Families in the rural villages of Malawi face many challenges. Most are subsistence farmers who struggle to feed their children. Education levels are generally low – a third of the males and two-thirds of the females cannot read or write. Hunger and disease kill many thousands of people – particularly children – every year. One of the most common killer diseases is malaria, which accounts for as much as 15 to 20 percent of deaths among school-age children in the region. But a new Save the Children program has bought down death rates from malaria by 72 percent in some villages.

Ghanaian health experts began reviewing measures to control HIV/AIDS at a first ever National Research Conference on Wednesday following a new survey which showed that HIV prevalence rates were rising in the country's main cities. Ghana's National AIDS Control Programme (NACP), which conducts Ghana's HIV/AIDS Sentinel Surveys, determined in 2002 that the HIV prevalence rate in Ghana was 3.4 percent, one of the lowest in West Africa.

The TAC has strongly welcomed the government's operational treatment plan for HIV/AIDS of November 2003. We also welcome the efforts being made by some provincial governments, including Kwazulu-Natal, Gauteng and Western Cape, to implement this plan. Overall, we recognize that there has been tangible progress by government in improving policies, budgets and plans to prevent and treat HIV infection.

However we are alarmed that this progress and the efforts of national and provincial government health departments and officials are being undermined by inaccurate comments by President Mbeki and Minister of Health, Manto Tshabalala-Msimang. On the evening of 8 February 2004 an interview with President Mbeki was broadcast live on SABC television and radio. Regrettably, his comments on HIV/AIDS contained serious factual misrepresentations. This and his single mention of "AIDS", in passing, in his State of the Nation address to Parliament on February 6th 2004 suggest that he still he refuses to accept the seriousness of the epidemic. We are concerned that this is causing confusion in the public and despair among people with HIV/AIDS and health professionals. The publication of the Operational Plan increases the need for leadership - rather than reduces it.

The President stated that no studies have been done using death data to determine AIDS deaths and that the only reliable death statistics we have are for road accident deaths. This is untrue. There have been two studies examining death registration data to determine mortality due to AIDS. Both were conducted by state institutions, Statistics South Africa and the Medical Research Council (see footnote 1). The Statistics South Africa report was commissioned by Cabinet. Both studies demonstrate the increased and massive mortality due to HIV. Their findings are included in a recent publication of the Health Department titled 'Health Statistics'.

Another government endorsed study, the Impact of HIV/AIDS on the Health Sector(see footnote 2), found high AIDS mortality among health-care workers and estimated that 13% of health workers deaths from 1997 to 2001 were HIV-
related. The study found that the HIV "epidemic has an impact on the health system through loss of staff due to illness, absenteeism, low staff morale, and also through the increased burden of patient load." In response to a question on his silence on AIDS, President Mbeki stated that his doctors informed him that diabetes is also an epidemic. He then questioned why no-one talks about diabetes, suggesting that AIDS unfairly dominates debate on health-care to the detriment of other diseases.

This too is misleading: the President's choice of diabetes as an example of a disease neglected in debate is unfortunate. Drugs for treating diabetes are heavily overpriced; there should be a campaign for their reduction. But unlike HIV (until November 2003), diabetes is treated in the public health sector. However, the President should be aware that according to an initial investigation into the burden of disease estimates in South Africa released in 2003 by the MRC, AIDS was responsible for 39% of lost life-years in 2000 -- more than the next 10 worst diseases. Diabetes is the 12th worst disease and is responsible for slightly more than 1% of lost life-years. The two diseases are incomparable in scale.

President Mbeki stated that few countries 'can hold a candle to South Africa's HIV/AIDS programme'. A number of developing countries do much better than South Africa when it comes to HIV prevention and treatment, often with far fewer resources. And certainly, the political leaders of many much poorer developing countries do better than South Africa in their public messaging. With its relative wealth and more sophisticated public health care infrastructure, South Africa should be leading the response in Africa to HIV/AIDS, but it is not. Currently, South Africa treats approximately 1,500 people in its public sector, who are not on drug trials, paying for their own medicines or being sponsored. Throughout South Africa, fewer than 40,000 people are on treatment. South Africa now has a competent implementation plan on paper, but its roll-out is being delayed.

By contrast:
* Brazil's government treats over 100,000 people and has less than a quarter of South Africa's HIV infections. Its prevention and treatment programmes are incomparably better than South Africa.
* Botswana is treating approximately 15,000 and Cameroon approximately 7,000 people.

TAC believes that confronting HIV, and mitigating its impact on the progress of our country, demands that we are truthful with ourselves and that we enter into genuine partnerships for HIV prevention and treatment. The continued failure of the President and Minister of Health to deal appropriately or caringly with the epidemic is undermining the delivery of decent health-care to millions of poor people. This is one of the most important challenges facing South Africa; the President and Minister of Health must lead not confuse and obfuscate.

- Footnote 1: See
20death/Causes%20of%20death.pdf and http://www.mrc.ac.za/bod/complete.pdf
- Footnote 2: See

Orphans are the "most neglected" part of the war against HIV/AIDS, "perhaps because they are the living, and, for some, shameful reminders of a disease gone rampant," UNICEF Canada President David Agnew writes in a Vancouver Sun opinion piece. There are 11.5 million AIDS orphans in Africa, and the number could grow to 20 million by 2010, Agnew says. In Zimbabwe, although the majority of orphans are cared for by their relatives, the "sheer number combined with the wretched economy ... has put enormous strain on those supports ... [and] orphans are increasingly left to fend for themselves," Agnew says.

A new scheme to pay hospital bills for all Kenyans will take effect on July 1, Health minister Charity Ngilu revealed this week. Ngilu said membership to the National Social Health Insurance Fund will be compulsory and free for poor Kenyans. Unlike in the past when medical cover was only available to people in formal employment, unemployed Kenyans and those in the Jua kali (informal) sector will now benefit, Ngilu said.

The proposed Certificate of Need (CoN) for doctors, which they claim intrudes on their right to freedom of movement, will remain. This was the word from Health Minister Manto Tshabalala-Msimang when she briefed the media on Monday as part of the government's social development and health cluster. "The government will move on the CoN framework to achieve our goals in terms of the constitution," the minister said. "The CoN will remain. It is intended to transform the healthcare sector in South Africa."

About 17 percent of Mozambique's teachers are HIV positive, considerably higher than the national average of 13 percent HIV prevalence among people aged between 15 and 49, declared Mozambican Prime Minister Pascoal Mocumbi in Maputo on Monday. Speaking at the opening of a seminar on education and AIDS in Maputo, Mocumbi said that this will lead to the death of 1.6 percent per year of the country's teachers.

Rich-country finance ministers meeting in Florida this weekend focused on the sinking dollar and rising U.S. debt, cautioning against excessive volatility in currency markets. They also called for more reductions in the debt burdens of Iraq and Afghanistan, and warned debt-strapped Argentina to comply with International Monetary Fund policies. Africa's debt, estimated at more than $300 billion, was not on the agenda. Nevertheless, debt cancellation campaigners are noting that President Bush's rationale for cancelling Iraq's debt - with new measures currently on the fast track - uses arguments that can be easily applied to Africa as well. The legacy of debt Mobutu Sese Seko left in the Congo, for example, is surely as dubious as the debt Saddam Hussein left in Iraq. This issue of AfricaFocus Bulletin contains a brief excerpt from a news report on the consequences of the debt crisis for Zambia, and recent material from the American Friends Service Committee and the Jubilee USA Network, both engaged in campaigns this year to bring the debt issue to wider public attention in the US.

Malawi's President Bakili Muluzi on Tuesday urged Malawians to break the stigma attached to Aids as a first step in fighting the disease, which has infected more than 14 percent of the country's 11 million people. "My own brother, third born in our family, died of Aids three years ago," said Muluzi as he launched a long-awaited official programme to fight the killer disease.

The Nigerian government on Friday announced that it is sending state and religious representatives to South Africa, Indonesia and India this week to observe testing of the polio vaccine and "bring back proof" that it is not contaminated with HIV, according to reports. In October 2003, health workers in Nigeria launched a project to immunize 15 million African children at immediate risk of contracting polio. However, the vaccinations were hampered when some Muslim leaders in the northern part of the country said the immunization effort is part of a U.S. plan to decimate the Muslim population by spreading HIV/AIDS and infertility.

In an astonishing about-turn, embattled Health Minister Manto Tshabalala-Msimang has denied outright she gave any commitment to the start of a national anti-retroviral roll-out. The shock announcement is sure to send Aids activists, the health profession and those affected by the virus into a tailspin. The minister and Nono Simelela, head of the government's HIV and Aids programme, laid out the planned roll-out in substantial detail last November. But now she says it will start when "everything is ready".

National Black HIV/AIDS Awareness Day on February 7 emphasized the disproportionate impact of the pandemic among Black people in the U.S. and globally. Africa Action's Executive Director, Salih Booker said: "National Black HIV/AIDS Awareness Day is so important because it forces us to confront the system of global apartheid that has shaped the course of the AIDS pandemic in the U.S. and globally."

With pointed jabs at the United States, a U.N. special envoy told a gathering of leading AIDS scientists that wealthy nations must make up for a "decade of financial abstinence'' to battle the global epidemic. Stephen Lewis, a Canadian diplomat who has been the United Nations' special representative for AIDS in Africa, made his case on Sunday for a dramatic increase in spending to fight the disease at the opening session of the 11th Conference on Retroviruses and Opportunistic Infections, held in San Francisco.

The development of Botswana's infrastructure, including transportation, urban growth and social mobility, has contributed to the rapid spread of HIV in the country, according to reports. With 38% of the adult population in Botswana estimated to be HIV-positive, the country has the highest HIV prevalence in the world.

The New York Times last Thursday profiled Zimbabwe's health care system, which "like the rest of [the country's] economic and social fabric ... is dissolving." With the economy in "free fall," Zimbabwe is "desperately short of even basic drugs and medical equipment," which is forcing a "once robust" health care system "close to ruin" and is taking a "human toll," according to the Times.

South African President Thabo Mbeki's attitude towards HIV and Aids is once again under scrutiny. He claims: "I don't know anyone who has died of Aids." So why does it continue to dominate the problems facing the South African people? People don't actually die of Aids. What kills them tends to be the so-called "opportunist" diseases that thrive because of the damage that the Aids virus, HIV, causes to the body's defence system; infections like TB, pneumonia, and even influenza. So President Mbeki's statement that he does not know anyone who has died of Aids is technically correct. But it is a bit disingenuous, and Aids campaigners say such remarks are profoundly unhelpful.

Experts from the Joint U.N. Program on HIV/AIDS and the Word Health Organisation published an article in this week's edition of The Lancet medical journal rejecting the theory that the primary means of HIV transmission in sub-Saharan Africa is unsafe injections. Epidemiological evidence shows that the major mode of HIV transmission in the region continues to be sexual transmission. However, the organisations agreed that the risk of unsafe injections should be reduced and suggested that data be improved for the identification of such risks.

The contentious topic of abortion in Kenya was revisited Wednesday, during events to mark African Women's Health and Rights Day. At present, the procedure is banned in the East African country. However, women's groups are urging government to open a debate on this policy.

In observance of Africa Health Day, the World Health Organisation (WHO), in partnership with the African Medical Research Foundation (AMREF), Africare and Medilinks, is organising an exhibition and a panel discussion on 19 February 2004 in New York highlighting health and development issues in Africa. Although Africa is the richest continent in the world, it has historically been perceived as a continent of relentless humanitarian emergencies caused by political instability, disease, famine and war. This perception fails to recognize the many positive development initiatives in Africa that have succeeded and flourished and resulted in improved health conditions for the children, women and men of Africa. Africa Health Day will aim to raise public awareness of these positive health programs in the Region and offer opportunities to further explore how to build a bridge to sustainable development.

Gaps in sexual and reproductive health care account for nearly one-fifth of the worldwide burden of illness and premature death, and one-third of the illness and death among women of reproductive age. These gaps could be closed and millions of lives saved with highly cost-effective investments, according to Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care, a new report released by The Alan Guttmacher Institute (AGI) and UNFPA, the United Nations Population Fund. Policy makers, governments and donor agencies have vastly undervalued the diverse returns - economic and social as well as in health - such investments would bring, the report stresses. It calls for improvements in reproductive and sexual health essential to the achievement of the Millennium Development Goals set by world leaders in 2000.