Your daily Selection of IRIN Africa PlusNews reports, 5/1/2006

May 1, 2006

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

Office for the Coordination of Humanitarian Affairs

Integrated Regional Information Network (IRIN) - 1995-2005 ten years serving the

humanitarian community

[These reports do not necessarily reflect the views of the United Nations]

CONTENT:

1 - SOMALIA: Free ARVs, but stigma hampers HIV/AIDS fight in Somaliland

2 - SOUTH AFRICA: Small clinic at centre of debate over traditional medicine

1 - SOMALIA: Free ARVs, but stigma hampers HIV/AIDS fight in Somaliland

HARGEYSA, 1 May (PLUSNEWS) - Patiently waiting for her monthly dose of

antiretrovirals (ARVs) at an HIV clinic in Hargeysa, capital of the

self-declared republic of Somaliland, Amina Hassan, a widowed 26-year-old mother

of two, is one of 110 people benefiting from free treatment in the region.

" I started taking the ARVs five months ago. I'm feeling stronger than before and

have added six kilos in my body weight, " she said. " I intend to continue taking

the drugs as the doctors are saying. "

Hassan said her husband had died four months earlier from an AIDS-related

illness, and when she too started falling sick, she had herself tested for HIV

and was diagnosed in December. Mercifully, her two daughters - aged two and four

- are negative.

The authorities in the self-declared republic - in the northwest of the Somalia

- joined the fight against the pandemic by establishing a commission in

September 2005 to plan and coordinate efforts against HIV/AIDS.

Free ARV provision began when dozens of internally displaced people in

Somaliland tested positive for the HI virus. Their appalling condition triggered

an appeal by the United Nations refugee agency, UNHCR, which saw the delivery of

the drugs to the HIV clinic in June 2005.

The provision of free ARVs by UN agencies has given hope to HIV-positive people

in the region, and encouraged more to volunteer for counselling and testing.

Hassan said it was the knowledge that the ARVs were available that gave her the

courage to get tested.

Despite the progress made in treatment, health authorities in Somaliland are

worried that significant challenges remain. Although HIV prevalence currently

stands at 1.4 percent, relatively low compared to neighbours Ethiopia and

Djibouti, insufficient information about the virus, and deeply entrenched

cultural and religious beliefs, continue to fuel the spread of the epidemic.

" We presume HIV first reached Somaliland over a decade ago and it has increased

tremendously over the past four years, but still a majority of the population

are not serious about its consequences, " said Dr Deq Saeed, of UNAIDS

Somaliland.

Alarming misconceptions still exist - even among the educated - with some

believing the disease is " foreign " and cannot be found in Somaliland, because

the country is a strong Muslim nation.

A behavioural study conducted by the UN Children's Fund in Somalia in 2004 found

that just 26.6 percent of women in Somaliland had ever heard of condoms. Only 13

percent of men and 3 percent of women in the region had ever used one.

" During a survey we conducted last year about the use of condoms in Somaliland,

some boys said that they think condoms are not safe and they instead use

polythene bags when having sex, " said Saeed.

Stigma and discrimination are also enormous barriers to the fight against the

epidemic in the self-declared republic. Health experts report that people have

even been physically attacked by family members for being HIV-positive.

" Recently we got a report that an HIV-positive girl was being attacked by

neighbours. When we visited her, we found she was staying in shanty house that

collapsed after neighbours and family members hurled stones at it, " Saeed

narrated. " The girl was accused of spreading HIV/AIDS in the area and had we not

gone to collect her, she could have been killed. "

The campaign to combat stigma was dealt a major blow when Olad Dorre, an AIDS

activist and the only person in Somaliland to publicly declare his status,

passed away in April.

" Owing to the stigma surrounding the disease, the majority of the patients are

not willing to open up and admit their positive status, " said Saeed. " We need a

workable strategy against stigma to be developed by all, including AIDS

activists. "

[ENDS]

2 - SOUTH AFRICA: Small clinic at centre of debate over traditional medicine

DURBAN, 1 May (PLUSNEWS) - Over the past few months, hundreds of people have

been streaming into an office building in Pinetown, on the outskirts of South

Africa's east coast city of Durban, looking for the clinic that sells ubhejane -

a herbal mixture they believe can treat HIV/AIDS.

The controversial traditional medicine has received vast media coverage, mainly

due to the backing it has received from influential political figures such as

the country's health minister, Dr Manto Tshabalala-Msimang, and provincial

health officials in KwaZulu-Natal.

Tshabalala-Msimang and KwaZulu Natal's health minister Peggy Nkonyeni reportedly

recommended to the mother of the deputy president, who runs a hospice in Durban,

that she should give ubhejane to her patients. The city's mayor, Obed Mlaba, is

also supporting the herbal remedy, and is sponsoring its supply to patients at a

hospice in Inchanga, a rural village about 40 km from Durban.

But ubhejane, a dark brown liquid sold in old plastic milk bottles, has yet to

undergo clinical trials to test its efficacy. All that has so far been

confirmed, according to tests by the University of KwaZulu Natal's (UKZN)

medical school, is that it is not toxic.

Despite the negative publicity in the national media, on the ground in

KwaZulu-Natal there seems to be far greater willingness to accept the

traditional medicine as an effective remedy. As a result, AIDS activists warn

that the government's apparent support for ubhejane could undermine the roll-out

of antiretrovirals (ARVs) - the orthodox treatment that can prolong the lives of

HIV-positive people.

The cost of ubhejane does not seem to have dented its appeal.

Government-supplied ARVs have been free since 2003, but a full course of the

herbal remedy retails at R374 (US$62.8), in a country where an average

low-income salary is around $250. Just 100,000 South Africans are receiving ARV

therapy out of the estimated 500,000 in need of treatment now. A total of five

million people are HIV-positive and will eventually require AIDS medication.

LOOKING FOR AN EASIER WAY?

Antiretroviral treatment has long been a fraught issue. The government adopted a

cautious approach from the start to the provision of the life-prolonging

medication, and has engaged in a bitter stand-off with AIDS activists over the

pace of the rollout. President Thabo Mbeki has appeared willing to listen to

AIDS dissidents; misleading statements by the health minister over ARV toxicity,

and a damaging debate that tended to frame nutrition in opposition to ARVs, have

all sent mixed signals.

Back in Pinetown, a scruffy industrial location, Dudu (last name withheld) a

staff member at the 'Nebza AIDS Clinic' where ubhejane is sold, was explaining

how to take it. The bottle with the blue lid was for making the viral load

undetectable; the bottle with the white lid was for boosting the CD4 count - a

measure of the strength of the immune system. Patients are advised to stop

smoking and drinking while on the treatment, and abstain from sex or use

condoms.

A more precise explanation of how the mixture reduces the amount of virus in the

body or increases the CD4 count was not forthcoming. But the first-time clients

she was instructing were more interested in whether their appetites would

increase, or if they could stop taking ARVs.

Thirty-five year old Lindiwe (not her real name) has been on ARVs for the past

year, but said she would prefer traditional medicine. " ARVs are for life and you

must remember to take them everyday ... at least with this one [ubhejane] it's

something from my culture and it's easier, " she told PlusNews.

According to South Africa's department of health, 70 percent of South Africans

consult traditional healers regularly. Queen Ntuli, who has been practising for

the past 20 years, explained that it was an issue of familiarity with the

community.

" People come to us because they trust us, " said the petite 40-year old healer.

" We live with them and we've been given power by the ancestors. We also don't

just focus on the disease, we go beyond the sickness. " <table width= " 180 "

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South Africans talk about herbal remedies versus antiretrovirals

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Despite high levels of awareness surrounding ARVs, " people who are on ARVs

already will still come to me [for treatment] ... they are scared about taking

it forever and are always looking for an easier way, " said Ntuli, who is a

member of the KwaZulu-Natal Traditional Healers Council, and also works with

UKZN's medical school instructing western-trained medical students on herbal

medicine.

But a problem was that traditional healers themselves often did not understand

how HIV worked, she noted. Some genuinely believed they could get rid of the

virus, while others deliberately misled people into believing that they could

cure HIV/AIDS. Ntuli explained that many traditional healers did not realise

that their medication was just treating the symptoms - and not the virus.

Zeblon Gwala, who makes ubhejane and runs the Nebza AIDS clinic, is not a

traditional healer, but told PlusNews that his grandfather, who was, appeared to

him in dreams and gave him the recipe.

He said its recent popularity has meant he has been staying up till late brewing

the medication, grinding the ingredients by hand, and trying to get more plastic

bottles. The 89 different herbs found in ubhejane are sourced, he said, from as

far a field as the Democratic Republic of Congo.

Gwala is adamant that he has never claimed he can cure AIDS, and since there

have been no trials looking at whether people on ARVs can also safely take

ubhejane, he strongly advises his clients against mixing the two.

SCIENCE vs TRADITION

Deputy dean of UKZN's medical school, Professor Nceba Gqaleni, who led the

pre-clinical tests on ubhejane's toxicity, said he does not reject the potential

value of the remedy. However, " when you want to put the product on shelves and

provide it in hospitals, you have a duty to do it properly ... you are now

entering a different terrain altogether " .

Gqaleni, who also sits on the World Health Organisation's expert committee on

traditional medicine, acknowledged the slow pace of research into traditional

medicine in Africa. " We have missed so many opportunities to study [traditional

medicine], " he commented.

But researching traditional medicine is not easy. Professor Herbert Vilakazi,

who has teamed up with Gwala to promote ubhejane, argued the rules for

registering medicines were " pharmaceutical-industry friendly " .

" Where do they expect this laboratory evidence to come from? Especially where

there is no tradition of studying or testing African traditional medicine, " he

commented.

The health ministry seems to share those concerns, and announced in a press

release earlier this year that " in finalising the regulation of these

[complementary, alternative, African traditional] medicines, we are avoiding the

pitfall of putting such products in the same regulatory environment as

pharmaceutical drugs whose testing is very different " .

However, in a recent report on 'AIDS, Science and Governance' director of the

AIDS and Society Research Unit at the University of Cape Town, Professor Nicoli

Nattrass, warned that " the most pernicious legacy of President Mbeki's dissident

stance on AIDS has been the erosion of the authority of science and of

scientific regulation of medicine in South Africa. "

According to Nattrass, scientists - including the regulatory body the Medicines

Control Council - have been portrayed " as, at worst, biased spokespeople for the

pharmaceutical industry, and at best, as promoting scientific protocols that are

inappropriate for traditional or alternative medicines " .

" Once science is discarded as the best yard-stick of efficacy, patients are at

the mercy of charlatans selling unproven substances. Responsible governments

should not place them in this position - especially in this age of AIDS when so

many people's lives are at stake, " the report concluded.

Traditional medicine had to be " comprehensively studied, marketed and licensed

properly " , Gqaleni said. " We have to define what ubhejane is, find out the

ingredients, the exact dosages ... it has to be subjected to proper scientific

scrutiny " . He added there was still not enough information on the effects of

traditional medicine on ARVs - which in some cases have proved to be

incompatible.

AIDS lobby group, the Treatment Action Campaign, has also reiterated the need

for more research into traditional remedies: " Many people use traditional

medicines, but they continue to die of AIDS. This shows why it is important to

invest more money into researching traditional medicines so that safe and

effective treatments can be identified, and that medicines that harm people can

be withdrawn. "

The country's politicians, particularly health minister Dr Manto

Tshabalala-Msimang, have long supported the need for 'African solutions' to the

AIDS problem. Traditional healers are seen as crucial to the revival of

indigenous knowledge systems suppressed during the apartheid era.

Nozuko Majola, deputy director of the NGO the AIDS Foundation, warned however,

against romanticising traditional medicine, particularly when dealing with

people living with HIV/AIDS. " We have to protect people from exploitation and we

cannot afford to jeopardise the public health system, " Majola said.

While ubhejane and other traditional medication were easier to accept and more

familiar for many people, politicians and traditional healers should not use

double standards, she added. " There is proof that ARVs work, all medicine must

go through the same procedures. "

[ENDS]

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May 1, 2006