard model of AIDS, but said that bringing the dissidents ''into the tent'' will be a good thing.
MR. MAKGOBA believes Mr. Mbeki to be a ''very intellectual person'' who is trying to inform himself on a disease that is ravaging his country. He wishes, however, that Mr. Mbeki had informed himself in private, fearing that he will be classified ''as one of those African leaders who doesn't care about science or technology.'' Tom Lodge, a professor of political science at the University of Witwatersrand, says that Mr. Mbeki shows the personality traits of what he calls ''an interferer, not a delegater.'' It is a trait that has come up in other arenas as well, he says.
At the moment, Professor Lodge points out, Mr. Mbeki is shuttling back and forth to Zimbabwe, trying to ease the tensions over the violence that has broken out as supporters of President Robert Mugabe have seized white-owned farms. But Professor Lodge says Mr. Mbeki should let his foreign minister do the traveling. ''He is running up to Harare every two minutes like an office boy,'' Professor Lodge said. ''The AIDS issue is the same. Maybe he will learn the lesson that a head of state does not busy himself with details.''
Source: New York Times
Monday, March 20, 2000
South Africa In a Furor Over Advice About AIDS
President Thabo Mbeki's decision to seek advice from two Americans who argue that H.I.V. does not cause AIDS has touched off an outcry at home and abroad and raised fears that South Africa's already soaring infection rate will climb still further. News that Mr. Mbeki recently consulted the Americans, a scientist and a professor of African history, leaked out this month, and is the latest of several disputes over how to treat AIDS in a country of 44 million people with one of the highest H.I.V. infection rates in the world.
Mr. Mbeki and his officials spoke with David Rasnick, a biochemist, and Charles Geshekter, a professor of African history at California State University, Chico, as the president was considering strategies to combat the virus, which has infected 12.9 percent of the nation's adults. He plans to convene international AIDS experts later this year, and telephoned the scientists to assess various AIDS treatments and to reappraise the evidence that concludes that H.I.V. causes AIDS. ''The president speaks to all scientists and to everyone who believes he's got something to contribute,'' said Parks Mankahlana, the president's spokesman. ''Until all the questions that keep cropping up are answered, we are not going to be able to say to a person who disagrees with the conventional thinking, 'You are wrong or right.' Mbeki has never said H.I.V. doesn't lead to AIDS,'' Mr. Mankahlana said.
Mr. Rasnick argues that H.I.V. does not cause AIDS, a view shared by Peter Duesburg, a professor of biochemistry and molecular biology at the University of California at Berkeley. The United Nations AIDS program, the World Health Organization and most scientists say the causal link between H.I.V. and AIDS is already well established. ''At first, we were thinking we would just ignore it, but now we think this confusion can really undermine all the efforts people have made to prevent this disease,'' Dr. Awa Coll-Seck, the director of the United Nations' Department of Aids Policy in Geneva, said in a telephone interview of Mr. Mbeki's move. ''People will reassure themselves, perhaps, that they can continue risky behavior because H.I.V. is not the real cause of AIDS,'' Dr. Coll-Seck said. ''It's becoming a real issue.''
Earlier this month, government officials scrambled to explain how $6.2 million of the country's $17 million AIDS budget went unspent last year. They said the money would be rolled over into next year's budget. And five months ago, Mr. Mbeki stunned health experts by questioning the safety of the standard anti-AIDS drug AZT. This week, Health Minister Manto Tshabalala-Msimang said the government had decided the drug should not be distributed in public hospitals. ''There is not enough information for me as the minister of health to expose women to a drug that we do not know about,'' Ms. Tshabalala-Msimang said. Concerns about AZT, particularly for children, have been raised in the United States. One study found that pregnant mice treated with AZT gave birth to babies with tumors. But after reviewing the mouse study and others like it, the National Institutes of Health determined in 1997 that the benefits of the drug far outweighed the potential side effects. One two-year study found that a short course of AZT treatment for women who did not breast-feed their babies reduced transmission of the virus by 50 percent.
But Mr. Mankahlana says South Africa cannot afford to accept the West's conventional wisdom about AIDS without investigating carefully since Western scientists have yet to discover a cure for the disease. ''The fact of the matter is, there is so much that is still unknown about H.I.V. and AIDS,'' said Mr. Mankahlana, who added that the government would spend an additional $11 million this year on research. Mr. Rasnick said he received a telephone call from Mr. Mbeki after he replied to faxed questions from the president about AIDS. Mr. Rasnick and his colleagues say AIDS is typically caused by recreational drug use and malnutrition.
Prominent scientists say this thesis, which is most prominently advanced by Mr. Duesberg, relies mostly on the data of other scientists and that those scientists disagree with this interpretation of their work. But on Jan. 21, Mr. Mbeki called Mr. Rasnick directly, to hear for himself. ''He wanted our views, and we gave them to him,'' said Mr. Rasnick in a telephone interview from his home in Saratoga, Calif. ''He had read everything we had written, everything that was available on the Internet. He knows there are some serious questions out there.'' ''I think he's courageous,'' Mr. Rasnick said. ''You start looking like a lunatic if you question the AIDS axioms. Knowing this in advance, he put his neck out there anyway. He wants to have a free and public hearing about all things related to AIDS.''
source: New York Times
Mr. Mbeki and his officials spoke with David Rasnick, a biochemist, and Charles Geshekter, a professor of African history at California State University, Chico, as the president was considering strategies to combat the virus, which has infected 12.9 percent of the nation's adults. He plans to convene international AIDS experts later this year, and telephoned the scientists to assess various AIDS treatments and to reappraise the evidence that concludes that H.I.V. causes AIDS. ''The president speaks to all scientists and to everyone who believes he's got something to contribute,'' said Parks Mankahlana, the president's spokesman. ''Until all the questions that keep cropping up are answered, we are not going to be able to say to a person who disagrees with the conventional thinking, 'You are wrong or right.' Mbeki has never said H.I.V. doesn't lead to AIDS,'' Mr. Mankahlana said.
Mr. Rasnick argues that H.I.V. does not cause AIDS, a view shared by Peter Duesburg, a professor of biochemistry and molecular biology at the University of California at Berkeley. The United Nations AIDS program, the World Health Organization and most scientists say the causal link between H.I.V. and AIDS is already well established. ''At first, we were thinking we would just ignore it, but now we think this confusion can really undermine all the efforts people have made to prevent this disease,'' Dr. Awa Coll-Seck, the director of the United Nations' Department of Aids Policy in Geneva, said in a telephone interview of Mr. Mbeki's move. ''People will reassure themselves, perhaps, that they can continue risky behavior because H.I.V. is not the real cause of AIDS,'' Dr. Coll-Seck said. ''It's becoming a real issue.''
Earlier this month, government officials scrambled to explain how $6.2 million of the country's $17 million AIDS budget went unspent last year. They said the money would be rolled over into next year's budget. And five months ago, Mr. Mbeki stunned health experts by questioning the safety of the standard anti-AIDS drug AZT. This week, Health Minister Manto Tshabalala-Msimang said the government had decided the drug should not be distributed in public hospitals. ''There is not enough information for me as the minister of health to expose women to a drug that we do not know about,'' Ms. Tshabalala-Msimang said. Concerns about AZT, particularly for children, have been raised in the United States. One study found that pregnant mice treated with AZT gave birth to babies with tumors. But after reviewing the mouse study and others like it, the National Institutes of Health determined in 1997 that the benefits of the drug far outweighed the potential side effects. One two-year study found that a short course of AZT treatment for women who did not breast-feed their babies reduced transmission of the virus by 50 percent.
But Mr. Mankahlana says South Africa cannot afford to accept the West's conventional wisdom about AIDS without investigating carefully since Western scientists have yet to discover a cure for the disease. ''The fact of the matter is, there is so much that is still unknown about H.I.V. and AIDS,'' said Mr. Mankahlana, who added that the government would spend an additional $11 million this year on research. Mr. Rasnick said he received a telephone call from Mr. Mbeki after he replied to faxed questions from the president about AIDS. Mr. Rasnick and his colleagues say AIDS is typically caused by recreational drug use and malnutrition.
Prominent scientists say this thesis, which is most prominently advanced by Mr. Duesberg, relies mostly on the data of other scientists and that those scientists disagree with this interpretation of their work. But on Jan. 21, Mr. Mbeki called Mr. Rasnick directly, to hear for himself. ''He wanted our views, and we gave them to him,'' said Mr. Rasnick in a telephone interview from his home in Saratoga, Calif. ''He had read everything we had written, everything that was available on the Internet. He knows there are some serious questions out there.'' ''I think he's courageous,'' Mr. Rasnick said. ''You start looking like a lunatic if you question the AIDS axioms. Knowing this in advance, he put his neck out there anyway. He wants to have a free and public hearing about all things related to AIDS.''
source: New York Times
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