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#196 - 11/28/03 07:44 PM The health issue we need to remember always
Mtshede Offline

Registered: 08/02/02
Posts: 632
Loc: London
A mixed prognosis

Nov 27th 2003
From The Economist print edition

For all this week?s sobering statistics, the global fight against AIDS is steadily gaining strength

IN THE modern world, 20 years seems a long time to be at war, but it is hardly surprising when the enemy is as elusive, and pervasive, as HIV?the virus that causes the disease AIDS. It is two decades since scientists first identified the cause of what was a baffling new syndrome ravaging immune systems and destroying lives. Since then, AIDS has gone from being the scourge of relatively small groups, such as homosexuals and intravenous-drug users in rich countries, to arguably the biggest threat to life and prosperity in the developing world.

Although the epidemic continues to tear across Africa, Asia and Latin America, there is much optimism among policymakers and public-health experts that the battle against the disease has reached a turning point. Anti-AIDS programmes are growing larger and more coherent. And there is a growing political commitment to ensure that more money is spent and, crucially, new methods are exploited, in getting AIDS drugs to poor people.

Hope might seem odd in the face of this week?s grim accounting from UNAIDS?the United Nations agency monitoring the disease. In its annual report on the epidemic, it estimates that a shocking 40m people are infected with HIV?2.5m of them are children. In 2003 alone, 5m were newly infected. Although the total number of people living with the virus seems to have grown more slowly in recent years, Peter Piot, head of UNAIDS, cautions against complacency. This apparent levelling off of the figures is largely the result of a steady rise in the AIDS death rate, from just over 2m in 1999 to 3m this year.

UNAIDS, the UN's HIV/AIDS initiative, presents its latest report on the worldwide spread of the virus. The International AIDS Society posts scientific research on AIDS at the society's annual conference. The UN Global Fund to Fight AIDS, TB and Malaria gives information on its efforts to combat AIDS, and provides statistics and research. ?Fund the Fund? campaigns to make up the Global Fund's budget shortfall by proposing ?equitable contributions? based on a percentage of GDP. The White House outlines its AIDS policy. The Bill and Melinda Gates Foundation gives information on its activities on fighting AIDS.

Despite such dreadful figures, Stephen Lewis, Kofi Annan?s special envoy for AIDS in Africa, says he is more optimistic than he has been for years. Firstly, political leaders, especially in sub-Saharan Africa, are no longer as silent or apathetic as they were in the 1990s. Many are avidly, and publicly, discussing how to build up their national health-care systems to deal with AIDS. Much of this planning has yet to translate into action, though. And significant issues need to be addressed, such as the stigma that prevents people from getting tested or unfair inheritance laws that leave widows vulnerable. Nevertheless, public acknowledgment of the size of the problem and the need to act are important steps in the right direction.

The second reason for optimism is that there is now more money available. UNAIDS says about $4.7 billion was spent on AIDS in low and middle-income countries this year, compared with just $200m in 1996. The American Congress looks set to approve $2.4 billion to be spent next year, largely in the 14 countries that stand to benefit from the Bush administration?s five-year plan to fight AIDS in Africa and the Caribbean. The multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria, which was founded last year, has already committed $2.1 billion to projects in more than 120 countries.

And yet much more will be needed, both from wealthy donors and the governments of poor countries. Another $4.1 billion is needed by 2005 merely to honour and extend the Global Fund?s commitments for example. UNAIDS says the world needs a total of $10 billion a year by 2005 just to keep AIDS in check.

The biggest change in the past year is a significant boost to the prospect of providing anti-HIV medicines. At the moment, only 800,000 people take the cocktail of drugs needed to keep HIV under control. More than three-fifths of these patients are in rich countries. Most of the rest are in Latin America. Poor people have gone without drugs because they have been too expensive, and the countries where they live lack the staff and medical systems to deliver the appropriate medications.

These factors are now changing. Since 2000, the cost of the drug cocktail needed to treat AIDS has fallen from $10,000 per patient annually to $300. This is largely thanks to competition from generic medicines, produced by firms such as Cipla, a drugmaker in India. Innovative drug firms holding patents on these medicines have also cut their prices for poor countries. Prices will also fall further thanks to a new deal brokered by the Clinton Foundation, a charity established by the eponymous former President Bill. Four Indian drugmakers will produce anti-retroviral medicines for roughly $140 per patient annually?courtesy of production efficiencies worked out between the foundation and the drugmakers.

There have been other moves this year to expand access to drugs. In August, members of the World Trade Organisation (WTO) agreed on compulsory licensing, so that countries without the capacity to make their own drugs could import generic versions from countries whose domestic patent laws might prohibit this. Canada is now planning to change its laws to allow its home-grown companies to supply this market.

This week also saw the launch of Cumvivium, a new charity set up by the International Federation of Catholic Pharmacists with the blessing of the Vatican. The federation aims to help poor countries to obtain two-dozen types of low-cost pharmaceuticals, and hopes to receive funds from the European Union for this. It has signed agreements with over 60 drug firms, and wants to start pilot schemes in two countries early next year.

In addition, the South African and Chinese governments announced this month that they would provide anti-retroviral drugs to everyone who needs them. This is a huge step forward for countries that have spent years downplaying their AIDS crises. South Africa?s programme is particularly bold. Mr Piot calls it ?historic?. It will cost about $680m a year by 2007 to buy drugs, set up clinics and train thousands of health workers.

This flurry of activity will receive a further encouragement when, on December 1st, the World Health Organisation (WHO) launches ?3 by 5??a plan to get 3m people on anti-retroviral treatment by the end of 2005. If this is achieved, it will represent a ten-fold increase in the number of people in poor countries taking anti-retrovirals. This will be no easy task, warns Jim Kim, one of the programme's architects.

The WHO also hopes to use its negotiating clout to help poor countries procure good drugs cheaply, and its expertise to create the health-care systems to deliver them. This will involve training volunteers, rather than just qualified medical personnel, to deliver simplified drug regimens and to monitor their effects, in remote parts. Rather than waiting for a complex laboratory assessment before starting treatment, as would happen in richer places, patients will be prescribed drugs straight away. This is controversial, but groups such as M?decins Sans Fronti?res, a big aid organisation, have shown that it can work. Dr Kim is unapologetic: ?If they wait to do things as we do in the West, then it will take too long and there will be many more deaths.?

Money for the initiative may well come largely from the Global Fund. Richard Feachem, its head, reckons the programme will cost roughly $3 billion a year for the next two years. And the WHO is busy forming emergency-response teams to help countries participate in the scheme. Already 20 countries have applied to join. The scheme will require careful monitoring but Dr Kim says it will prolong the lives of millions of people. It will also have the useful side-effect of establishing health-care systems that can deliver long-term therapies. These, in turn, should prove useful in coping with future chronic diseases, such as diabetes. Offering people therapy could also encourage them to seek testing and counselling. As more people find out that they are HIV positive, the stigma surrounding the disease should hopefully diminish.

Orphans of the storm
If the world is, at last, trying to muster an adequate medical response to AIDS in poor places, the same cannot be said about the vast socio-economic implications of the epidemic. It is hard to fathom, let alone fix, a situation in which most teachers and farmers are expected to die of AIDS, as in Botswana.

Arguably the epidemic?s cruellest legacy, though, is the orphans it is leaving behind. Around 11m children in sub-Saharan Africa have lost at least one parent to AIDS. This is 11 times the number in 1990. The situation is about to get a lot worse, according to a report published this week by UNICEF. By 2010, there could be as many as 20m AIDS orphans in sub-Saharan Africa. Even if widespread anti-retroviral treatment takes hold, some think it will, at best, spare only 1.8m children from such a loss.

If not for AIDS, the number of orphans worldwide would have been tumbling. As it is, roughly one in ten sub-Saharan children is now an orphan. A third of these are the result of AIDS. Orphaning rates above 5% worry UNICEF because they exceed the capacity of local communities to care for parentless children. So how do places such as Zambia, where almost 12% of children are AIDS orphans, cope?

Not well enough, says UNICEF. More than half the countries south of the Sahara have no national plans to care for AIDS orphans. Most African orphans are taken in by their extended families which have, in the past, masked the problem by dispersing it. These households, though, are often headed by frail grandparents struggling to cope with these extra dependants.

Arguably the epidemic?s cruellest legacy is the orphans it is leaving behind. Around 11m children in sub-Saharan Africa have lost at least one parent to AIDS

Orphans tend to be poorer than non-orphans, and to face a higher risk of malnutrition, stunting and death?even if they are free of HIV themselves. They also endure the psychological trauma of watching parents waste away, and often have to watch as their subsequent care-givers suffer the same fate. Many are also separated from their siblings. Small wonder that a recent study of more than 350 AIDS orphans in Congo found that nearly 40% were suffering from post-traumatic stress, and a third were depressed, anxious or irritable.

Their future prospects, too, are grim. Orphans are less likely to attend school?partly because they cannot afford the fees but also because step-parents tend to educate their own children first. Many drift on to the streets, as the teeming slums of Nairobi and Lusaka attest. Many go to work. In Zambia, for example, more than two-thirds of the child prostitutes are AIDS orphans. As a result, these children are themselves at high risk of HIV infection.

As Mr Lewis points out, the orphan problem could have dire long-term effects. Today?s AIDS orphans, he says, are having children of their own. As they have never learned parenting skills from their own mothers or fathers, they may find it hard to be parents themselves.

Some church groups and other NGOs are trying to break this awful cycle. In Malawi, for example, Save the Children is supporting a programme that tries to help orphans in their own families. This is better than institutionalising the children, an option that is also more expensive.

In Uganda, another international NGO called Plan is helping families to come to terms with an impending death. This includes training guardians and helping soon-to-be-bereaved children to prepare ?memory books? so that they will have a record of their parents.

Some governments have made moves to tackle the orphan crisis. In Uganda and Kenya, free primary-school education is allowing millions more children?including AIDS orphans?to get an education. Uganda has been so successful in curbing its epidemic that the number of AIDS orphans should start to decline by 2010. No other sub-Saharan country can expect such a blessing. One preliminary estimate from Columbia University puts the cost of tackling Africa?s orphan problem at $4 billion annually. But as AIDS spreads elsewhere in the world, so too does the orphan problem, in countries as far afield as Haiti and India.

While there is welcome progress across many fronts in Africa, much more needs to be done. The same is true of other regions where the disease is now taking hold?among them eastern Europe, India and China. Indeed, the lessons learned and mistakes made in Africa should prove useful elsewhere. But it will take years before the impact of these new, large-scale initiatives are felt. AIDS itself is hard enough to beat; its broader social effects defy any quick fix.

#197 - 11/29/03 09:18 PM Re: The health issue we need to remember always
Ndukuzibomvu Offline

Registered: 01/04/03
Posts: 176
Loc: KwaGuqangamadolo
Mnumzane Mtshede, sawubona futhi:

Thanks for the timely posting of this article, on the weekend of The Nelson Mandela 46664 Aids benefit concert khona lena eKapa.

I have frequently wondered what it will take to achieve a sustained attenuation of the AIDS pandemic. The probability of an effective vaccine being designed in the near future is miniscule, I think. At the moment, I believe the modus operandi in the fight against this disease should be EDUCATION, and a return to ancient cultural values. The most painful thing about AIDS is that it hurts children (who are the future, technically) the most. Of course, this means that its repercussions will be felt for a long time, well into the next century. AIDS robs children of their parents, robs them of their childhood and their innocence. Little children, across all cultures and geographical regions, tend to see the world as a playground full of all sorts of possibilities and wonders. Viewed through a child's eyes, the universe is sublime, a paradise. And, quite frankly, that's the way it should be. Beautiful. I believe that childhood is one of the SWEETEST human experiences. I can't see how a human can be human without first experiencing the joy and the innocence of childhood. Childhood is just great. In light of this, now think about what it's like to be robbed of your childhood, permanently. This is precisely what AIDS does to countless children all over the world, especially in Sub-Saharan Afrika. The question then becomes, what can/should we do to combat this disease? Why is this disease's rate of propagation not diminishing? Is there something that we, as a culture, can do to contain this monster? Why is it so easy to spread AIDS, and why are we so mute when it comes to this disease?? I do not have the answers, but I feel that our ancestors were a more organised culture than we are today; and they probably would have found ways of containing this disease, had it arisen in their time. Mthwakazi omuhle, mina ngibona sengathi kusafanele sigcine amasiko akithi, ikakhulu ngalemihla yemikhuhlane emibi kangaka.

Thousands of Zulu virgins converge at the Enyokeni Zulu Royal Palace in September EVERY year, to celebrate Umkhosi woMhlanga (Reed Dance Festival). The Reed Dance is an function that promotes PURITY among virgin girls and RESPECT for young women. This ceremony helps to preserve the custom of keeping girls as virgins until they get married. The festival itself is part of the annual festivities on the calendar of the Zulu nation.

Nonke niyazi kahle nje ukuthi emandulo omame bekungabantu abanezithunzi, izindlovukazi uqobo.
Babehlonishwa abantu besifazane emandulo, wawuzwa uMnumzane ethi kunkosikazi wakhe "MAMA". Ngalezonsuku, babefundiswa amajaha namantombazana ukuziphatha kanye nokuzihlonipha. Kambe namhlanje bangaki abantu abanaso isikhathi sokufundisa abantwana nezizinto ezimqoka kanjena? Uyazi, umuntu wesifazane uyafana xathu nomhlanga (kumbe inqodi) okhula ezibukweni nomfula omkhulu, uma singafanisa amanzi nenhlonipho. Bobaba nabomame, kasifundiseni abasakhulayo iSintu, kanye nokuzihlonipha; njengoba nathi basifundisa abazali bethu. Ngokubona kwami, nokhu kunganceda ekulwiseni lesisilo samagcikwane egazi.


#198 - 12/01/03 07:00 PM Re: The health issue we need to remember always
khanyi Offline

Registered: 10/18/03
Posts: 6
Loc: harlow ,essex,uk
NDUKUZIBOMVU AND MTSHEDE thank you for bringing up the HIV/AIDS topicwhich l would like to say among our culture its becoming a taboo talking about it which is a shame really as thousands of people die each day. lm working as a midwife and lm so interested in broadening my knowledge on the disease so that l go back home and impart my knowlegde to the suffering thousands of people. What we need now is change in attitudes especially men they dont understand the seriousness of the disease as they seem to be sleeping around a lot especially at home. Im hoping to work with pregnant women so to reduce transmission to children the developed countries have greatly reduced mother to child transmission rates to 7% while in Sub-saharan Africa the rate is at 15-25%. We over here should find ways of getting financial help to buy these drugs not involing mugabes govt of course.South Africa, Botswana, Uganda and Kenya have been given donations by Bill Gates foundation cause their countries are stable and what of zimba. LETS ALL PULL OUR WEIGHT TOGETHER TO REDUCE THE INFECTION RATE REMEMBER DECEMBER IS AIDS AWARENESS MONTH.

#199 - 12/04/03 04:37 PM Re: The health issue we need to remember always
Bhudaza Offline

Registered: 11/09/02
Posts: 586
Loc: Byo, Mthwakazi
WHO accused of huge HIV blunder

19:00 03 December 03

Exclusive from New Scientist Print Edition.

The positive HIV test was a surprise. The boy ? let's call him Sipho ? never had a blood transfusion. He did not inject drugs or have unprotected sex. He died when he was just seven months old, yet another South African victim of AIDS.

The natural assumption was that he must have picked up the disease from his mother in the womb, but her HIV test came back negative. So where did Sipho catch the virus? No one can be sure, but it is most likely that he was infected in hospital, perhaps by a needle that had not been sterilised after being used on an infected patient.

The World Health Organization thinks that tragedies like Sipho's are very much the exception. It estimates that unsafe injections during healthcare account for just 2.5 per cent of HIV cases in Africa, and that the vast majority of infections are via sex.

But some researchers believe the role of dirty needles has been greatly underestimated. If they are right, relatively simple measures could save millions of people worldwide.

This week, the group Physicians for Human Rights based in Washington DC sent an open letter to the WHO and UNAIDS. It calls for more resources to be spent on preventing infection by dirty needles. The letter says people should be educated about the dangers, and measures taken such as providing syringes that cannot be used more than once.

But the WHO and UNAIDS have long resisted the suggestion that injections are an important driver of the epidemic. "It has been a huge struggle to make the case that this is a significant part of the epidemic," says Ernest Drucker, an AIDS expert at Yeshiva University in New York. "We've run into a firestorm of protest."

"The worry is that if too much attention is paid to unsafe injections it will take away from the message about sexual transmission," says James Whitworth at the London School of Hygiene and Tropical Medicine, who backs the WHO position. Another fear is that vaccination programmes will be undermined if injections are seen as risky.

While these concerns might be valid, critics argue the consequences of downplaying the role of dirty needles are far worse. The most vociferous of them is David Gisselquist, an independent researcher in Hershey, Pennsylvania, who has published a string of papers highlighting dirty needles as a major risk factor (New Scientist print edition, 1 March 2003).

Using the WHO's own estimate that 7.6 per cent of infections in 1988 were from dirty needles or blood transfusions, he says healthcare is to blame for 10 million infected people today. If needles cause closer to half of all infections, as Gisselquist believes, tackling the problem would have kept the epidemic confined to high-risk groups, he claims.

"In Asia, if we don't get that message out, the epidemic could really blow up," he warns. The WHO's own figures, based on observations in hospitals and clinics, suggest that up to 75 per cent of injections in parts of south-east Asia are carried out using unsterilised equipment, compared with just 20 per cent in sub-Saharan Africa.

Gisselquist's work prompted the WHO to hold a meeting on unsafe injections in March 2003. He says data supporting his claims was presented, but it was not reflected in the meeting's conclusions. Instead, the press release proclaimed: "An expert group has reaffirmed that unsafe sexual practices are responsible for the vast majority of HIV infections in sub-Saharan Africa."

Six months before the meeting, UNAIDS drew up a report, which has been seen by New Scientist, that contradicts this position. Based on a review of 23 studies, it concludes that in sub-Saharan Africa, "contaminated injections may cause between 12 and 33 per cent of new HIV infections". That is far higher than the accepted 2.5 per cent figure.

That report has never been published, prompting Gisselquist to accuse the WHO of ignoring evidence that does not support its views. But according to Peter Ghys of UNAIDS in Geneva, the document was a preliminary draft that has since been incorporated into a much larger summary of the evidence. That study, due to be published early next year, will support the WHO estimate of about 2.5 per cent.

George Schmid, a senior researcher on HIV at the WHO in Geneva and author of the revised study, says the apparent change of view arises because a statistical technique used in the 2002 draft is inappropriate for HIV.

The reviewed studies calculate a "population attributable fraction", the proportion of infections in the population due to a specific risk factor. Schmid says this method works for non-infectious diseases, but not when infected people can affect the future course of the disease by infecting other people.

Gisselquist's critics also ask why hepatitis C, which is mainly spread by needles, does not mirror the pattern of HIV infection, and why HIV has spread in some countries with relatively good healthcare.

In response, Gisselquist claims hundreds of studies have reported significant numbers of children who, like Sipho, have contracted the disease despite having HIV-negative parents or parents with a different HIV strain.

A study of nearly 10,000 South Africans released in 2002, for instance, found that 5.6 per cent of children aged between 2 and 14 were infected. Most children infected by their mothers die before their second birthday, so the surprisingly high figure points to infection routes other than sex being important.

But Schmid says the results of all these studies are questionable. For instance, the instrument used to collect samples in the South African study was not approved by the FDA for use on children, he says. Schmid is now helping to design a follow-up study.

Whatever its results, there is little likelihood of the argument being resolved. Drucker claims that the longer WHO and UNAIDS deny a major role for injections, the harder it is becoming for them to climb down. The real tragedy, he says, is that injection safety is an easy win compared with trying to promote safe sex. "Clearing up the medical care system is not such a major task."

#200 - 12/04/03 09:25 PM Re: The health issue we need to remember always
Mtshede Offline

Registered: 08/02/02
Posts: 632
Loc: London
Mnewethu Ndukuzibomvu many thanks for that endorsement of the message of this month of AIDS awareness. Your comments on the loss of the right of our children to enjoy a childhood certainly caused some emotion as I am deeply aware of the tribulations of a small child of my own son's age who lost his dear Mum to this dread disease. As we settle down to enjoy a Christmas in the UK good food turns to ash in my mouth and the sound of Christmas carols sounds like a lament. Anything and everyhing that can be done to revitalize venerable institutions and encourage a sense of decorum in people in their relations is to be welcomed profoundly. In times past there were sophisticated mechanisms relating to custom and the esteem that the gentler gender was held in Nguni society. Let us work in every way to recreate that situation.

And Khanyi thank you too for shedding light on this matter. May God bless your efforts to protect the health of people so sorely in need of professional attention!

Bhudas this article you have posted desrerves wide attention. President Mbeki has attracted widespread criticism for some of his pronouncements and it is only right that the WHo too deserves fierce scrutiny. All mediums of disease transmission need to be identified and regulated.

I will repeat the lesson that has been learned and learned again over a period of time.

It is simply this: unprotected intercourse for any person, black or white, pink or brown, with a number of partners has a positive relationship to the possibility of becoming HIV infected. I hope never to muddy the waters of debate in this respect.


#201 - 12/27/03 05:12 AM Re: The health issue we need to remember always
Zwangendaba Offline

Registered: 04/27/03
Posts: 1399
Loc: New York, New York, USA

When such topics are flighted on the Inkundla site, I feel touched about the diversity and seriousness with which they are discussed.

Njengo Mthwakazi, I feel we under-estimate our strength. We are such a powerfull people otherwise no one would be as worried as they are about us.

What do we do with our strength???

Like other Societies do, let us start with the people in the diaspora. We need to organise ourselves for the advancement of Mthwakazi. When we say that AIDS is devastating our society, we must have a recognised panel that can approach DONNORS and let them know that we are doing this as people of Matebeleland for the people of Matebeleland. A lot of Donnor organisations already know about Mthwakazi. Just go through the Google Website.

Bafowethu, akula muntu ozasenzela. Babethi kasibulawe, lalamhlanje bathi kasibulawe.

We must form ourselves into panels that represent every facet of activity in Mthwakazi, from Health, sports, social, education, food, etc.

Sigida ndawonye bantu beNkosi.

Li Zwangendaba.


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