[e-drug] AIDS in Africa : the African governments with their backs to the

["Planet Africa" <planetafrica@asso.globenet.org>]

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E-drug: AIDS in Africa : the African governments with their backs to the 
wall
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Press Release - Act Up-Paris - 04/27/00

AIDS in Africa : the African governments with their backs to the wall

The recent international consultation organized by WHO/UNAIDS about the use 
of sulphamethoxazole-trimethoprime, or cotrimoxazole, to prevent 
HIV-related opportunistic infections, which gathered in Harare March 29 
through 31 various experts, clinicians, African political leaders and 
activists, ended up in a victory : after six months of pressure over UNAIDS 
by Act Up-Paris, constructive recommandations have at last been expressed : 
this treatment must be part, in all of Africa, of a minimum package of care 
for people with HIV & AIDS, as soon as the first symptoms of the infection 
appear.

At first look, such a recommandation in favor of access to a basic, cheap 
 antibiotic/antifungal which is already commonly used in Africa to cure all 
sorts of infections, and which PWH&A in the North have been using daily for 
the last ten years, might seem short of a revolution. Cotrimoxazole is 
hardly a panacea, in this era of antiretroviral treatments. Yet, the fact 
remains that at this time the prophylactic interest of this drug is largely 
ignored and hardly exploited throughout the African continent. PWH&A in 
South Africa, Burundi or Benin are left with nothing, save for, at best, 
the announcement of their status accompanied by some advice to live 
"positively".

These recommandations could change the deal : the governements will no 
longer be able to hide behind the possible resistance of local germ strains 
to the drug as an excuse for doing nothing ; the doctors will no longer be 
able to claim powerlessness to justify their refusal to break the news of 
HIV status to their patients - and people living in Africa will finally 
have one good reason to get tested !!

But for these recommandations to be implemented on the field will take more 
than merely sending a directions-for-use leaflet to all prescribers. In 
each country, the head of the national AIDS programmes must make 
cotrimoxazole prophylaxis a working priority, and enlist the strong 
mobilization of the Health Ministry : access to Voluntary Counseling & 
Testing must be strengthened ; drug distribution must be improved ; doctors 
must be trained and communities, informed.

>From now on VCT center should systematically offer cotrimoxazole 
prophylaxis to all patients. From now on, no mother-to-child transmission 
reduction initiative should leave mothers without care after childbirth, no 
TB programme should leave its many HIV patients to simply wait until the 
next opportunistic infection arises.

- In Senegal, Togo, Burkina Faso, as in the majority of African countries, 
there is but only one single Voluntary Counseling & Testing center in the 
whole country.

- In Cote d'Ivoire as in all of West Africa, only a few doctors in the 
capital city are now using cotrimoxazole as a prophylaxis, while in most of 
English-speaking Africa, even experts are completely ignorant of the 
prophylactic interest of the drug.

- While in Mali the monthly cost of the treatment is $0.5, this cost may 
reach $10 in Cameroon from the private pharmaceutical sector, and $15 in 
Zimbabwe!

- In Malawi, in Tanzania, poverty is such that additional financing must be 
sought, in order to ensure sustained drug supply

- In Zimbabwe, in Zambia, PWH&A organisations have been devoting 
considerable efforts to vitamins and nutritional supplements, as they were 
informed of the interest of cotrimoxazole prophylaxis neither by doctors 
nor by the authorities.

Act Up-Paris calls to African governments to go into action. The ball is 
now in their court, and PWH&A will not wait another ten years before they 
have access to halfway decent care, and treatment !

Planet Africa
planetafrica@asso.globenet.org


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