Push on to prove poor can get AIDS drugs

The Associated Press
Wednesday June 13, 2001

KHAYELITSHA, South Africa — Grace was coughing up blood. Her feet were numb. Her head pounded. Her mouth was full of sores. Her throat burned with a choking infection. Ulcers riddled her stomach. 

She was thin and bedridden and certain she was about to die. 

That was two weeks ago – before the AIDS medicine. 

Now, she no longer coughs up blood. The sores have cleared up, and the throat infection – treated simultaneously with another medication — is gone. The one meal of thin porridge she struggled to eat every day has turned into six daily meals filled with fruit and meat. She has gained 19 pounds. 

The miracle is not Grace’s amazing recovery. It is that an unemployed woman living in a shack with six other people would get the expensive medicine that can turn AIDS from a killer into a manageable disease. 

Grace, who is probably the first poor person in South Africa to get free AIDS medication, owes her health to a small program designed partly to prove it is possible to provide AIDS drugs to poor South Africans, and partly to shame the government into making them available. 

“We came here to demonstrate that it is not too costly ... and we came here to demonstrate that it is not too difficult, that it is totally feasible,” said Dr. Eric Goemaere, head of the South African mission of Medecins Sans Frontieres, the international humanitarian organization running the program. 

About 4.7 million South Africans are infected with HIV, but only a few thousand have private health insurance that covers the cost of medication. 

Government officials have expressed concern about the drugs’ toxicity and the lack of the necessary health infrastructure, especially in rural areas, to administer them. 

“We have no plans to introduce the wholesale administration of these drugs in the public sector,” Health Minister Manto Tshabalala-Msimang told Parliament last week. 

Tshabalala-Msimang told Parliament on Tuesday that just treating AIDS-related illnesses could overwhelm the national health budget. She said a government study had shown that the treatment priority should be fighting tuberculosis, which badly affects AIDS sufferers. 

These statements infuriate AIDS activists, whose hopes for a national treatment program were sparked in April after drug companies ended their challenge to a South African law that could allow the import or manufacture of cheap copies of patented AIDS drugs. 

Now, activists are planning a series of protests, painting the fight for AIDS treatment as an extension of the struggle against apartheid – a battle for the rights of the powerless. 

“We think it is quite appalling. (The government) is basically prepared to make these people expendable,” said Nathan Geffen of the Treatment Action Campaign. 

The Medecins Sans Frontieres’ program in the poor Cape Town suburb of Khayelitsha hopes to persuade leaders not to abandon Africans, who make up 70 percent of the world’s 36 million AIDS-infected people. 

Some experts worry whether poor Africans will adhere to the pill-taking schedule needed to prevent the virus from becoming resistant to antiretroviral drugs, but Goemaere is certain they will. He says the labs and doctors needed to support a drug program are available, at least in cities. 

“We are realistic. There is no way (the government) will suddenly drop antiretrovirals all over the place,” he said. 

However, South Africa should at least begin pilot programs and draw up guidelines for using the medicine where it is feasible, he said. 

“They have a unique opportunity to learn from a project like us,” he said. 

The group, which won the 1999 Nobel Peace Prize and is known as Doctors Without Borders in English, began giving the medicine to patients last month at its three clinics in Khayelitsha. Only about a dozen people are on the drugs so far, but the program will eventually treat 150 adults and 30 children, Goemaere said. 

After Grace, 36, tested positive for HIV in 1999, her boyfriend left her and her health slowly crashed. She and her baby son, who is not infected, moved into a shack with a friend and the friend’s four children. 

By the beginning of this year, she was so weak she could no longer do chores. 

By May, she could not get out of bed. 

“I thought I was going to die,” said Grace, who asked that her last name not be used because of the stigma AIDS carries here. 

At the end of May, an ambulance brought her to the clinic. 

Grace had never heard of antiretroviral drugs until Dr. Francoise Louis gave her a daily regimen of 3TC, AZT and nevirapine. Within four days, she started feeling better. Within a week, the feeling returned to her feet, and her mouth sores were gone. 

She has started doing chores again and is beginning to take walks around her neighborhood. 

“The tablets are very strong,” she said. “I’m feeling much better now.” 

After watching Grace’s health slowly seep away, Louis is heartened by her recovery. 

“It’s very moving, but it makes me angrier that everyone is not on this,” she said. 

As Louis spoke, her thoughts kept returning to the tragedy, just two hours before. 

A woman in her mid-twenties – in the final throes of AIDS – was inexplicably sent to the clinic instead of the nearby hospital emergency room. Dangerously dehydrated and beyond the doctors’ help, she sat in a wheelchair in the waiting room amid an expanding pool of her own diarrhea. Other patients, in tears, stroked her head and held her hand. 

She died within 10 minutes. 

Louis hopes the small project will eventually save millions of South Africans from that fate. 

“She didn’t die in dignity,” Louis said.