Treat people now!

"Treat people now!" is to become the slogan for a campaign by Aids activists and people living with Aids to gain access to affordable treatment for HIV and Aids. This was agreed at a one-day meeting in August at which members of the Aids Law Unit of the Legal Assistance Centre informed more than forty participants about existing medication that can be used to control or prevent HIV and Aids, and the barriers existing in Namibia that prevent access by poor people to these treatments.

Preventing Mother to Child Transmission

Tenu Avafia of the Aids Law Unit informed the meeting that the Ministry of Health and Social Services has now established two pilot sites, in Windhoek and Oshakati, at which pregnant women who have tested HIV positive can be given Nevirapine to reduce the transmission of the virus to their babies during labour. The programme also provides counselling to both parents and gives advice on how to prevent transmission of HIV to their baby through breastfeeding. More than this, the programme provides medication for both parents (if the father is also HIV positive) to help them live longer with Aids and take care of their child or children.

Only about 30% of babies born to HIV positive women become infected with the virus. Some of these babies are infected whilst in the womb, some are infected during birth, and some are infected whilst breastfeeding. Nevirapine can provide a strong protection against HIV transmission from the mother to the child during the birth process. The meeting was informed that while the Ministry of Health has said that 250 women at each of the two pilot sites can be enrolled for the Prevention of Mother to Child Transmission programme, up to now only one hundred of these five hundred places have been filled.

This news was shocking to the participants. They suggested that a lack of information and transparency about this programme is preventing women from joining and thereby having a chance of preventing their babies being born only to face illness and death in childhood.

Participants from other parts of Namibia questioned why only women living in Windhoek and Oshakati were eligible to receive Nevirapine, pointing out that this was a form of discrimination. Tenu Avafia responded that the Namibian Constitution prohibits discrimination on any grounds, and said that the Aids Law Unit would be willing to assist pregnant HIV positive women from anywhere in Namibia to challenge this discrimination in court.

In the year 2000 the rate of HIV infection among pregnant women tested in various parts of Namibia was as follows:

Katima Mulio  33%
Windhoek      31%
Oshakati      28%
Walvis Bay    28%
Onandjokwe    23%
Swakopmund    23%
Keetmanshoop  17%
Gobabis        9%
Rehoboth       9%
Opuwo          7%

Considering that the drug Nevirapine is available in Namibia, that it needs to be given only once to the mother and once to the baby, and costs little more than N$ 80, the meeting failed to understand why all pregnant HIV positive women are not receiving this drug in our country. Participants said it was inhumane, criminal and draining the human and material resources of Namibia, as it is far more cost effective to provide treatment to prevent infection than treatment to babies dying of Aids. The meeting vowed to launch a Treatment Literacy Campaign to educate pregnant women about their right to information and treatment.

Protecting rape survivors from HIV

The Aids Law Unit also informed the meeting about treatment that has been developed to provide survivors. of rape with protection against transmission of HIV from therapist. This is called PEP (Post-Exposure Prophylaxis). The rape survivor must take this treatment for 28 days, and the first dose must be taken not later. than 72 hours after the rape.

With this treatment the rape survivor reduces the risk of transmission of HIV from a rapist by 80%. However, the medication is most effective if taken as soon as 2 hours after the rape. The treatment currently costs about N$ 3000.

Investigations by the Aids Law Unit have revealed that PEP is not available at any hospitals and clinics in Namibia, to either health care staff who have needle stick injuries or rape survivors, despite media reports of last December quoting a Ministry of Health official who said that it had been introduced countrywide.

Again the meeting was shocked by this news and agreed that people needed to be informed urgently of their right to access treatment immediately after being raped so that pressure can be placed on the Ministry of Health to make PEP available at all clinics and hospitals across the country.

Affordable treatment for people living with Aids

Delme Cupido of the Aids Law Unit informed the meeting about treatment that has been developed for people living with HIV, which can provide protection against developing full-blown Aids for many years. This treatment is called HAART (Highly Active Anti-Retroviral Therapy) and consists of a number of drugs that must be taken in combination to keep the body's immune system strong enough to fight off other diseases like TB that often lead to the death of people who have Aids.

The drug companies who developed these drugs over many years are charging very high prices for them in order to gain back the money they have spent on research and also to make a profit. However, similar drugs are now available much more cheaply from countries like Thailand and India, where companies are producing 'generic' Aids drugs, which are copies of the original brands. This has made it possible for poor countries such as Brazil and Botswana to begin providing Aids drugs to all people living with Aids who need them.

Aids activists and people living with Aids participating in the meeting questioned why generic drugs are not yet available in Namibia to make treatment accessible to everyone. Delme Cupido mentioned some of the barriers to access, which are high costs, the underdevelopment of the health system and lack of training for staff, and the belief that learning how to take the correct combination of drugs regularly is too difficult for most Namibians. Yet people living with Aids who work for government are able to access the treatment and 95% of their costs are covered by the Government Medical Aid.

Pilot projects that provide HAART in a number of poor countries and centres such as Khayelitsha in South Africa have shown that Africans are just as capable as anyone else of learning how to take the drugs properly. In Brazil, the provision of generic drugs has cut the number of deaths from Aids by more than half over a period of three years, from 1996--1999, and has reduced the number of Aids patients in hospitals by 80%.

Generating political will to provide treatment

The meeting concluded that the lack of political will by the Namibian government was the main barrier to the provision of Aids drugs to people who need them. Of the estimated 200 000 people currently living with Aids in Namibia, only about 15 000 need drugs right now, as the treatment is only required once the immune system has been seriously affected by the virus. Our neighbouring country Botswana was cited as an example of a poor country that has found the political will to tackle the many challenges presented by Aids and has begun to provide treatment to all Motswana who need it. Why not Namibia?

Participants said that NGOs and people living with Aids should from now on closely monitor the spending priorities of our government. Questions were raised about the morality of building the Heroes Acre and a new presidential village at exorbitant costs when the funds allocated for these projects could already have literally saved the lives of thousands of Namibians.

The meeting ended with a resolution to launch a nationwide Treatment Literacy Campaign to provide information on Aids treatment to all sectors of our society and build strong public support for the demand to "treat people now!"

For more information contact the Aids Law Unit of the Legal Assistance Centre at [phone].