Aids disputes continue while children die

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Around 4800 people die each week of HIV/Aids in South Africa - close to the loss of life suffered by America on September 11.

Between government attempts at creating awareness, pressure groups wrestling to try and make anti-retroviral drugs (ARD) available to pregnant women with HIV and continuous squabbling over whose figures are correct, it is health care workers who have to witness people dying every day - most of them because they had no money to buy the drugs which could have improved their quality of life.

Even for a short while.

One of the institutions that wages an ever-increasing struggle against HIV/Aids is the Chris Hani/Baragwanath Hospital in Soweto - the home of at least 44 percent of all HIV positive people in the Johannesburg metropolitan area, according the iGoli 2010 HIV/Aids Impact and Intervention Analysis.

Here doctors daily wonder whether the struggle is worth the trouble. All they ever wanted was for disputes over insignificant issues such as figures to go away, that everybody unites, admitting to the problem and try and do something about it.

Dr Alan Karstaedt, chief of the adult HIV/Aids clinic at Bara says the epidemic will not stabilise for some time to come. "In 1997 26 percent of adults admitted to medical wards were HIV positive. In 1999 the figure was 31 percent. Among women between 25 and 34 years it had been 60 percent HIV positive."

Extensive research into mortality rates were conducted in the hospital. A consultant has been keeping figures of her patients since 1988: in the period up to 1991 the death rate was six percent of which one percent could be attributed to HIV/Aids. In the first six months of this year 42 percent of deaths could be attributed to HIV/Aids Karstaedt said.

Preliminary 2001 figures show that at least two thirds of patients under the age of 45 in medical wards died as a result of HIV/Aids he adds.

Over the past decade deaths as a result of tuberculosis increased from five percent to 18 percent, as a result of meningitis from two percent to 11 percent and pneumonia figures increased from 11 to 19 percent. Other, non Aids-related mortality rates have remained stable.

Karstaedt added that as a country becomes more mature at socio-economic levels, people start dying more of lifestyle diseases than contagious diseases or during labour. "Now at least 50 percent of deaths are again occurring as a result of contagion - we are going backwards."

He maintains comprehensive care strategies are required and not only for terminal patients. Hospital capabilities should also be considered.

"In countries to our north it was found that HIV positive patients were often admitted in favour of sick patients who were not infected by the virus. This might be since doctors believed those who were not infected to be healthier, while in fact they were seriously ill. The scales can naturally also tip the other way."

To witness HIV/Aids taking its toll in children's wards is a heart-rending sight. Between 40 and 50 die every month while in hospital. And Aids is to blame in 80 and 90 percent of cases.

Professor John Pettifor chief of paediatrics at Baragwanath says mortality rates in children's wards has increased over the past six years from 3.6 percent to 9.2 percent.

"This can be ascribed to HIV/Aids. Admissions have increased by 25 percent from 4 500 to 6 000 patients a year. Almost half of the patients have HIV/Aids."

He stressed that patients who are admitted are very sick. "We have an overnight ward for less serious cases. A child has to be seriously ill before being admitted to the general ward. And our figures are based on this group."

Pettifor says "about 99.999 percent of HIV positive babies acquired the virus from their mothers and at least one third die before they reach their first birthday. Among HIV negative babies death rates are 18 in each 1000. In the HIV positive group the figure is 380 in every 1000."

He believes a national programme to prevent transmission from mothers to babies (ARD is part of a trial programme and only available at certain institutions) cannot ensure that 100 percent babies are born free of HIV.

But it could help a lot. "The programme could ensure that only 10 percent of babies are born with the virus. We have a shortage of nurses and this could help to relieve the pressure on them. These patients need constant care."

Pettifor believes squabbles should stop. "The government should remove its eye patches and admit to the problem. We need a much more integrated attempt: admit that HIV causes Aids, treat pregnant women with HIV/Aids and provide hospice care and home care for the community."

Dr Tammy Meyers chief of the HIV/Aids clinic for children agrees with Karstaedt that HIV/Aids has overturned health patterns.

At the clinic, staff try and improve the quality of life for HIV/Aids children - mainly without ARD. Children older than two years, or those who survive and are not often sick (the so-called long term non-progressors) are treated here.

"Some of the eldest are 14 years old. We treat symptoms and try to prevent HIV/Aids related infections. Only a handful are able to afford ARD."

Their only hope at being treated with ARD is when clinical trials are being conducted. Patients at ante natal research units at the hospital also enjoy the benefit. "A total of 27 of our patients participated in trials when researchers required patients. Only one could not continue. The others are doing fine."

Currently they have 400 patients. The mothers of at least a third have died. Technically they are Aids orphans, Meyers says. "Most of them are under the care of grandparents or family."

Meyers says clinic personnel believe they have to struggle in the battle against Aids without any support. "Without political motivation we are stranded. But we do what we can. If only our attempts could be co-ordinated. But the government did too little too late.

As soon as South Africans start thinking things are changing President Thabo Mbeki says something weird - as when he questioned the veracity of Aids mortality rates in September. Opposition parties and Aids pressure groups deplored his remarks since his information was based on the impact of the epidemic six years ago.

What is happening at Bara and several other South African hospitals, proves the findings of the Medical Research Council (MRC) its chief, Professor Malegapuru Makgoba, said when he announced the much maligned report The Impact of HIV/Aids on Adult Mortality in South Africa last month. The South African Medical Association recently declared its support for the report.

Figures recorded in the report resulted in renewed mudslinging. The report states that 10 percent of all HIV in the world occurs in South Africa and that 24.5 percent of all deaths in 2001 were Aids-related. Among adults under 40 the figure was 40 percent. The experience at hospitals including Bara and the King Edward VIII hospital where 50 percent of all beds are occupied by HIV/Aids cases, underscores these findings Makgoba said.

There is, however, light at the end of the tunnel. In a recent article in the Sunday Times Health Minister Dr Manto Tshabalala-Msimang, Arts, Culture, Science and Technology Minister Dr Ben Ngubane and Dr Essop Pahad in the Presidential Office, all members of a special presidential HIV/Aids task team wrote: "The government requested the (MRC) report since it recognises the importance of HIV/Aids. When the work is completed and we are certain which factors influence mortality rates only one requirement is left: for us to unite against, and eradicate the true enemy, the HI virus." - Beeld, Thalyta Swanepoel

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