Bay Windows - National News, October 26, 2000
Bruce Mirken, Bay Windows correspondent

But three months later the TV cameras have gone and little has changed for the average HIV-infected South African. TAC, a grassroots organization with only six staff people to cover the entire country, still faces enormous obstacles. In late September we spoke to TAC International Secretary Nathan Geffen. The 29-year-old, who teaches computer science at the University of Capetown, joined TAC last February because ôI believe this is the biggest health crisis facing South Africa. Not only now, but for the last few decades, if not centuries.ö

Bay Windows: What sort of care is available to most people with HIV in South Africa?

Nathan Geffen: It differs widely depending on area and socio-economic status. If youÆre an upper middle-class executive, then you can probably just afford to pay R2400 ($345) a month for the least expensive triple-drug therapy ù not including a protease inhibitor ù plus doctorÆs bills, etc. But for the vast majority of the countryÆs population this is not a remote possibility.

ThereÆs very much a two-tier health system in South Africa. The private sector is very sophisticated, even by U.S. standards, but private health-care is extremely expensive. The vast majority of people do not have access to it.

Public health care is very patchy. There are some centers of excellence. Take Groote Schuur Hospital in Cape Town, for instance. ItÆs famous, because the worldÆs first heart transplant was performed there. ItÆs facilities are pretty good, by and large. Yet most hospitals in South Africa cannot afford fluconazole (a drug used to treat cryptococcal meningitis and thrush).

BW: What percentage of HIV-infected South Africans can access combination therapy?

NG: I read recently that of the estimated 4.2 million people with HIV, less than 10,000 have access to [effective anti-AIDS treatments].

BW: What about treatment for opportunistic infections like PCP, MAC, etc?

NG: It varies widely. Systemic thrush and cryptococcal meningitis are major problems. Pfizer is apparently charging the government R29 per (fluconazole) pill, give or take a rand. Yet Biolab and Siam in Thailand are selling 200mg fluconazole for less than R2 a pill. When the government tried to introduce legislation to make it easier for them to import the generic version, 42 pharmaceutical companies took legal action against the government. The case is still in court, pretty much in limbo.

BW: So the government still canÆt import or produce generic drugs?

NG: We believe they can. ThereÆs legislation in the Patents Act which allows the government to issue compulsory licenses if they deem it necessary or if a company has been abusing their patent.

TAC has announced two initiatives in this regard: 1) We will take Pfizer to court within the next few months, on the basis of them abusing their patent. 2) We are launching a defiance campaign. We will import generic medication into the country. This action is imminent, a few weeks away.

BW: Some companies, including Pfizer, have gotten favorable press with offers of discounted drugs to African countries. How does TAC view those offers?

NG: TAC launched a campaign against Pfizer earlier this year and generated a lot of bad publicity for them. Our demands were very reasonable and have not changed. Either Pfizer must issue a voluntary license for the importation of [generic] fluconazole or they must drop their price to less than R4 per 200mg tablet.

In response, Pfizer offered to make a donation of fluconazole to HIV-positive people with cryptococcal meningitis, if they couldnÆt afford to buy the drugs. We welcomed this at first. Then Pfizer entered negotiations with the South African government to work out the details.

Pfizer put some harsh conditions onto any deal, including: 1) No generic importation.2) [The donation was] only [for] crypto, not systemic thrush. 3) They would have to be closely involved in the distribution program ù incredibly patronizing: South Africa has a sophisticated health-care service and we certainly donÆt need Pfizer to ôhelpö administer it for us. 4) Pfizer refused to make similar offers to other third world countries. We havenÆt asked for charity. We accept that they need to make a profit. We just donÆt want them to hide their monopolistic practices behind the veil of intellectual property rights.

BW: Is the South African government doing dealing effectively with the companies?

NG: The government is in a difficult position. The drug companies have taken legal action against them. In addition, they were put on a U.S. trade watch list not very long ago.

As a result of enormous pressure from U.S. groups like the Consumer Project on Technology and ACT UP [New York and Philadelphia, not to be confused with the ôdissidentö ACT UP San Francisco], they backed down, but the threat hangs over the government all the time.

Apparently thereÆs been no shortage of back-room bullying from U.S. trade representatives to stop the South African government from pursuing generic imports. Nevertheless the government needs to show more courage in this regard.

BW: How accurate is the estimate that 4 million or more South Africans are infected.?

NG: The figure is the best estimate thatÆs been made, but thereÆs a wide margin of error. You can probably give or take one or two million from that figure. Nevertheless, we can be sure that the epidemic has reached catastrophic proportions.

BW: Some Americans claim there really is no AIDS epidemic in Africa, that people are dying from the same diseases as always ù TB, malaria, etc. ù and South AfricaÆs health crisis is simply one of poverty, nutrition and inadequate health care.

NG: The claims are beyond absurd. ItÆs obvious to any one living in South Africa whoÆs vaguely in touch with day-to-day realities that something serious is happening. Healthy people are getting sick and dying in large numbers. But leaving very obvious and convincing anecdotal evidence aside, I read a study today of a small rural area, which looked at increases in mortality over the last few years. There was a slight increase in death by suicide and accidents, but a massive, very statistically significant increase in mortality in people between the ages of 20 to 49, all of it related to HIV and TB, with the increase in TB deaths highly correlated with HIV. Hospitals are overflowing. Mortality in Durban has increased massively since 1994.

BW: Deaths between ages 20 and 49 are significant because diseases related to poverty or malnutrition generally hit the very young and very old first, right?

NG: Precisely. Besides, well off, well-known people have died as well.

BW: [Those who deny that HIV causes AIDS at all] went to the Durban conference in significant numbers. Did they make any attempt to contact TAC or get your views?

NG: Not that IÆm aware of. They have certainly spread slanderous lies about us. Ultimately, they will become irrelevant though. It seems they have lost the sympathetic ear that they had in the highest echelons of government.

BW: Really? In his recent Time interview [South African] President Mbeki sounded like he was falling further into the denialist camp.

NG: The last few weeks have been very interesting. The President and the Minister of Health released confusing statements about their stance on HIV being the cause of AIDS. However, their coalition partners, the Congress of South African Trade Unions and the South African Communist Party, as well as elements in the African National Congress, were critical of the confusion that was created and unequivocally stated that HIV causes AIDS. The President backtracked to some extent and has now stated that government policy is made and carried out on the basis that HIV causes AIDS.

BW: What other issues are at the top of your agenda?

NG: The Medical Research Council and countless organizations and doctors have called for the implementation of a country-wide mother-to-child transmission prevention program. It is affordable and probably cost-saving. Yet the government has dragged its feet on the issue and has not made its intentions clear as to whether or not it is going to implement the program. Conservatively, a mother-to-child transmission prevention program would prevent about 14,000 HIV infections a year and cost R300 million. More likely, it will stop about 40,000 infections a year and cost less than R300 million. Also, many studies indicate that preventing infections is cheaper than treating HIV-positive children.

Therefore, weÆve announced that we are taking legal action against the government based on a number of constitutional clauses, including (1) the best interest of the child, (2) the right of the mother to make reproductive choices, (3) the right to dignity and equality and (4) the right to health-care, so long as the government can afford it. We have a very progressive constitution in South Africa, of which weÆre very proud.

BW: What can Americans do to help?

NG: Many things. Put pressure on the drug companies to lower their prices, drop their court action against the South African government, and to grant voluntary licenses to the South African government for importation of essential generics. Put pressure on the U.S. government to stop the backroom bullying, to stop getting false PR out of AIDS (such as through miserly donations to African countries, cleverly masking their attempts to block generic importation)

Highlight the drug company contributions to the Presidential campaigns. Donate money to organizations like TAC. òòò

(Tax-exempt donations for TAC can be made through the South Africa Development Fund, 555 Amory Street, Boston, MA 02130. Make checks payable to the South Africa Development Fund and indicate the funds are for TAC. 100 percent of the donation will go to TAC. U.S. dollars are acceptable. For more information about TAC, go to www.tac.org.za or e-mail info@tac.org.za.)
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