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Wednesday, 30 January, 2002, 17:17 GMT
Africa's Aids drugs debate heats up
Aids sufferer
Over 25 million people have HIV or Aids in Africa
By the BBC's Mark Ashurst

Drug companies have offered huge discounts to Botswana, where there is a higher percentage of HIV-positive people in the population than anywhere else in the world.

The companies' action is prompted by wanting to establish the viability of prescribing certain medicines in an African environment.

Botswana has found however, that even with limitless funding, it is difficult to help people who need access to anti-retroviral drugs.

Despite money pouring into Botswana, there are real difficulties in implementing successful programmes.

"Even when there are no financial constraints, if these drugs are freely available, it is very, very difficult to actually implement the programme," said Donald de Korte, a former head of US drugs firm Merck in South Africa who is running a pilot scheme.

"A lot needs to be done in building up infrastructure, to train and educate doctors, nurses, counsellors - to mobilise the community to ensure that people adhere to therapy when they go back into villages," he said.

Mbeki's stance

Debate continues to rage across Africa over the best use of anti-retroviral drugs, which prolong the lives of HIV-positive people.

Patient holding up anti-retroviral drugs packet
Anti-retroviral drugs can prolong the lives of HIV-positive patients
A court ruling means that South Africa can licence companies to produce these drugs cheaply, but president Thabo Mbeki questions whether money should be better spent elsewhere.

The president's controversial stance on Aids has angered both activists and a significant proportion of the medical establishment in South Africa.

He argues that HIV may not be the sole cause of immune deficiency in Africa, where the poor suffer the effects of poor nutrition, unsafe water and the relentless assault of opportunistic infections.

And Mr Mbeki maintains that a more comprehensive response than pharmaceuticals is needed.

"When you ask the question: does HIV cause Aids - the question is - does a virus cause a syndrome. It can't - and I think it's incorrect from everything that I read to say immune deficiency is acquired exclusively from a single virus," he said.

Policy opposed

Opposition against President Mbeki's policies is strong within South Africa.

Late last year, a South African court overruled government policy - ordering public hospitals to provide anti-retroviral drugs to pregnant women.

It is hoped they will reduce mother-to-child transmission of HIV - although scientists are divided over the long-term effect of the drugs.

The South African government is also able to licence companies to produce cheap anti-retroviral drugs, after pharmaceutical companies dropped a case opposing the move last year.

President Thabo Mbeki
President Mbeki argues that HIV might not be the sole cause of immune deficiency
Aids activist Zackie Achmat said: "The reasons the companies withdrew is because of the tremendous international mobilisation.

"Governments condemned them, the European parliament passed a resolution saying drop the case, the ordinary citizens, their consumers, said drop the case," he said.

So the framework is in place for cheap anti retroviral drugs to be made available by companies, local government, even trade unions - any group that can set up its own clinics.

"Nobody has suggested that at one fell swoop from tomorrow, there should automatically be an anti-retroviral drug available at every shop and hospital immediately," said Ebrahim Patel, secretary-general of the Clothing and Allied Textile Workers Union.

"If the political will is there, the practical programme to introduce it, to roll it out, can be found."

But he also warned that there was an economic cost that society paid for not making the drugs available.

Universal access

Even as South Africa debates whether to use these drugs, Botswana has adopted a policy of universal access.

To date the policy of universal access to drugs has only been adopted in Botswana, where 38% of its population is HIV positive.

Botswana's policy is less than six months old but it is critical to the development of Aids policy in Africa.

However, failure to complete simple therapies can create further problems in a country where even tuberculosis remains a killer.

Tuberculosis is easily cured by a single tablet taken once a day, but failure to complete even that simple treatment has led to new drug-resistant strains developing.

If the same happens with HIV, an entire generation of research into anti-retroviral drugs could be wiped out, stalling hopes of the only permanent solution - a vaccine.

The BBC's Mark Ashurst
"Botswana's policy is less than six months old but critical to the development of Aids policy in Africa."
See also:

28 Nov 01 | Africa
Africa devastated by Aids
04 Jan 02 | Africa
UN demands more Aids money
08 Oct 01 | Business
African firm wins Aids drug permit
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