ImpActAIDS Newsletter

He may not have won the Nobel Peace Prize himself but South African Aids campaigner Zackie Achmat says the fact that it has gone to an African woman for the first time is a victory for the entire continent.

"I think every single person on the continent and every person who works in environmental justice will celebrate this day," Achmat told reporters in Bronkhorstpruit outside Pretoria, where he was attending an Aids conference.

"The victory of Wangari Maathai is not only important for the fact that she's a woman. She's also the first African woman to win the Nobel Peace Prize. From that point of view it's very important for us," he said. "It's a happy day for every blade of grass in Africa."

Maathai, 63, Kenya's assistant environment minister, won the prize on Friday for her campaigns during the late 1980s and 1990s against government-backed forest clearances in her home country, which saw her beaten by police and held in jail.

Achmat and his Treatment Action Campaign (TAC) have won international acclaim for their work to combat HIV/Aids in South Africa, which has more people infected with the disease than any country.

Last October, after years of pressure from the TAC and the international community, the South African government dropped its long resistance to life-prolonging anti-retroviral drugs (ARVs) and agreed to provide free treatment in public hospitals.

Nearly five million South Africans are infected with the HI virus that can eventually lead to Aids. Activists say expensive treatment is out of the reach of most poor South Africans, leading to around 600 Aids-related deaths every day.

Achmat, who is HIV-positive, was nominated for the Nobel by the Philadelphia-based American Friends Service Committee. He said he was relieved that the anxious wait for the big announcement was finally over.

"It's going to improve our work. It means we're not going to get hunted down by the media," he quipped.

DAR ES SALAAM, Oct. 1 (Xinhuanet) -- Starting on Oct. 1, some of the HIV-positive people in Tanzania are to get free-of-charge anti-retroviral drugs (ARVs) to prolong their lives as the country starts its special assistance program.

As many as 3,360 adults and 940 children are among the first beneficiaries of this program.

The Tanzanian government has promised to distribute free ARVs to no less than 30,000 people in fiscal year 2004-2005 while the number of HIV/AIDS patients receiving free ARVs will increase to 220,000 between 2005 and 2006.

The government has worked out a four-year national care and treatment program in that HIV/AIDS prevalence rate now stands at 10 percent in Tanzania, with 140,000 sufferers dying from the disease annually, out of almost two million people living with thevirus.

Mother-to-child infection is high in the country.

Tanzania is among the poorest countries in the world. Most people in the rural areas each live with less than a US dollar a day whereas a monthly dose of anti-HIV/AIDS drugs costs more than 30 dollars.

The free drugs, purchased by the government at a cost of 26 billion Tanzanian shillings (26 million dollars), will first be distributed through 32 local hospitals and the services will be extended to 91 hospitals and health centers throughout the country. top

NEWS

Glaxo seeks dismissal of hearing into its Aids drugs prices
September 23, 2004

By Vernon Wessels

Johannesburg - GlaxoSmithKline, the world's largest maker of HIV treatments, has asked South African competition authorities to drop an "unfounded" probe into the price of its Aids drugs.

The Los Angeles-based Aids Healthcare Foundation has asked the competition tribunal to rule whether Glaxo's antiretroviral drugs are excessively priced. The group, which distributes free medicines in South Africa, may sue Glaxo if the tribunal rules against the UK-based company.

"Glaxo doesn't believe that the foundation's claim has any merit," the company said. It asked the tribunal to end the probe "on the basis that the complaint requested by the foundation is unfounded".

The tribunal can fine a company as much as 10 percent of local revenue for breaches of competition law. Last year the competition commission, which investigates complaints before referring them to the tribunal, found Glaxo abused its market dominance.

Glaxo reached a settlement with the commission by allowing other producers to make its Aids drugs at a reduced cost.

"It's very ironic that the foundation has filed this complaint against Glaxo, since in June 2003 we signed an agreement with them to supply the Ithembalabantu clinic in Umlazi with Glaxo's antiretrovirals at not-for-profit prices," said Michael Spector, the general manager of Glaxo's South African unit.

The foundation operates Ithembalabantu, the isiZulu word for people's hope, as a free Aids treatment clinic in the KwaZulu Natal township of Umlazi with the Network of Aids Communities of SA, a local non-governmental organisation.

"Like most bullies, Glaxo was full of bluster when it vowed repeatedly that it would appeal the very filing of our tribunal complaint," Michael Weinstein, the president of the foundation, said. "Glaxo hides behind a wall of lawyers and legal arguments, attempting to assert technicalities as to why the tribunal should not hear this case."

The organisation was in the process of drafting an answering affidavit to Glaxo, said Musa Ntsibande, a director of Strauss Daly, the foundation's legal representatives, in a telephone interview. "After that we will apply for a hearing date with the tribunal."

Glaxo has agreed to allow drug manufacturers, such as Aspen Pharmacare, Thembalami Pharmaceuticals and Feza Pharmaceuticals, to distribute its medicines in Africa.

The foundation and the Treatment Action Campaign (TAC), an Aids advocacy group, filed the complaint with the competition commission in January 2003.

The foundation rejected the settlement Glaxo struck with the commission and the TAC because it had not been included in the process and the agreement "didn't go far enough", Ntsibande said.

Statistics SA estimated in July that 3.83 million of the country's 46.6 million people were infected with Aids.

The UN put the number higher in a report it issued in the same month, estimating that 5.3 million South Africans had Aids.

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Web Issue 2110	October 08 2004

Geldof defends Blair plan for African debt

MICHAEL SETTLE, Chief UK Political Correspondent

BOB Geldof last night rallied behind the proposals of Tony Blair and Gordon Brown to cut Third World debt after Europe's aid chief denounced Britain's efforts as similar to the accounting malpractices of Enron.
The plain-speaking anti-poverty campaigner accused Poul Nielson, the outgoing EU humanitarian aid commissioner, of "talking through his arse", adding: "He shouldn't have his job if he doesn't want to help."
Mr Nielson incurred the wrath of the Band Aid organiser after he claimed the government's plans to relieve poorer nations of their debt would force future generations to pay the price of glory for today's politicians.
"Everybody is worried, for very good reasons, about the debt burden of developing countries, so to introduce a new dimension of debt … only to impose on our children in the donor countries the burden of actually paying what we now take the glory for doing – that I don't like," Mr Nielson told MEPs in Brussels.
"This should be about solidarity, not about borrowing from our children," argued the EU's outgoing aid chief.
His criticism centred on the chancellor's brainchild, the International Finance Facility (IFF), which aims to double to £600m a year the aid to the world's poorest countries. The plan involves issuing bonds in the markets using donor countries' long-term funding commitments as collateral.
Britain, which will use its presidency of the G8 and the EU next year to make reducing poverty and debt a global priority, believes the IFF is essential to meet the United Nations' so-called "millennium development goals" of reducing poverty by half, cutting infant mortality by two-thirds and ensuring every child has primary schooling.
Yet Mr Nielson said the IFF plan "smells too much of innovative Enron accounting". Accountancy malpractices led to the fall of the US energy giant.
During the British-sponsored Commission for Africa summit in Ethiopia, Geldof rounded on Mr Nielson, telling reporters: "It's rich of the EU aid commissioner. He should look to his own books. They're wholly woeful in what they do. I don't think the debt relief issue is economic sophistry if that's what he's suggesting. I think the IFF is elegant, timely, simple, necessary."
Mr Blair and Meles Zenawi, his Ethopian counterpart, sitting next to the Irish rock singer, also brushed aside the EU commissioner's criticism – albeit in more diplomatic language.
"Obviously, we support the IFF and do not think it is an accounting gimmick," said Mr Zenawi.
The prime minister added: "There will be particular aspects (of our plans) people have difficulty with … Let's have a debate and see if we can persuade people."
Also at the press conference, in Addis Ababa, Mr Blair pressed the international community to raise £122m to help people caught up in violence in the crisis-hit Darfur region of Sudan.
He said Britain planned to train 20,000 African peacekeepers over the next five years to boost the continent's ability to respond to conflicts like the one in Darfur, where the Janjaweed, the pro-Sudanese government Arab militia, have been raiding African villages, killing tens of thousands of locals and forcing more than a million to flee their homes.
The commission's report on what Africa needs to do to develop its infrastructure and to avoid war and famine in the future will be published next spring in time for the UK's presidency of the G8 and EU.
"Next year will be the year of decision for Africa and the international community," said the prime minister. "The time for excuses will be over."
In the past 50 years, 186 coups and 26 major wars have killed more than seven million people and cost Africa more than £200bn. Half a dozen African nations are still troubled by serious conflicts.
HIV and Aids complicate efforts to promote economic growth and development on the continent. More than 26 million Africans are infected with HIV and an estimated 15 million have died from Aids.
"The problems are multiple. We know them all," said Mr Blair.
"The difference is that this time we have to put together a plan that is comprehensive in its scope and has at its core a real partnership between Africa and the developed world."

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BMI valuable tool for assessing when to start ARVs in resource limited settings

Michael Carter, Wednesday, September 29, 2004

Body mass index (BMI) at the time of HIV diagnosis can predict survival according to a study conducted in The Gambia and published in the October 1^st edition of the Journal of Acquired Immune Deficiency Syndromes. The study found that patients with a BMI below 16 have a similar prognosis to those with CD4 cell counts below 200 cells/mm³. The investigators believe that BMI could be a low cost, low technology means of assessing when an individual needs to start antiretroviral therapy.

Although viral load measurements and CD4 cell counts are basic diagnostic tools and play a key role in the initiation and monitoring of highly active antiretroviral therapy (HAART) in rich countries, many resource-limited countries lack the funds or technology to use these tests. Investigators from the London School of Hygiene and Tropical Medicine wished to see if BMI at the time of initial HIV diagnosis provided a robust, affordable, and easily used monitoring tool, capable of determining the prognosis of HIV-positive individuals.

Between 1992 and 2001 a total of 1657 individuals in The Gambia had their BMI assessed within three months of their initial HIV diagnosis. CD4 cell count was also measured and patients had their Karnofsky score assessed. The Karnofsky score is a measure of how well a patient is doing, on a scale from 0 to 100, where 100 is when the patient has no complaints or evidence of disease, 50 is when the patient requires considerable assistance and frequent medical care, and 0 is when the patient is dead.

At the time of HIV diagnosis, individuals had a median BMI of 18.8 kg/m², the median CD4 cell count was 250 cells/mm³ and the median Karnofsky score was 80. A total of 11% of patients were assessed as having wasting at baseline, and at this point 16% were also diagnosed with tuberculosis.

Investigators found a significant relationship between CD4 cell count and BMI at baseline. The median BMI for patients with a CD4 cell count below 200 cells/mm³ was 17.9 kg/m². Patients with a CD4 cell count between 200 – 500 cells/mm³ had a BMI of 19.5 kg/m² and individuals with a CD4 cell count above 500 cells/mm³ had a BMI above 20 kg/m² (p < 0.001).

Karnofsky score was also significantly related to BMI (p = 0.05).

BMI at the time of HIV diagnosis was able to predict survival time. A total of 849 patients (51%) died during follow-up with individuals with a low BMI at diagnosis having the greatest risk of death. The overall mortality rate was 229 per 1000 patient years of follow-up and median survival was 2.8 years. However, median survival for patients with a BMI below 16 was only 0.8 years compared to 8.9 years for individuals with a BMI above 22 at baseline (p < 0.0001).

Patients with a BMI below 18 at diagnosis were 3.4 times more likely to die than individuals with a BMI above 18 kg/m², i.e. the hazard ratio (HR) was 3.4. The HR of death for individuals with a BMI below 16 was 6.4 kg/m² compared to patients with a BMI above 22 kg/m². The investigators note that this “is similar to the HR of those with a CD4 cell count below 200 cells/mm³ compared with those with a CD4 cell count above 500 cells/mm³ (HR 6.8).”

Even after adjusting for type of HIV (HIV-1, HIV-2 and dual infection), CD4 cell count at baseline, age, sex, infection with tuberculosis, and the receipt of Pneumocystis pneumonia (PCP) prophylaxis, a BMI below 16 kg/m² still involved a HR of death of 2.5.

Even if a patient had a high BMI at baseline, they still had a significantly increased risk of death if it fell during follow-up. A total of 166 patients had a BMI above 18 kg/m² at diagnosis. Of these 109 died during follow-up. Median survival for these patients, once their BMI dropped below 18 kg/m², was 0.8 years, and their mortality rate was 571 per 1000 patient-years. This compared to a mortality rate of 112 per 1000 patient years for patients whose BMI remained above 18 kg/m².

“Our data show that baseline BMI recorded within three months of the diagnosis of HIV infection is a strong and independent predictor of mortality in this West African cohort. The magnitude of this predictive effect, and the sensitivity and specificity were similar to those of the CD4 cell count on mortality”, write the investigators. They add that they found a persistent and strong “independent association between BMI and mortality; indeed the increased risk of a BMI <18 is comparable to the increased risk with a CD4 cell count <200.”

The investigators believe that their findings have important implications for antiretroviral access programmes in resource limited countries, and conclude “BMI at diagnosis is a low-technology, affordable, prognostic indicator, independent of age, sex, CD4 cell count, or HIV type.”

Reference

van der Sande MAB et al. Body mass index at the time of HIV diagnosis: a strong and independent predictor of survival. J Acquir Immune Defic Syndr 37: 1288–1294, 2004.