Your daily Selection of IRIN Africa PlusNews reports, 3/10/2004

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U N I T E D N A T I O N S

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network

CONTENT:

1 - ETHIOPIA: Focus on local manufacture of anti-retroviral drugs

2 - LESOTHO: Anti-AIDS programme working with the youth

3 - RWANDA: 45 to take part in HIV/AIDS vaccine trials

4 - ZIMBABWE: Ambitious plans to roll out ARVs

1 - ETHIOPIA: Focus on local manufacture of anti-retroviral drugs

ADDIS ABABA, 10 March (PLUSNEWS) - Pharmacist Sudhir Sathe stands by an

idle production line. By now, he says, desperately needed antiretrovirals

(ARVs) for 70,000 AIDS patients a month could be rolling off the gleaming

conveyor belt.

Bethlehem Pharmaceuticals – one of only two factories in Ethiopia licensed

to produce the potentially life-saving ARVs – blames the static situation

on international funding delays. " We do not need to state the urgency of

getting these drugs out, " said 51-year-old Sathe, who has worked in the

pharmaceutical industry for 27 years. " We are frustrated. "

The Bethlehem Pharmaceuticals factory, sited in the outskirts of the

capital, Addis Ababa, was awarded a licence to start producing the drugs

in early August. The other factory so licensed is in northern Ethiopia.

Ethiopia has 2 million people living with HIV. The virus has orphaned some

1 million children. Experts estimate that the virus kills around 600

people a day, while two-thirds of all deaths in Addis Ababa of people aged

between 20 and 54 are AIDS-related.

But, says Bethlehem's chief executive, Yordanos Tadese, despite promises

by international organisations, no funds have been forthcoming.

<b>FACTORY READY TO START PRODUCTION</b>

The factory was opened by Trade Minister Girma Biru in a blaze of

publicity last year. Now, Yordanos says, it is imperative that funds be

found to make it possible for locally manufactured ARVs to be produced. He

says he could produce them more cheaply than the cost of current generic

imports, and has been ready to start production of the desperately needed

medicines for the past six months.

" We have got the capacity, we are ready to go, but we need international

organisations to release funds to the country as soon as possible, " said

Yordanos, a former stockbroker based in the USA. " We could have started

producing them as soon as we got the licence if we had had the financial

support, " he added. He went on to say that the initial cost of buying the

raw materials needed for manufacturing the ARVs was too high for his firm

to underwrite without additional funding and support.

Meanwhile, banks in the country were unwilling to finance the production

of ARVs drugs as they considered the enterprise too risky, Yordanos told

PlusNews.

The company, which is currently producing antimalarial drugs and

antibiotics, is seeking funding through the World Health Organisation

(WHO) under its 3 by 5 initiative. The US $350-million scheme, which was

launched on World AIDS Day in December 2003, aims to treat 3 million

people by the end of 2005. Ethiopia is one of the 20 countries to benefit

from the programme. WHO experts visited the Bethlehem factory in this

context in January.

WHO estimates that 6 million people infected by HIV in the developing

world need access to ARV therapy to survive, but only 400,000 so far have

access. In Africa, where 70 percent of all people living with HIV/AIDS

reside, drugs are available to just 100,000 people – a mere 2 percent of

those in need, says WHO.

<b>WHO INITIATIVE</b>

At the launch of the 3 by 5 initiative, WHO Director-General Dr Lee

Jong-wook said lack of access to ARV therapy posed a " global health

emergency " .

Dr Piot, the UNAIDS executive director, echoed his comments. " We

firmly believe that we stand no chance of halting this epidemic unless we

dramatically scale up access to HIV care, " he said at the launch.

" Treatment and prevention are the two pillars of a truly effective

comprehensive AIDS strategy, " he added.

Bethlehem is also looking to the EU for support under an innovative plan

to transfer manufacturing technology to Third World countries to enable

them to fight AIDS, tuberculosis and malaria. Under the plan, developing

countries were granted the right to produce generic drugs to fight health

crises, overriding patents held by major pharmaceutical companies. The

deal was struck as part of the 2001 Doha Declaration on Public Health.

Ungphakorn, a spokesman for the World Trade Organisation (WTO) said

Ethiopia was under " no constraint " in the matter of producing its own

ARVs. " It is up to Ethiopia to decide for itself whether its law should

provide that protection, " Ungphakorn told PlusNews from the WTO office in

Geneva. Meanwhile, although Ethiopia is still awaiting WTO membership, new

regulations mean that it has until 2016 before it has to apply

pharmaceutical patents.

The need for Ethiopia to start mass-producing ARVs has also been spelt out

in stark terms by its health ministry. The ministry and the HIV/AIDS

Prevention and Control Office have warned that fake drugs are being sold

in the country as desperate people search for medical help. The danger is

that those living with the virus may develop resistance to treatment if

they use drugs that do not meet the correct standards or do not use them

properly.

<b>ARVs STILL IN SHORT SUPPLY</b>

Ethiopia's efforts to support growing numbers of AIDS patients are still

confronted by huge financial hurdles. The country began a limited

distribution of ARVs late last year. The drugs – imported from India - are

currently available at six clinics and cost around $50 for a month's

supply. Bethlehem says it can produce the same quantity for $20. But even

then, for many the drugs are simply unaffordable.

According to health experts, at least 200,000 people in Ethiopia could

qualify for the treatment, which is being made available on a

first-come-first-served basis. However, the costs dwarf the country’s tiny

health budget, which stands at $120 million a year - just under $2 per

person.

The government is examining two ways of ensuring a greater supply and

reducing the cost - financial support from the Global Fund and through

generic drugs. It has secured multi-million dollar funding, but the money

has yet to be distributed in full. The health ministry has been allotted

$425 million for the production of ARVs. Bethlehem has applied for $25

million of this amount to produce anti-AIDS drugs and expects an

announcement later this month. Bethlehem is also working with a South

African-based NGO called Initiative for Pharmaceutical Technology Transfer

to help raise finances.

Yordanos told PlusNews that he had personal experience of the HIV/AIDS

pandemic, having lost members of his family to the virus. " We have a lot

of Ethiopians who live with HIV/AIDS who do not have the capability to

purchase these drugs, " he said. " Our aim is to reach these people with a

good quality, affordable medicine. We have to think of these people who

are suffering with HIV/AIDS. "

The raw materials mainly come from India and China, according to Sathe,

who will be in charge of producing the ARVs, and who was brought in by

Bethlehem for his skills. " We have the means to do this and can do it to

the standards of the rest of the world, " he said. " As soon as we get the

funds for the raw materials, we can start producing drugs. "

[ENDS]

2 - LESOTHO: Anti-AIDS programme working with the youth

JOHANNESBURG, 10 March (PLUSNEWS) - Mamokete Lemphane is used to being

driven out of homes, insulted and abused - all in the cause of fighting

HIV/AIDS in the northeastern Mokhotlong district of Lesotho.

" When I used to visit houses in the villages and start talking about

HIV/AIDS, people often pushed me out of their homes and abused me. Now I

know better - I start by talking about general good health tips, " a

giggling Lemphane explained.

The 22-year-old is a member of the Mokhotlong Youth Network, which seeks

to spread awareness of the disease among villagers.

Lemphane helps to man the UN Children's Fund (UNICEF)'s youth centre,

opened under the auspices of the UN's Southern African Youth (SAY)

projects on AIDS in the town of Mokhtolong. The centre operates out of a

container, which houses computers and educational games.

" I am proud of what I do, " she said. A volunteer worker, Lemphane supports

her family of two siblings and a mother by providing hair-braiding

services, and still finds time to open the centre daily. There are 20

other young volunteers who also conduct regular HIV/AIDS door-to-door

outreach programmes in the surrounding villages and provide computer

training to those who visit the centre.

The SAY projects were launched in 2002 in Lesotho, where 27,000 children

up to the age of 14 are infected with HIV - adolescents, aged 10 to 19

years, constitute 25 percent of the population. According to UNICEF,

HIV/AIDS prevalence has reached 51 percent among Basotho women aged

between 15 and 24.

Yuki Suehiro, assistant programme officer with UNICEF in Lesotho, said the

task of her organisation, through the SAY projects, was to teach the youth

life skills by using the multipurpose centres, which not only provide

recreational facilities but develop social skills and improve basic

education, all focused on AIDS awareness.

" Adolescents in Lesotho have limited access to basic social services and

many are unemployed and out of school, with little recreation

opportunities, " Suehiro said. Since the launch of the project two years

ago, UNICEF had managed to establish youth networks in two districts -

Mokhtolong and the capital, Maseru.

" We have not been as successful in Maseru as we have been in Mokhotlong,

where the government-run district youth office and the local traditional

chief have been extremely supportive, " Suehiro said. " We are in talks with

the Lesotho Planned Parenthood Association, which has constructed a brand

new youth centre in Maseru. "

UNICEF has branched out to other provinces and are getting involved in

existing youth centres, like the one in the district of Mohale's Hoek in

southern Lesotho. The centre, established by the Selibeng Youth

Association, was in need of a basketball court, which UNICEF constructed

under the auspices of the SAY projects.

" We help to teach sports-based life skills through basketball. The youth

acquire leadership skills, team building and reproductive health education

through sports - it is one of our successful projects, " Suehiro said.

The World Health Organisation's contribution to the SAY projects has also

been positive, she said. The agency has set up adolescent health corners

in several hospitals across the country, where assistance is provided to

teenage mothers, and there are games and videos on HIV/AIDS and sexually

transmitted diseases in the waiting rooms.

The UN agencies have been working closely with Lesotho's Ministry of

Gender and Youth. Nthabeleng Lepholisa, the principal executive officer in

charge of youth district officers said the government, inspired by the UN

initiative, had decided to build its own multipurpose centres across the

country.

The ministry has trained 35 youth and sports officers, and 60 youth

volunteers, who will all be involved in programmes imparting life skills

education and helping young people to make informed decisions in the

context of HIV/AIDS.

[ENDS]

3 - RWANDA: 45 to take part in HIV/AIDS vaccine trials

KIGALI, 10 March (PLUSNEWS) - Some 45 Rwandan volunteers are to take part

in tests for a new HIV/AIDS vaccine, the minister of state for HIV/AIDS

and other infectious diseases in the Ministry of Health, Innocent

Nyaruhirira, said on Wednesday.

The 10-month long trials, conducted by a US-based San Francisco project in

conjunction with the International AIDS Vaccine Initiative, are due to

begin before the end of March in the Rwandan capital, Kigali, he said.

Rwanda has an HIV infection rate estimated at 13 percent in urban areas

and 5 percent in rural areas. Nyaruhirira said that between 10 percent and

13 percent of Rwanda’s 8.1 million people were HIV positive.

He told PlusNews that the trials would explore the volunteers' immunity,

monitor the adverse effects of the vaccine and analyse the kind of

antibodies that are produced.

" We certainly hope that an effective vaccine would eventually help many of

our people, " he said.

Rape, used as a weapon of war during the 1994 genocide, accelerated the

HIV infection rate. " Militiamen who knew very well that were infected

intentionally raped women, " Nyaruhirira said.

Since the introduction of antiretroviral drugs (ARVs) in Rwanda four years

ago, the prices for the drugs have dropped from US $727 to $27 per dose.

However, only a small portion of HIV/AIDS patients have access to ARVs.

Rwanda is still waiting for money from the HIV/AIDS Global Fund in order

to further reduce ARV prices to at least less than a dollar a day for a

patient.

[ENDS]

4 - ZIMBABWE: Ambitious plans to roll out ARVs

JOHANNESBURG, 10 March (PLUSNEWS) - Zimbabwe plans to roll out

antiretroviral (ARV) treatment this month at five pilot centres across the

country, and expects to have 260,000 of an estimated 520,000 HIV-positive

people on the programme by the end of next year.

Given the country's current health crisis the task appears formidable, but

health officials are optimistic, despite overwhelming obstacles,

particularly the acute shortage of foreign currency.

The ministry of health said the government's rollout programme would

benefit from the experience gained by local NGOs, faith-based

organisations and the private sector, all of whom have already implemented

drug distribution, albeit to a limited number of people. The World Health

Organisation (WHO) is also providing technical support and has encouraged

the development of tools for delivering the ARVs.

The authorities point to existing laboratories at most hospitals, a strong

medicines regulatory authority and the availability of cheaper generic

drugs as positive signs for success ofthe programme.

The triple generic drug treatment is expected to cost less than Zim

$100,000 (US $25) per month thanks to partnerships with local

manufacturers, such as Varichem.

" Our major problem is to make sure that we have a reliable and adequate

supply of drugs, " the coordinator of AIDS and TB programmes in the

ministry of health and child welfare, Dr Owen Mugurungu, told PlusNews.

" Zim $2 billion [uS $474,608] is coming from the AIDS levy and Zim $10

billion [uS $2.4 million] from the Ministry of Finance, so we have Zim $12

billion [uS $2.8 million] available to us, " he explained.

The five pilot sites for the programme have been chosen because of their

location and existing infrastructure, and include the two largest referral

hospitals in the country, Harare hospital in the capital, and Mpilo

hospital in second city, Bulawayo.

" Between the two of them, Harare and Mpilo will take about 1,000 patients

each and the other three centres about 500 to 600 each. Of the 4,000

[initially] patients we aim to treat, at least 800 are children, " Muruguni

noted.

The pilot hospitals all have Opportunistic Infections Clinics (OIs) and

will also be able to carry out CD4 counts which measure the strength of

the body's immune system. At present, CD4 testing facilities are only

available at the Harare and Mpilo hospitals. Patients would qualify for

treatment if the results of the CD4 count was below 200.

The OI clinic at Harare Hospital currently has a modest staff complement

of one medical officer and one physician, two nurse counsellors and two

trainee nurses. It is housed in cramped quarters in the outpatient

building, but plans are underway to move to bigger premises to cater for

the anticipated increase in patient load.

" The clinic has been running since October 2003 and we have been treating

people with drugs, although not with the ARVs. We have people waiting

already, although they are less than 100, " the head of the clinic, Dr

Chimedza, told PlusNews.

He added that the CD4 count would help to monitor the effectiveness and

possible side-effects of the drugs.

There were also moves to approach the Department of Social Welfare and the

UN's World Food Programme to step up aid to food-insecure people

identified for treatment.

It is likely that around 7.5 million of the country's estimated 11.65

million population will require food aid through the next few months.

[ENDS]

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