iClinic - July 14, 2000
Marjolein Harvey
He was speaking at a press briefing on Friday morning, the last day of the AIDS2000 conference, in Durban.
Chair of the board of directors of Sama, Zolile Mlisana, said that doctors must provide clear scientific guidance to government, reiterating that HIV does cause AIDS and that a comprehensive plan to implement mother-to-child HIV transmission (MTCT) treatment must be in place before the end of the year.
"Sama supports the evidence that HIV causes AIDS. Our concern is that while levels of awareness about the causes of transmission are quite high in SA, infection continues to spread at devastating levels," says Mahlathi, quoting a speaker at the conference who said: "Soon SA will be manufacturing more coffins than anything else."
Mahlathi says that the voice of the medical profession on HIV/AIDS as a health issue must be loud and clear. "We do not challenge the right of President Thabo Mbeki to question theories, and we respect the rights of the community to demand intervention. However, shifting blame cannot lead to a positive outcome.
"I have seen tremendous courage among the thousands of people at this conference living with HIV/AIDS, which they largely gained through the vast networks of support groups. We as scientists tend to shy away from the socioeconomic and cultural issues," says Mahlathi.
On the issue of research, member of Sama's board of directors Tony Mbewu stresses that it should be appropriate to SA. "When doctors respond our advice must be clear, purposeful and consistent in order to address the questions of our patients, society and government," says Mbewu.
Sama expects government to have in place before the end of 2000 a clear and comprehensive strategy and action plan on MTCT which should be based on existing data, research, current pilot studies, drug safety and efficacy, resources and environmental influences such as sanitation and nutrition.
Medical practitioners and healthcare providers should have access to treatment and technology and skills in order to provide affordable, appropriate and comprehensive care to their patients, says Sama, adding that government should continue to promote the development of vaccines, which should be available to everybody.
Sama asks for continued partnership with government and agrees that part of the focus in the fight against AIDS should be on the provision of primary healthcare and treatment for poverty-related diseases like tuberculosis and malnutrition.
Sama calls for honesty on the part of the business sector and health economists. "The community needs clarity on recent publicity on the affordability of treatments. It is vital that the pharmaceutical industry and govenment resolve this issue," says Mahlathi.
Sama is the voluntary body of all people who are registered as medical professionals and has a membership of more than 16 000 doctors in the public and the private sector. The association should not be confused with the health professions council, as it fulfils a more trade unionist and professional role.
Sama's relationship with government is one of love and hate: "We work together in many areas, as medical professionals we can advics government on health policies. But sometimes we agree to disagree," says Mbewu.
In the medical profession, poverty has been recognised as an important factor for health, according to Mahlathi. He also says that MTCT care is sorely lacking in this country, but even a comprehensive strategy to treat TB is difficult, even though BCG vaccines are widely available, because it is very hard to ensure DOTS (directly observed treatment, short course) compliance.
"Before we roll out MTCT we need to improve our health systems, especially facilities for pre- and post-counselling and the ability to provide formula feed and access to clean water. We need to move beyond simplistic solutions like just providing antiretrovirals," says Mahlathi.
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