HIV/AIDS Socio-Economic Impact: Medical Research Council briefing

Meeting report

SCIENCE AND TECHNOLOGY PORTFOLIO COMMITTEE
15 March 2005
HIV/AIDS SOCIO-ECONOMIC IMPACT: MEDICAL RESEARCH COUNCIL BRIEFING

Chairperson: Mr N Ngcobo (ANC)

Documents handed out:
Medical Research Council briefing
Medical Research Council briefing: PowerPoint presentation

SUMMARY
The Medical Research Council (MRC) presented a short overview of their organisation. Their Interim President, Professor Anthony Mbewu, reported that HIV/AIDS was associated with poverty, concomitant sexually transmitted diseases, and the social disorder of migrant labour. Indications were that the infection rate between men and women between the ages of 15 and 19 were dropping. Statistics South Africa had come to the conclusion that 2.8% of deaths in South Africa were HIV/AIDS-related. He questioned these results and postulated that it would be closer to 26%. The best intervention to combat the epidemic would be prevention.

The Committee asked questions on the ‘stubbornness’ of the youth; the difference between the findings of Statistics South Africa and the MRC; growth in the MRC budget; HIV infection rates among the Asian ethnic group and women, and the role of sexworkers. The Minister of Science and Technology also shared his views on the problem.

Dr Matsabisa (MRC: Indigenous Knowledge Systems) did not get the opportunity to make a presentation on the role of traditional healers in the fight against the epidemic, due to inadequate time. It was agreed that he would brief the Committee at a later point.

MINUTES

Medical Research Council briefing
The Medical Research Council’s Interim President, Professor Anthony Mbewu, said he could not exactly quantify the socio-economic cost of HIV/AIDS, but it was possible to make an informed guess. It was possible to determine which sectors would be affected, and how best to mitigate the problem.

Professor Mbewu said the MRC’s vision was to build a healthy nation through research. The MRC was a 36-year-old statutory council, whose budget amounted to R165 million and their turnover to R350 million. Their staff included 300 scientists, 300 technologists and a support staff of 200. The MRC also supported 250 scientists and 200 technologists, who followed a multi-disciplinary approach.

Sketching the context of the disease, Professor Mbewu noted that South Africa had emerged from a 300-year colonial history and 50 years of apartheid rule. Many studies have shown that AIDS was associated with poverty. He further indicated the regional difference in HIV infection rates. The problem areas correlated with the former Bantustans. The poorly understood national history of the disease occurred within a society with a racially unequal infant mortality rate and varied household living conditions.

Professor Mbewu noted that the rate of infection of adolescents between the ages of 15 and 19 might be on the decline. The social disorder introduced by migrant labour had fuelled the epidemic, along with poverty, poor housing and poor sanitation and water provision, which all contribute to the weakening of the immune system and the subsequent acceleration of HIV to AIDS.

Some progress on HIV/AIDS and its impact on the economy has been made. They were aware that concomitant sexually transmitted diseases the critical factors. The rates of sexually transmitted diseases amongst women were very high in the 1990’s. Through the expansion of healthcare facilities this rate was on the decline. Primary healthcare was one of the most crucial interventions.

Professor Mbewu said that Statistics South Africa released its cause of death survey data, but because of the stigma surrounding HIV/AIDS, their figures for related deaths were well below what was actually being experienced in clinics and hospitals. South Africa was also in the grip of a tuberculosis epidemic, partly fuelled by HIV/AIDS. HIV could also be driving the influenza and pneumonia deaths. To arrive at a better idea of the epidemic, they had used modelling to estimate true levels of HIV/AIDS. The toll of AIDS deaths was severe. The government has mobilised and they had seen some successes.

Prevention was vital in dealing with such a fatal, incurable disease. They had had some success in the primary healthcare campaign. Many of the people who died in their 20’s and 30’s were economically active. He used the mining sector, with HIV prevalence of 28%, as an example. Public hospitals were also severely burdened. A project assessing the impact on infants has been rolled out.

The economic impact of HIV/AIDS would include a disruption of production and a fall in economic growth of between 0.3 % to 0.6%. Professor Mbewu concluded that the government needed to take extra steps to address the epidemic, and that the most important goal was prevention.

Discussion
Mr R van den Heever (ANC) asked more about HIV being a poverty-related disease. Professor Mbewu said that it was generally accepted. He told of a Tanzanian study, in co-operation with Harvard University, dealing with nutrition, where 1 000 pregnant HIV-positive women were studied. Half the cohort was given multi-vitamins over five years. They showed a 30% reduction in mortality and a 30% reduction in progression to full-blown AIDS. This showed that in the African context, when nutritional supplements are given, the mortality and regression to AIDS could be reduced by such a figure.

Professor I Mohamed (ANC) said a discussion of this importance should have been longer. He was shocked that the MRC’s budget was R25 million in 1994. He asked if they were still experiencing a problem in the allocation of their budget. He said this would not be acceptable. Professor Mbewu said that they would always welcome more money. The government has generously doubled their budget between 1999 and 2001. There could use more money, especially for support for extra scientists.

Professor Mohamed also asked for the MRC’s view on a basic income grant. Professor Mbewu said he was not qualified to speak about these grants. Simply giving money to people would not necessarily be a suitable intervention.

Professor Mohamed wondered if there was a political agenda in underestimating the extent of AIDS-related deaths Ms F Mahamed (ANC) also enquired about the accuracy of the table specifying the ‘Number of associated deaths for the ten leading reported natural causes of death in 2001’. Professor Mbewu said that the figure of 2.8% for ‘HIV disease’, the tenth disease in descending order, was clearly not correct. He simply did not know if the figure of 26% were correct.

Professor Mohamed wondered if death certificates were completed in a way to avoid payment of benefits. Professor Mbewu suspected that there was a stigma about writing HIV on death certificates.

Ms F Mahamed (ANC) what research has been done regarding the effect of HIV/AIDS on per capita income and if the South African economy were prepared for a globally competitive market. Professor Mbewu said his presentation was brief because they simply did not know. They expected a reduction of GDP growth between 0.3% and 0.6 %. The number of scientists, particularly black and female scientists, were woefully inadequate to ensure that South Africa keep its population healthy and grow the economy in a sustainable fashion.

Ms Mahamed also asked if any research had been done on Asian mortality rates in South Africa. Professor Mbewu said that AIDS mortality rates were difficult to estimate, but it was even more difficult to estimate between ethnic groups.

Ms Mahamed asked why women had higher infection rates. Professor Mbewu said that women seemed to be more susceptible biologically, but there were also psycho-social issues that might also be a determinant of why women get infected two to five years earlier in age.

Mr A Mlangeni (ANC) said he expected to see more about the impact on the economy. He then asked if young people were dying because of ‘stubbornness’ to use condoms. Professor Mbewu answered that the youth were actually hearing the message and starting to change their attitudes and behaviour.

Mr Mlangeni also asked if there were an improvement in the relationship between the MRC and traditional healers. The Chairperson said more time was needed for this issue. Another meeting would have to be arranged.

The Chairperson said that Britain announced a breakthrough in 1998 regarding a very expensive but successful drug, and asked about research progress in this regard. Professor Mbewu said that he could only guess that the Chairperson was revering to fusion inhibitors. They were useful, but had limitations in terms of side-effects and toxicity.

The Chairperson also asked how the USA had conquered the spread of the epidemic. Professor Mbewu answered that the disease had ‘matured’ in the USA and that their deaths had ‘plateaued’. That country had a constant figure of 14 500 deaths per annum, which was 2% of the people living with HIV, or 80% of those with full-blown AIDS.

Mr J Blanché (DA) referred to the graphs showing ‘HIV and syphilis prevalence among antenatal clinic attendees, aged below 20 years: 1991 – 2003’. He found it disturbing that the trend shot up from 1993 onwards. It was at the same time that the government has become more liberal regarding sexworkers. The prevalence among women in the 20 to 24 age-group had also shot up at that time. He asked if the MRC had done any studies to see what the opening up of the sex industry had anything to do with it. Professor Mbewu said he did not know, but they had done some research on the topic. He suspected that the sex industry did not drive the epidemic.

Mr B Mnyandu (DA) said traditional healers should come forward and prove their claims relating to the treatment of the virus, otherwise they should stop ‘ripping off’ the public. The Chairperson said the traditional healers should not be judged until they presented their findings.

The Chairperson said he would allow 15 minutes for a presentation on the role of traditional healers. Dr G Matsabisa (MRC: Indigenous Knowledge Systems) said that it would be very difficult to relay his topic in 15 minutes. He suggested that the presentation be made at a later date. The Chairperson and the Committee agreed.

The Minister of Science and Technology, Mr Mosibudi Mangena, said that it was clear that they had a very serious problem. The issue was not simple, and should never be simplified. There was no cure for AIDS and a vaccine was not in the pipeline anytime soon. The scientific community was working very hard. Every government department was affected by the epidemic. The Department of Science and Technology should ensure that there were facilities and resources available to ensure that scientists made their contributions most effectively. He made a call for mobilisation campaigns to ensure that prevention was addressed more. He expressed concern about the socio-economic profile of the HIV infected and said poverty just had to be reduced. Science councils also needed to receive their due.

The meeting was adjourned.