Africa Has Five Million H.I.V.-Positive People, More Than Any Other Country

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November 19, 2014

THE AIDS REBEL

Important points:

·  The article talks about Zach Achmat an AIDS activist from Cape Town, South Africa.

·  Africa has five million H.I.V.-positive people, more than any other country.

·  Thabo Mbeki was the successor of Nelson Mandela as president. He denounced Western antiretroviral- which suppressed the H.I.V virus, as harmful for the health. He wanted to find a cure by using conventional wisdom or through a medicine made in Africa. The drug Virodene (a South African drug) one that Mbeki felt proud of initially was later found to be toxic.

·  AIDS has been racially charged in Africa. There were also conspiracy theories that AIDS was a way to wipe out blacks.

·  In October 1997 drugs became available but the antiretroviral triple therapy was extremely expensive.

·  Achmat decided to go on a drug strike; he would not take drugs until everyone could afford them.

·  A Pfizer drug cost around $14 a day and in place where generics drugs were available the cost was 75 cents.

·  Achmat has to create an action plan that would mobilize people at a national and international level to remove the stigma associated with HIV in Africa. To find leverage to bring affordable HIV medicine to the poor. Achmat was personally touched by having a good friend of him died because he was not able to afford the medicine.

·  Achmat started civil disobedience called: Treatment Action Campaign

·  As the campaign started three million South Africans had H.I.V but fewer than a hundred had talked about their disease.

·  In April 1999 a government official announced that he had H.I.V. It was then that Achmat stage with Drug Strife, this act helped TAC become more noticeable.

·  Achmat wanted to impart the message that H.I.V/ Aids is like diabetes it can be managed if the medicine is taken. Also he wanted to stress that they did not have enough access to the medication because they were poor not because there was no medicine available.

·  Through the campaign they hoped to bring HIV medicines to the poor.

·  The first clinic offering antiretroviral therapy in South Africa is in Khayelitsha a ramshackle township. A place with the highest tuberculosis rates.

·  Achmat first target the Western pharmaceutical. TAC publicized how by 1999 forty thousand babies were being born each year with H.I.V- and how if the mothers were given AZT the likelihood of the babies developing the virus would diminish by half.

·  By addressing the death of children TAC shamed the manufacturer Glaxo to reduce the drug price.

·  TAC team up with Doctors without Borders, ACT-UP, Health GAP, and Consumer Project on Technology.

·  Results from activism that Achmat lead made Clinton Administration removed South Africa from its sanctions watch list and ended its campaign against the Medicines Act.

·  Africa was then free to develop generics, but Mbeki started speculating that antiviral was toxic.

·  A group of AIDS dissidents emerge: Their startling claims were:

1.  H.I.V was a harmless “passenger” virus.

2.  Aids were a life-style disease, caused by poverty and malnutrition.

3.  Antiretroviral drugs did not help patients. It often damages their immune system.

·  Their claims did not have any scientific evidence. But Mbeki claimed that AZT was a danger to health.

·  Mbeki started thinking as a conspiracy theorist. He likened antiretroviral therapy to the “biological warfare of the apartheid era.

·  Achmat was surprise to see that the hardest battle was not against the pharmaceutical Glaxo but rather against the A.N.C leadership.

·  In 2000 Achmat was arrested for smuggling. He went to Thailand and bought five thousand capsules of fluconazole, which helped alleviating his thrush. The drug was sold in Thailand for twenty eight cents per capsule.

·  After this Pfizer offer Diflucan free to clinics in South Africa.

·  However even with cheap drugs, Achmat did not see any changes in the government.

·  Nelson Mandela joined the TAC’s cause.

·  In 2002 Mandela visited Achmat in his home while he was sick. Later Mandela also visited the clinic in Khayelitsha, and after being offered a H.I.V positive shirt by one of the patients in the clinic, he took his own shirt off and put the TAC shirt on.

·  Short after the President cabinet issued a statement saying that the budget for AIDS prevention and treatment was going to be triple.

·  A month of protests stops once TAC leaders were able to meet with a political leader. Government announced that an extra four hundred million dollars budget would be given to medical treatment.

·  Unless the Cabinet deem antiretroviral appropriate and announce a national treatment program, TAC would continue civil disobedience.

·  Achmat realized that some positive development have taken place since his drug strike.

People were living more openly with H.I.V.

Drug prices were down.

Money was being allocated by treasury to HIV.

·  Achmat did not want to become one of the two hundred and fifty thousand deaths a year, so he decided to start taking the medicines again. People needed him and his voice was a powerful one for the movement.

Courtney Sprague Notes

Risks of rigidity:

•  crucial to adapt research and analysis to shifting circumstances and variations between populations

•  specific health and social justice concerns affect different demographics

•  sweeping generalizations of a region or culture can obscure realities

•  reports can distort realities in favor of particular agenda/national interest

Trends/indicators in global health:

•  maternal mortality - reflects health system

•  life expectancy - notably low in South Africa

•  high-income countries more affected by non-communicable diseases

•  low-income countries more affected by communicable diseases and suffer higher rates of child mortality

•  life expectancy varies both between countries and between populations within a single country

•  poor health outcomes correlate with socio-economic status, racial and ethnic characteristics

Disparity v.s. inequity:

•  inequity - imbalance, systemic, embedded, unnecessary, avoidable, unfair, social disadvantage

•  disparity - neutral, incidental

•  health equity - highest level of health for all people

•  requires valuing everyone equally

Role of applied research in health:

•  everyone is susceptible to dominant assumptions

•  health research is inherently applied

•  linking theory with practice in ways that are meaningful and produce results

•  applied research is critical for for exposing dynamics that engender health inequities

•  research must be methodologically sound and culturally viable

•  cultural and social factors key

Brazil:

•  first developing country to begin manufacturing generic H.I.V. medications in order to make them available to entire population

•  pioneering act

Treatment Action Campaign and South African activism:

•  resistance to lack of available H.I.V. treatment involved mass movements of communities and “average” people, as well as visible heroes such as Zackie Achmat

South Africa’s Struggle:

•  high H.I.V. prevalence

•  life expectancy correlates with race

•  S.A.’s initial failure to provide treatment for H.I.V. arose from government’s denial of relationship between H.I.V. and A.I.D.S.

•  women of reproductive age (15-44 years)

•  H.I.V. is the leading cause of death

•  pregnancy and childbirth complications are the 2nd leading cause

•  life expectancy of for black South African women is 62 years!

•  82 years in U.S.

Sprague’s study findings:

•  poor health outcomes for black women of reproductive age

•  29.5% prevalence rate has remained constant for 3 decades

•  What accounts for stagnation?

•  only 14.6 % of women and 10% of children had access to H.I.V. treatment

•  system barriers -

•  inadequate clinic staffing

•  absence of counseling and testing for women receiving prenatal care

•  individual barriers -

•  stigma/fear of diagnosis

•  poverty

•  interventions must address structural poverty and socio-cultural norms in order to be effective

Ask critical questions!

Questions:

•  How do stereotypes affect health?

•  What is our role as global citizens? How should we engage the process of globalization?

•  What is the role of government in addressing an epidemic?