HIV/Aids in SA: briefings by Medical Research Council, National Indigenous Knowledge Office & Professor HW Vilakazi
Science, Technology and Innovation
29 August 2006
Meeting Summary
A summary of this committee meeting is not yet available.
Meeting report
SCIENCE AND TECNOLOGY PORTFOLIO COMMITTEE
29 August 2006
HIV/AIDS IN SOUTH AFRICA: BRIEFINGS BY MEDICAL RESEARCH COUNCIL, NATIONAL
INDIGENOUS KNOWLEDGE OFFICE AND PROFESSOR HW VILAKAZI
Chairperson: Mr ENN Ngcobo (ANC)
Documents handed out:
Medical Research Council: HIV and AIDS Research in
South Africa
National Indigenous Knowledge Office (Department of
Science and Technology): Mission, Vision and Policy Objectives.
Professor HW Vilakazi (Special Advisor to Office of
the Premier: KwaZulu-Natal): HIV/AIDS, Suffering, Death, Science and
Responsibility
Nelson R Mandela
School of Medicine by Prof N Gqaleni
SUMMARY
The Committee received presentations by the Medical Research Council,
National Indigenous Knowledge Office and Prof HW Vilakazi on HIV/AIDS in South
Africa. The presentations dealt mainly with relevant statistics, the progress
made with research as well as the role and use of traditional medicines. The
Committee agreed that as HIV/AIDS impacted on the whole nation, the issues
presented were of the utmost importance and that everything possible had to be
done (including funding) to assist with research into a cure for the virus,
both scientifically and by way of traditional medicines.
MINUTES
Medical Research Council (MRC) presentation on HIV/AIDS research in SA
Professor AD MBewu (President) made the presentation to the Committee and gave
a broad overview of the current status of research. He explained that it was
clear that South Africa was in the grip of a major epidemic, for which there
was no cure and which really took off after 1990. Professor MBewu also touched
on the following:
The prevalence of HIV/AIDS amongst antenatal clinic care attendees (1990 –
2005): The figures showed that in 2005, 30.2% of women attending antenatal
clinics were HIV positive and that by extrapolating the statistics to the
general public, it was shown that approximately 11.3% of the population was HIV
positive.
HIV prevalence levels by sex and age group (2005). Statistics have shown that
young women were the most affected group and that 25% of young women were
infected.
Top ten causes of death (2004). HIV/AIDS topped this list at 29.8%. Professor
MBewu said that it was difficult to arrive at accurate figures due to the
reluctance to state HIV/AIDS as the cause of death on death certificates.
HIV prevention. Prof MBewu stressed that the only real “cure” was prevention by
way of abstinence, the use of male and female condoms, anti-retrovirals (ARVs)
for prevention management, vaccines, vaginal microbicides and male
circumcision.
The MRC were currently studying the following:
-Behavioural Intervention as the main source of infection;
-Epidemiological Studies: 5.54 million
South Africans were already infected and life expectancy was falling;
-Clinical research: 1000 scientists across South Africa were involved in
research;
-Health systems poverty and intersectoral intervention: The impact of AIDS on
the economy might lead to the reduction of the Gross Domestic Product (GDP) by
0.4% by 2010;
-Prevention of mother-to-child transmission: The chances of transmission during
vaginal delivery were 21 – 43%;
-Natural products and nutrition for immune modulation. It was shown that 80% of
South Africans used traditional medicines and that multivitamins and vaccines
were very important.
-South African AIDS Vaccine Initiative:
Prof MBewu said that this vaccine research initiative by the MRC was the
most impressive HIV vaccine development programme in the developing world.
-Prevention technologies (microbes and male circumcision): Studies into
technology (microbes) that would be in the control of women as well as studies
into male circumcision as a possible prevention method.
Matters relating to microbicide trials, novel therapies (biotechnology), human
development and community involvement and evidence-based medicine was also
briefly touched on by the MRC.
Discussion
Mr S Dithebe (ANC) thanked Professor MBewu for a very clear and precise
presentation and said that he had the following questions:
-What role could gold play in stemming the tide of HIV/AIDS?
-Did the African Potato (traditional medicine) affect the efficacy of ARVs?
-What was the MRC’s position regarding Uganda’s success in using indigenous
methods (traditional medicines as well as culture) to combat the disease?
Professor IJ Mohamed (ANC) stated that he did not agree with the assessment
that the rate of infection was reaching a plateau. In looking at the prevalence
levels by age group, he would infer that the levels were higher in the 25 – 29
age group than it was in the 20 – 24 age group as indicated in the presentation
as, in his opinion, infection occurred earlier. Why did the different organisations’/bodies’
estimates of the numbers of AIDS deaths vary so dramatically from each other?
He requested clarity regarding the contradiction in the relation of AIDS
related deaths versus death caused by Tuberculosis in 2000 and 2004. Prof
Mohamed said that concerning behavioural issues, he recently read an article in
which it was indicated that men in Zimbabwe forced women to use certain herbs
vaginally which enhanced the danger of transmitting the virus. The article also
highlighted the behavioural problem of men having a number of sexual partners
and he concluded that it was clear that the issue of social behaviour needed to
be addressed.
An ANC Committee Member asked what impact illegal immigrants had on HIV/AIDS
prevalence.
Mr J Blanche (DA) wanted to know why the infection rate started to go up in
1996 as that was the year in which campaigning started in earnest. He further
said issues such as sanitary habits should first be addressed before extreme
measures such as male circumcision were considered.
Mr SN Nxumalo (ANC) asked why South Africa’s progress with the vaccine
currently being researched was not more widely communicated to the world in
order to allay accusations that South Africa’s HIV/AIDS programme was pathetic.
Mr Nxumalo further said that he understood from the presentation that there
were 354 379 AIDS-related deaths in 2006 and he wanted to make sure that this
was correct.
The Chairman told Professor MBewu that at a previous occasion the Committee was
informed by a Dr Taka that Tanzania was seven years away from finalising a new
drug that would cure HIV/AIDS and that with regard to Tanzania’s traditional
medicine programme, they were informed that 14 people were already tested and
that it was found that their status had changed from positive to negative. He
asked for elaboration on this. In conclusion, he asked why it was that women
were more vulnerable to the virus than men.
In response to the question regarding gold as treatment for HIV/AIDS, Prof
MBewu confirmed that research was being conducted regarding gold compounds that
could be useful in HIV/AIDS but that it was in the very early stages.
Prof MBewu said that, with regard to the African Potato, there have been
reports in the literature of a possible interaction with ARVs but that more
research still had to be done.
Concerning Uganda, Prof MBewu informed the Committee that one had to remember
that a big part of the country was in a state of virtual civil war and that the
plotting of HIV prevalence in Uganda was done by extrapolating from pregnant
women attending public health clinics to the general population and that
therefore great care had to be taken with the interpretation of increases,
declines, etc. Further it should be remembered that most African countries were
10 years ahead of South Africa on the epidemic curve which would affect the
rate of decline in such countries. He concluded that there were mixed messages
regarding the reliability of some of the evidence in terms of changes in
prevalence and that one had to very careful in making claims of dramatic
changes in the sexual behaviour of young people in any country.
Prof MBewu responded that all that was being said was that it looked as if the
epidemic might be reaching a plateau in terms of prevalence but that it was a
plateau at a very high level when 30% of women attending antenatal clinics were
HIV positive and this data always had to be interpreted with caution. Referring
to the sharp rise in the infection rate figures relating to 1996, he said that
caution had to be taken as these figures usually had confidence intervals and
so 17% often meant that 17% was the median but the true figure could be
anywhere between 15 – 21%.
With regard to the reference to the infection rates pertaining to the 20 – 24
age group and the 25 – 29 age group, Prof MBewu agreed that the infection rate
was probably higher in the first age group. Because of the stigma surrounding
putting HIV/AIDS as the cause of death on the death certificate it was very
difficult getting a handle on the true numbers of deaths and as a result of
this a lot of AIDS related deaths might be “hiding” under deaths due to
tuberculosis and pneumonia, etc. This accounted for the seemingly lower
AIDS-death figures in relation to for instance Tuberculosis-related death
figures.
Prof MBewu explained that the difference in figures used by the various
organisations was mainly due to the different types of models used but that
recalibration and recalculation were constantly being done to address this
issue. Regarding social behaviour the MRC said that behavioural science in
South Africa was in its infancy and that much more research, done by people
from the communities worst affected, was needed. Further that a lot of cultural
practises such as circumcision, initiation processes etc. still had to be
properly researched with a view to utilising them as preventative measures.
Prof MBewu informed the Committee that there was no evidence that HIV rates in
South Africa was related to illegal immigrants. He said that it was likely that
the explosive HIV epidemic in South Africa could be relayed back to migration
and migrant labour and the economic and sexual practices involved.
With regard to circumcision the MRC said that they would be very cautious with
this approach and went on to say that data from Orange Farm indicated a 60%
reduction but that countries were advised to wait until all relevant studies
were completed.
Prof MBewu said that they were very proud of the vaccine research and that
there was worldwide offers to collaborate and that South Africa’s Comprehensive
HIV/AIDS Plan was demonstrably a huge success.
Prof MBewu said that there were illegal trials on a product in Tanzania but
that this was stopped once it was discovered. On the issue of when a HIV vaccine
would be available it was explained that the AIDS virus was a very difficult
virus and that it was not known when an effective vaccine would be available.
In terms of the claims made that people converted from positive to negative,
Prof MBewu said that this was a curiosity which very rarely happened and that
one should be very careful of reports claiming this. He further said that it
did in fact seem that women were more vulnerable to the virus and that this
might be due to the difference in their genital tracts compared to male
genitalia but that probably the most important reason was that of social
behaviour in terms of gender power relations regarding transmission from men to
women.
Presentation by the National Indigenous Knowledge Office (NIKO), Department of
Science and Technology (DST)
The presentation by Dr Tswane focussed on indigenous knowledge which included
traditional medicines. It was explained that in the past indigenous knowledge
was marginalised and that the Office for Indigenous Knowledge was established
to recover and develop that knowledge. The mission of the Office was to
integrate indigenous knowledge with other knowledge systems and their vision
was to create innovative society through indigenous knowledge development and
management for sustainable development.
The African Union declared 2001 – 2010 as the decade for traditional medicine
and a Directorate for Traditional Medicine was created by the Government in the
Department of Health. This was the framework in which the Indigenous Knowledge
Office worked to research, develop and advocate indigenous knowledge and
traditional medicines. The following important aspects were also highlighted:
-Recognition of current laws;
-Recognition of new Epistemology;
-Promotion: many claims of cures in traditional societies went unnoticed and
should be brought to the knowledge of other institutions;
-Protection: trust between traditional healers and the science community had to
be established and knowledge holders had to be protected;
-Monitoring and evaluation: a regulatory system to combat bio-piracy was
essential;
-Protection of individual property rights had to be incorporated into existing
legislation;
-Pre-informed consent: knowledge holders had to agree to the transfer of their
knowledge prior to transfer and beneficiation agreements had to be put into
place and also placed in a regulatory system so that they could be monitored.
Important issues such as safety, efficacy, quality control, labelling,
packaging and advertising and marketing with regard to traditional medicine
were of utmost importance and would be monitored by the Department.
Clinical trials and clinical trial designs with regard to traditional medicines
would also be promoted and monitored.
In conclusion the Office on Indigenous Knowledge felt that there was scope for
new epistemologies in the national system of innovations and they aimed to
create enabling environments based on traditional knowledge.
Discussion
Mr PJ Nefolovhodwe (AZAPO) commented that there had always been a notion
that the indigenous knowledge system had to be validated by other systems and
he wanted to know if the Department was interacting with indigenous
practitioners.
Mr B Mnyandu (ANC) wanted to know how the Indigenous Knowledge Office linked
with the provinces and how they enabled traditional practitioners to interface
with their Office. He also said that many traditional practitioners were
falsely claiming that they had a cure for HIV/AIDS and that these claims should
be declared illegal given the seriousness of the epidemic.
Mr Dithebe said that in 2001 traditional healers and other stakeholders
gathered at Vlakplaas and adopted a declaration with the intention to establish
a centre for healing and reconciliation and wanted to know if there was any progress
in this regard as it was very relevant to the work being done by the Indigenous
Knowledge Office. He further said that he was very glad to hear of the
integration/synergy with the other scientific bodies but wanted to know whether
or not there were enough mechanisms in the IKS Policy Document to create such
integration/synergy.
Prof Mohamed asked about the progress of proposed legislation on property
rights regarding IKS.
The Chairperson said that a unit from the IKS previously informed the Committee
that they were working with a traditional healer from Limpopo who claimed that
he was very near to a cure for HIV/AIDS and he wanted to know what the current
position was regarding this effort. He asked to what extent interaction took
place with the United Nations IKS Office.
Regarding the issue of validation, the IKS Office said that in their opinion
they did not have to be validated by other epistemologies because they felt
that IKS was a science on its own and therefore their role was to interface IKS
with other knowledge and to educate the sceptics so that they could understand
what IKS was about.
Responding to the question relating to interaction with traditional
practitioners the Committee was informed that the IKS, through IKS centres in
the various communities, would work directly with knowledge holders and
traditional practitioners wherever they were. These centres would also record
knowledge which would be a beginning to sanctify said knowledge.
On the issue of intellectual property rights the IKS Office said the current
Patents Act did include aspects of indigenous knowledge but that there were
actually five Acts that pertained to intellectual property rights and that the
IKS Office was actively involved to ensure that indigenous knowledge was not
left out.
Dr Tswane (IKS Office) responded to the Vlakplaas issue by saying that at the
time the agreement was reached at Vlakplaas in 2001 they were still trying to
formulate a policy on IKS but that the Indigenous Knowledge Trust of South
Africa has since adopted the programmes adopted at Vlakplaas and were putting
effort into getting the programme off the ground.
With regard to institutional collaboration, Dr Tswane said that interaction
between the various roleplayers were strong.
Dr Tswane said that the traditional healer from Limpopo has since passed away
and his knowledge lost to the IKS.
With regard to interaction with the United Nations, the IKS Office said that a
channel of communication was being searched for as a matter of priority as the
proper channel was not clear at this stage.
Presentation by Prof HW Vilakazi
Prof Herbert Vilakazi (Special Advisor to Office of the Premier of KZN)
said the University of KZN and the Nelson Mandela School of Medicine were
carrying out research on a number of traditional products and medicines.
Further they were also piloting a curriculum on traditional healing/medicines
for the formal medical community. The purpose of the presentation was also to
introduce a traditional healer, Mr Gwala from Ndwedwe near Durban, who has
produced a herbal mixture called Ubhejane which seemed unique in its powers
according to both walking evidence as well as laboratory results. Some of the
positive results of Ubhejane were improved quality of life, improved CD4 counts
and reducing viral loads. Pre-clinical trial work now had to be done to
scientifically validate this product so that it could be registered with the
Medicines Control Committee (MCC). The clinical data so far has shown that
there was a need for additional investment in the product so that it could be
further developed. In order for the
work to continue the University now needed full disclosure accompanied by the
necessary Intellectual Property (IP) regimes for patents and trademarks as well
as good manufacturing practises. After this was done clinical trials on humans
could begin but funds were needed to fast track this process.
The problem at this stage was that the scientific community only accepted
laboratory results and discarded “walking evidence” while this evidence also
had to be taken very seriously. The health crisis in Africa as result of
HIV/AIDS necessitated changes and modifications in the route, pace and steps
taken in the fight against HIV/AIDS. In closing, a big problem was that people
would only accept the orthodox way of dealing with HIV/AIDS but that this
should not be allowed to stand in the way of beneficial traditional
methods/products and that funding was needed to solve this problem.
Discussion
The Chairperson said that President Mbeki had also indicated recently
that traditional medicine had to be given a chance and further said that the
dialogue taking place in this meeting was of the utmost importance.
Mr Nefolovhodwe said that he was of the opinion that indigenous knowledge/medicine
had to be given a chance as it could save lives. He asked to what extent the
University was interacting with Government in order to obtain resources for the
project regarding Ubhejane.
Mr M Benghu (IFP) commented that he was familiar with the Ubhejane project and
was pleased that it was being developed within the science and innovation
context as this would go far to repair the damage/loss of knowledge caused by
colonialism.
Mr Mnyandu said that he first learned about Ubhejane last year and that his
question to the University was whether Ubhejane could remove the virus
completely.
Mr Blanche said that he wanted to sound a word of caution that in modern times
modern man should not always use phrases such as colonialism. He said that
people did not trust indigenous knowledge because of a certain picture that was
painted about it and that maybe the term Indigenous Knowledge Systems should be
changed to for instance “Ancient Knowledge Systems”. In conclusion he said that
the challenge was to change modern man’s attitude to ancient remedies.
A Committee Member said that if the premise was that Africa was the cradle of
human kind, he could not see why the premise could not be that Africa was the
cradle of all knowledge, but he was convinced that the impact of
apartheid/colonialism would still be felt for a long time. He also said that
South Africa should not be ashamed to subject whatever body of evidence there
is to the strictest scrutiny for verification purposes.
The meeting adjourned.
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