South African Press Association (Johannesburg) - August 6, 2003

In response, HIV-positive judge Edwin Cameron said in his closing address: "The question is not when, but how soon?"

He reiterated a warning given on Tuesday by Western Cape deputy director general in charge of Aids, Dr Fareed Abdullah, that "a no treatment option does not exist."

Abdullah said that if South Africa did not implement a large-scale treatment plan soon, five-million people would die from Aids in the next eight- to 10 years.

Cameron told Sapa that neither the Western Cape example of an "implementable programme, nor Fareed Abdullah's comments, have been repudiated, which by implication means they have been endorsed (by government). We need treatment for all soon. We need time frames and dates."

South Africa's first national Aids conference opened in a mire of controversy late Sunday.

Protests were sparked by the Medical Research Council threat last week to deregister Nevirapine for the prevention of mother-to-child care (PMTCT) if further efficacy figures were not forthcoming from the manufacturers within 90 days. Boehringer Ingelheim, which manufactures the drug, says it is impossible to produce such figures in 90 days.

Despite protests and powerful figures testifying to the efficacy and safety of Nevirapine, from South Africa and beyond, it seemed, at the end, that bureaucrats within the Department of Health are keen to roll out more antiretroviral treatment.

The logjams appear to be coming from the Medicines Control Council on Nevirapine; and Minister of Health Manto Tshabalala-Msimang.

She presented figures that showed as part of its Aids preventative programmes, the Department of Health distributes an average of two condoms for every sexually active man each month (22-million), and one female condom to be shared among 10 women (100,000) every 30 days. HIV infection is 58 percent higher in South African women than men according to UNAids.

Tshabalala-Msimang said: "We will know we have succeeded when we have been able to prolong the period from HIV to Aids by supporting those who are infected with nutrition, nutritional supplements and natural medicines."

However, Abdullah responded: "No amount of microntrient replacement or alternative therapies will significantly reduce the burden of mortality." Abdullah provided data that showed that by 2006, if no anti-retroviral therapy was given to prevent and treat HIV/Aids, there would be an average of 1,4-million Aids cases a year in South Africa.

From 2004 onward, without interventions to treat and prevent HIV infection there would be about 700,000 deaths a year.

Universal anti-retroviral treatment would see mortality figures drop to 400,000 a year. Last year in South Africa, according to UNAids, 600,000 people died of Aids.

Professor James McIntyre of the Chris Hani Baragwanath PeriNatal HIV Unit in Soweto told the conference that of the 72 countries using Nevirapine in the world, South Africa was the only one considering delisting the drug for PMTCT. He said that worldwide 150,000 women and their babies had used Nevirapine, of which 80,000 to 100,000 were South African women and their babies during the past two years.

McIntyre pointed out that South Africa had treated more people than elsewhere because South Africa's HIV infection rates were higher. Only Botswana, which has a dramatically lower population and therefore lower number of HIV positive pregnant women, has a higher infection rate. South Africa also better resources to treat faster.

He warned that potentially 2,200 babies born each day to HIV-infected mothers in South Africa could die if the treatment was removed.

The seriousness of the impact of HIV/Aids came out in other papers too.

A paper delivered on behalf of the Institute of Molecular Medicine and Infectious Diseases in Durban found that scientists were detecting increasing numbers of people infected with more than one strain of the virus, posing challenges for treatment.

And in their survey, as in others, infection rates slipped out that showed that in many areas infection is far higher than the 30 percent claimed by government.

The MMID survey of sexworkers and their clients, showed 60 percent of the former were infected with the clients displaying infection rates of 56 percent. Yet another paper showed that in some parts of South Africa, figures for HIV infection in pregnant women was higher than that in sexworkers.

Professor Quarraisha Abdool Karim of the Centre for the Aids Programme of Research in South Africa discussed a study of sexworkers from 1996 to 1999 in KwaZulu-Natal that showed infection rates averaged 18,2 percent.

Although the province-wide statistics for HIV prevalence among pregnant women was 33,5 percent in 2001 in KwaZulu-Natal, it was as high as 50,8 percent in young pregnant women at Hlabisa clinic in northern KwaZulu-Natal in the same year, she said.

Rodney Hoff of the US National Institutes of Health noted that HIV was overwhelmingly a disease of young people -- those under the age of 24 -- and women. Of the 14,000 new HIV infections every day, 600 were in South Africa, and more than 95 percent were in developing nations. More than half of the infected were women.

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