Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
Mail & Guardian (Johannesburg) - August 18, 2006
Belinda Beresford and Sapa
The South African government stand -- decorated with the lemons, beetroot and garlic linked to Health Minister Manto Tshabalala- Msimang's aversion to anti-retroviral drugs -- was invaded by Treatment Action Campaign (TAC) activists, some lying on the ground to symbolise South Africa's Aids dead.
"Fire Manto now!" they chanted to passers-by, charging that South Africa's Aids response was "the worst in the world and not the most comprehensive".
An organiser has been reported as saying that the anti-retroviral medicines for the stand had been mislaid in luggage on the flight to Canada.
Health Ministry spokesperson Sibani Mngadi accused the TAC's Nathan Geffen of "making abusive utterances" and threatening government officials running the stand. He called on TAC leaders to act against "intolerant behaviour".
It was at the International Aids Conference in Durban in 2000 that the South African government first came under heavy fire for its attitudes to the epidemic and to ARV therapy.
At this year's event, attended by 24 000 registered participants, the South African stand reminded the world that Tshabalala-Msimang has repeatedly recommended nutritional treatment for Aids, apparently as a substitute for ARVs. At the opening of the exhibition, she said South Africans should be able to choose whether to use ARVs, or (as yet untested) traditional remedies.
It was at the International Aids Conference in Toronto 10 years ago that the revolution in anti-HIV treatment began. Results were presented that led to the adoption of Highly Active Anti-retroviral Therapy, an ARV cocktail. Such combination therapy countered HIV's high mutation rate, which can render it quickly resistant to single-drug treatment.
This year the World Health Organisation (WHO) revealed that more than a million people were receiving ARV therapy in sub-Saharan Africa, a 10-fold increase since December 2003. The WHO estimates that by the middle of this year only a quarter of people worldwide who need the therapy will be receiving it.
Multiple drug therapy does have its drawbacks -- more drugs mean the risk of more side-effects and drug interactions and less systematic treatment adherence.
One breakthrough at the Toronto conference was the announcement of interim results suggesting that people who have been successfully on conventional ARV therapy, meaning that HIV is no longer detectable in their blood, may be able to move to a single-drug treatment or monotherapy.
The South African government's emphasis on nutrition and traditional medicines continues to spook Aids workers, who fear that infected people will see such interventions as a substitute for ARVs. There is concern that people are delaying seeking conventional medical help -- which leads to less successful drug treatment.
This was confirmed at the Toronto conference by researchers from South Africa, Kenya and Uganda, who found that people with advanced Aids and very low CD4 counts were significantly more likely to die shortly after starting ARV therapy.
A report by the Southern African Development Community released earlier this week recommended a greater focus on the B in the ABC campaign -- being faithful.
The report says that multiple concurrent sexual partners are one of the main drivers of the epidemic in the region, because people do not use condoms consistently during stable sexual partnerships -- even if they have two or more such relationships at the same time.
It said the epidemic in the region had become so entrenched and so generalised that most infections were now occurring among people considered "low-risk".
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