South African report shows devastating impact of HIV/AIDS

By Barry Mason
22 October 2001

South Africa’s Medical Research Council (MRC) has only just released its report drawn up in July, “The Impact of HIV/AIDS on Adult Mortality in South Africa”.

The ANC government had attempted to delay its publication until December, but was forced to release it under the pressure of public opinion and criticism in the media from church and trade unions leaders. Details from the report were leaked in September in the Mail and Guardian newspaper.

According to the report, South Africa has 4.7 million people with HIV/AIDS, more than any other country. One in nine of the whole population and one quarter of adults are infected. 40 percent of deaths were AIDS related in the year 2000. Without effective intervention, this will rise to 66 percent by the year 2010 with a cumulative figure of 5 to 7 million deaths from the disease. The report estimates that deaths this year will total 195,000—more than double the numbers who died as a result of accidents and violence in the year 2000. South African President Thabo Mbeki recently attempted to minimise the impact of AIDS by claiming that total deaths in one year from accidents and violence would exceed those from AIDS.

The report predicts life expectancy will fall from the current 54 years to 41 by 2010. Two groups particularly hit are young women in their 20s and young men in their 30s.

Astonishingly the death rate amongst women in their 20s is higher than that of women in their 60s—the report describes this as “a unique phenomena in biology.” Dr Malegaparu Makgoba, the MRC president, introducing the report said: “There is no precedent for this in history. You have a situation where the younger females who are supposed to be healthy and productive are dying in greater numbers than their mothers.”

Ten years ago the number of pregnant women tested for the HIV virus at antenatal clinics was one in a 100—today the figure is one in four. 43 percent of all deaths at the Chris Hani Baragwanath hospital in Soweto are attributable to AIDS.

Experts have described the MRC review as the most authoritative model of the effects of HIV in South Africa to date. It was the result of a comprehensive investigation and has been subject to stringent review by scientific peers. One of the reviewers was Dr Peter Goldblatt, chief medical statistician for England and Wales.

The authors of the report express their concern at the result of the findings saying, “These shocking results need to galvanise efforts to minimise the devastation of the epidemic”. Dr Makgoba commented, “It presents the country with stark choices. There should be active intervention.”

In attempting to refute the report the ANC government used a group called Stats SA, which claimed the MRC completely overestimates the number of cumulative deaths by 2010, saying it should be only one to two million. They have been taken to task by Professor Rob Dorrington of the University of Cape Town, one of the report’s authors. Accusing them of a “trashing” operation, he pointed out that their results are “completely incompatible” with the empirical data in the report. Present figures for those attending antenatal clinics showing that five million are HIV positive. Their misuse of the statistical model involved in the prediction of the disease “is evidence of how little experience and knowledge they have in the field”, said Dorrington. Their report was “riddled with half-truths and misunderstandings. It gives new meaning to the phrase lies, damned lies and statistics.”

Interviewed by the Mail and Guardian, the MRC report authors said that Stats SA had said that the only way to determine the size of the epidemic was to conduct a sample of the whole population, testing blood or saliva. They agreed that there was a need to collect more information, but added, “we believe there is sufficient data already available to gauge the extent of the epidemic. The need for better data must not prevent the analysis and interpretation of available data sources to best inform the decision-makers as soon as possible.” In a clear challenge to the ANC government, they said that prevention of mother to child transmission would significantly reduce the number of child deaths. The ANC still refuses to make the necessary drugs available.

In a separate development the South African government’s Central Energy Fund (CEF) has put R80m (£6.3m) into trials of a coal-based drug Oxihumate-K in research that is supposed to show its anti-HIV/AIDS properties. The trials are taking place on 350 patients in a military hospital in Tanzania and are being conducted jointly with the University of Pretoria. Although the MCC had overseen an exploratory trial of the drug in 1993, it has no knowledge of the current trials.

Concerns have been raised about the trials and it has been suggested that the patients were not in a position to give informed consent. Professor Udo Schuklenk, head of bioethics at the University of the Witwatersrand, commented, “You need to question why soldiers were used. It doesn’t seem necessary to use them—unless the researchers are claiming that they represent a scientifically and medically distinct group. That’s where I would start worrying and criticising.”

Oxihumate-K was first developed in the 1980s by Enerkom and promoted as a nutritional supplement. Enerkom do not claim the drug was a cure for AIDS, but that it boosts the immune system. The trials give the appearance of being a re-run of the notorious Virodene experiment. Virodene was first developed four years ago at the University of Pretoria and received financial and political support from the ANC government, claiming it was a new cure for AIDS. It was subsequently totally discredited and the main ingredient shown to be a cleaning fluid.

Oxihumate is being tested in the same military hospital in Tanzania, where until recently researchers had continued testing Virodene. The researchers were expelled from Tanzania in September.

After being exposed for its involvement with Virodene, it appears that the ANC government is attempting to distance itself from the present trials. Health Minister Manto Tshabalala-Msimang has visited the clinic in Tanzania where the trials are being held, but a South African government spokeswomen said she was not aware of the trials.

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