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AFRO-NETS> Kaiser Daily HIV/AIDS Report - Tue, 15 May 2001

Kaiser Daily HIV/AIDS Report - Tue, 15 May 2001

* Citing Cost and Infrastructure Concerns, South Africa Has 'No In-
  tention' of Purchasing 'Cheap' Antiretrovirals
* Nigeria's Promise of AIDS Drugs Raises Hopes, Decreases Disease
  Stigma, Boston Globe Reports
* Anglo American Board of Directors Supports Executives' Plan to Pro-
  vide Employees with Drugs
* 'NewsHour' Begins Weeklong Series on AIDS in Africa with Malawi Re-
  port, Annan Interview

Citing Cost and Infrastructure Concerns, South Africa Has 'No Inten-
tion' of Purchasing 'Cheap' Antiretrovirals

Despite the "courtroom victory" last month that opened the door for 
the South African government to buy "cheap" antiretroviral drugs, 
Health Minister Dr. Manto Tshabalala-Msimang said in an interview 
with London's Guardian that the government "has no intention" of pur-
chasing the drugs. Instead, the government will "limit itself" to 
purchasing antibiotics for tuberculosis and other infections that 
kill HIV-positive individuals, as well as those not infected with the 
virus. The South African government, despite "pressure" from local 
and foreign AIDS activists to buy the antiretrovirals, says the 
treatments are still too expensive and the country lacks the infra-
structure to "distribute the drugs safely." Although the pharmaceuti-
cal company Cipla has offered to sell the drugs to South Africa for 
$250 per person a year, Tshabalala-Msimang said that the price is 
"still to high." She added, "It is $250 times millions of people 
times the infrastructure that we do not have times the health workers 
who are not yet trained times prevention measures." However, the ad-
vocacy group Treatment Action Campaign is "threatening" to sue the 
government for failure to provide antiretroviral treatment in order 
to prevent vertical HIV transmission. In addition, the London-based 
Anglo American mining company is interested in purchasing the drugs 
for its workforce and may seek a compulsory license so the drugs 
could be produced cheaply in South Africa (Boseley, Guardian, 5/14). 

Meeting with Industry

In related news, Tshabalala-Msimang met with leaders of five pharma-
ceutical companies on Friday to discuss the regulations of the Medi-
cines and Related Substances Control Amendment Act, which the compa-
nies claimed in court was unconstitutional. While the drug makers 
dropped their case last month, the two sides agreed to have the com-
panies provide "early comment" on the regulations prior to a three-
month public comment period. To "speed up the process," the govern-
ment and the drug firms will establish a "working group" of represen-
tatives from industry and government to foster "interaction ... on 
areas where there [are] diverging views," Tshabalala-Msimang said. 
The companies involved in the discussions include Bayer, Boehringer 
Ingelheim, GlaxoSmithKline, Merck and Roche (South African Press As-
sociation/BBC Monitoring, 5/14).

Nigeria's Promise of AIDS Drugs Raises Hopes, Decreases Disease 
Stigma, Boston Globe Reports

Nigeria and other sub-Saharan African countries are set to distribute 
a "meager round" of discounted anti-HIV drugs this month, but only 
Nigerians who can afford the therapy will receive the treatments at 
this time, the Boston Globe reports. Although more than four million 
Nigerians are HIV-positive, there are only drugs available for 
10,000, creating an "ethical problem for doctors," Dr. John Idoko 
said. Idoko, who has run AIDS drug clinical trials for three years 
for GlaxoSmithKline, helped establish a regional laboratory to test 
immunity levels in people with HIV/AIDS and began Halt AIDS, a pre-
vention and education program, said that he has been "inundated" with 
requests for medication in the past several weeks. According to the 
Globe, "just the whiff of a promise of treatment is revolutionizing 
the entire strategy of fighting AIDS in Africa. Suddenly, in a land 
where almost everyone was unwilling even to discuss the disease, peo-
ple are asking to be tested. Before the promise of anti-AIDS drugs, 
people had little reason to learn if they were infected." When Nige-
ria was under the rule of military dictator Sani Abacha, who died in 
1998, there was no government spending on AIDS prevention or educa-
tion. But last year the government appropriated $100,000 for AIDS, 
and this year Nigerian President Olusegun Obasanjo increased the 
amount to $20 million. However, given the country's reputation for 
corruption, the question is whether the money will be well spent, and 
"whether the country can develop a workable plan to use it," the 
Globe reports (Donnelly, Boston Globe, 5/13).

Anglo American Board of Directors Supports Executives' Plan to Pro-
vide Employees with Drugs

The board of directors for the London-based mining giant Anglo Ameri-
can PLC has agreed to support company executives' plan to assess if 
and how AIDS drugs can be provided to the company's 160,000 African 
workers, 20% of whom are HIV-positive, the Wall Street Journal Europe 
reports. The board, however, has not yet committed to providing the 
drugs. Anglo American will run a clinical trial to address how to 
help workers adhere to the complex drug regimens and handle the side 
effects, and to analyze treatment costs and benefits. Company execu-
tives have said that offering medicine will help manage the disease 
and may save corporate dollars in the long run. The board's decision 
to consider the drug provision was welcomed by South African AIDS ac-
tivists (Schoofs, Wall Street Journal Europe, 5/15).    

'NewsHour' Begins Weeklong Series on AIDS in Africa with Malawi Re-
port, Annan Interview

"NewsHour with Jim Lehrer" last night featured an interview with U.N. 
Secretary-General Kofi Annan, in which he discussed his proposal for 
a $7 billion to $10 billion international fund to fight AIDS in de-
veloping countries. When asked by correspondent Elizabeth Farnsworth 
if the $200 million President Bush has pledged toward a global AIDS 
fund was "enough," Annan said, "I think as the president himself 
said, this was a fund contribution and there is probably some more to 
come. Obviously, our target is to get $7 billion to $10 billion addi-
tional money applied to the epidemic, and I would hope that the 
president's action [Friday] would energize other leaders and other 
people in society to come on board. ... But I think we launched it 
[Friday], and I think it was an important beginning." When asked who 
will administer the fund, Annan said, "We will have a board that will 
oversee the money and [m]ake the decisions. The board will include 
representatives from donor governments, from recipient governments, a 
civil society, including those organizations fighting the AIDS epi-
demic, people from the private sector and the international organiza-
tion[s]. There will be a small secretariat attached to this ... that 
will do the day-to-day administration. But the funds will be handled 
by the World Bank; they will do the banking responsibilities. And of 
course there will be a scientific advisory body attached to it to en-
sure that we are aiming for the right result and ... we would ensure 
that we are effective and we are getting value for money." Responding 
to Farnsworth's question regarding how the funds will be divided be-
tween programs such as prevention and antiretroviral drugs, Annan 
said, "I think we are setting up a single global fund with several 
windows. It will be a fund for AIDS and infectious diseases such as 
tuberculosis, as well as malaria. I have no doubt that some govern-
ments will target their contribution [to be] used only for AIDS. Oth-
ers may want it used for tuberculosis. And I hope others will give us 
flexibility to use our funds as we see fit. ... [T]he quality of 
those programs will play a role. ... [W]e will give the money to 
those programs that we believe ... are likely to be most effective." 
Annan said that the next step in setting up the global fund will come 
at the June U.N. General Assembly special session on AIDS in New 
York. "I hope between now and then governments will have time to de-
termine how much they are going to contribute to the fund. ... [T]he 
G8, they're meeting at the end of July, [and] would also be taking up 
this issue. ... I trust ... and urge that they all pay into one 
fund," Annan said.

Leadership a Must

Annan said that he feels there has been a "great sea change" in rais-
ing awareness and mobilizing world leaders on this issue in the last 
year. "We need leadership all across from the North and South, and so 
I was very encouraged by the strong support of President Bush for 
this effort. And I have reason to believe that all the leaders in 
Europe and others will come on board. In fact, President [Jacques] 
Chirac of France made a strong statement [Friday] morning supporting 
the approach and the fund" after the donation announcement in Wash-
ington, Annan said.

Drugs and Intellectual Property

On the topic of drug manufacturers and intellectual property rights, 
Annan said that President Bush's message was that the "intellectual 
property regime has to be respected so the pharmaceutical companies 
will have the incentive to continue their research to produce medica-
tion, cure and vaccine[s] for diseases like AIDS." Although Annan has 
spoken to the pharmaceutical companies and understands the incentive 
argument, he said that "we should be able to buy generic medication, 
and we should be able to offer treatment to those who have been hard-
est hit by the disease" (Farnsworth, "NewsHour with Jim Lehrer," PBS, 

Malawi Struggles with Epidemic

"NewsHour" also re-aired its April 25 segment on Malawi's AIDS epi-
demic. Correspondent Elizabeth Farnsworth traveled to the country to 
"grasp the scope of the AIDS catastrophe engulfing southern Africa" 
(Farnsworth, "NewsHour," PBS, 4/25). 

The Kaiser Daily HIV/AIDS Report is published for, 
a free service of The Henry J. Kaiser Family Foundation, by National 
Journal Group Inc. c 2001 by National Journal Group Inc. and Kaiser 
Family Foundation. All rights reserved.
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