Growth and Development Summit Agreements: NEDLAC progress Reports

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.