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Last Updated: Tuesday, 26 April 2005, 07:49 GMT 08:49 UK
South Africa's broken HIV promises
By Nick Miles
BBC News, Cape Town

Generic drugs factory
The battle to provide cheap ARVs in South Africa has been a long one

A year after the ruling ANC party's third election victory, opposition politicians and HIV pressure groups say the South African government has failed to keep its pledges over HIV/Aids.

More than five million South Africans are HIV positive.

For several years after the virus become widespread the South African government's policy was not to make anti-retroviral drugs (ARVs) available to all the people who were HIV positive.

The government was not convinced that ARVs were a cost-effective way of treating HIV.

That position changed in November of 2003 when the cabinet voted to provide ARVs across the board.

But critics of the government say the progress since then has been too slow.

Political will?

"They keep on moving the goalposts over the number of people receiving anti-retroviral drugs," says Diane Kohler Barnard , the health spokesperson for the main South African opposition party, the Democratic Alliance.

Zackie Achmat
Zackie himself is HIV-positive

"They said 50,000 people would be on ARVs a year ago and they are still way short of that. There seems to be inefficiency and a lack of will to meet the targets."

In February last year President Thabo Mbeki said he would make anti-retroviral drugs available in at least one hospital or clinic in each of the country's 53 districts. The health ministry says that it has achieved that target, 122 centres are now dispensing ARVs.

Almost 40,000 people are now receiving the drugs.

"In rural areas, uptake is not as fast as we would like because it's hard to get our message across to everyone," says Sibani Mgnadi, the spokesperson for the health ministry.

"Uptake is faster in the more developed provinces like Gauteng where it's easier to recruit health workers and where we've got more laboratories to check who qualifies for the drugs".


Anti-retroviral drugs have been shown to lengthen the lives of people who have contracted HIV.

But in South Africa there's still a heated debate about how effective they are.

Nelson Mandela has campaigned for more action to fight Aids
The government employs what it calls a broad strategy to deal with the problem.

That includes providing ARVs whilst also making multi-vitamin supplements available to more than a 150,000 people with HIV.

"We'd prefer people to use a number of different strategies to fight the virus," says Sibani Mgnadi

"It's not government policy to stress the supremacy of one treatment over another in combating the virus".

It is statements like that which have angered the government's critics.

"It's a dangerous and damaging policy," says Zackie Achmat, chairperson of the Treatment Action Campaign which has lobbied the government to provide ARVs for a number of years.


"It's allowed organizations to come in and make what we consider to be unsubstantiated claims about the effectiveness of vitamin supplements in HIV treatment."

Child at a TAC rally
The nutrition campaign could confuse those receiving ARVs
Over recent months a company that sells vitamin supplements based in Holland, called the Matthias Rath Foundation, has taken out adverts in South African newspapers and put posters up near HIV treatment centres stressing what it says are the dangerous side effects of ARVs.

There is evidence that some people are stopping their 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 HIV positive.

"Our clients are very confused," HIV counselor Flora Tabela told me as she packed ARVs into a bag before setting out on her daily round.

"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."

The Matthias Rath Foundation says that far from spreading confusion it is trying to give people living with HIV /Aids enough information to be able to decide what type of treatment to request.

"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 companies".

There are conflicting reports about how effective vitamins are at treating people with HIV.


At a recent World Health Organization conference in Durban looking at nutrition and HIV, there was much evidence put forward to suggest a healthy balanced diet can make anti-retroviral drugs more effective, but the jury is still out on whether vitamin supplements can permanently put off the onset of Aids.

South Africa's Health Minister Manto Tshabalala-Msimang has famously urged people to eat lots of garlic and beetroot to fight the effects of Aids.

At the moment the South African health ministry says that there is no evidence that the Matthias Rath Foundation is acting irresponsibly in South Africa.

There are no reliable figures for the number of people who have stopped taking anti-retroviral drugs as a result of the foundation's campaigns, but they are sowing major doubts in peoples' minds and that is a worrying trend for many health workers who have worked to get ARVs to the people of South Africa.

Opposition politicians are calling on the government to make unequivocal statements about ARV and vitamin treatments.

"President Mbeki and his health team need to stop dabbling with HIV dissidents," says Diane Kohler Barnard from the Democratic Alliance.

"Once and for all the government needs to face up to the scale of the pandemic".

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