Adopt informed HIV/AIDS approach

There is nothing wrong with a health ministry anywhere encouraging people to live more healthy lives. Everyone who takes regular rest, exercises in moderation, eats regular meals of nutritious food, quits smoking and drinks very little alcohol will be a lot healthier on average than a heavy-drinking smoker who stays up all night lying on a sofa while eating junk food.

In fact most would agree that all health ministries should be encouraging healthier life styles for two reasons. First there is the responsibility to tell people how to be more healthy, and secondly a healthy population requires a lot less State expenditure on hospitals, clinics and doctors.

Where South Africa is getting it wrong is placing this healthy living programme at the centre of its policy of helping those living with HIV, and stressing the value of a healthy life style just for such people, rather than the population as a whole.

At the start of the HIV pandemic, and while the virus was spreading like wildfire across most of Southern Africa, there was little that could be done to help those living with HIV to prolong their lives, and make those lives more useful, than to switch to a healthy life style.

But what health minister Manto Tshabalala Msimang forgets is what many of the groups of people living with HIV, and those brave people who came out into the open about their status and spread the good word about healthy living, gave as their reason for such a lifestyle switch.

People asked them why they should live what they saw as a boring and dull life just to gain an extra year or two. And these very practical people replied that perhaps in that year someone would discover a cure, or a way to prolong life.

And that happened. The anti-retrovirals were discovered, tested and put into mass production. And some of those who were the leaders of the healthy life style were among those who managed to live long enough to benefit from these new drugs.

ARVs are not a cure. But they can give years or decades of decent life to those living with HIV. And the full benefits of the drug regime will be felt, and the side effects minimised, among those who eat properly, give up smoking and generally look after themselves. But without ARVs all the healthy living in the world will not prolong life more than a year or two.

We see this with other chronic illnesses. People with high blood pressure need specific drugs to live a decent life. Those drugs work better if they also alter their diet, reduce stress and generally look after their bodies. But it is the drug that is critical; the healthy life adds value.

South Africa’s neighbours follow this policy. They are battling, with far more limited resources, to bring ARVs to as many of those living with HIV as they can. The doctors prescribing the ARV treatment do encourage changes in diet and the like, just as they encourage diabetics, those with hypertension and heart disease and the like, to take their medicine regularly and change the way they live.

But no one pretends that the secondary treatment of diet can replace the primary treatment of ARV therapy.

The second approach being taken, and Zambia and Zimbabwe are both doing research, is to see if among the traditional herbal medicines there is anything that has an ARV effect, or even a cure.

But this research is being directed by top-flight doctors monitoring patients and testing for all the symptoms of HIV infection continuously. The research programme is not daft. HIV is a mutation of retroviruses found in African primates and there is a reasonable chance that this retrovirus, or similar viruses, might have entered African populations in the past.

Some herbalist somewhere might well have found a treatment that helps, and if that treatment can be found, another family of ARV drugs might well be derived.

We have seen this with antibiotics, drugs that kill bacteria. European women were putting mouldy bread on open wounds for centuries before someone finally figured out that many of those moulds were the common penicillin mould and so would have value. The old wives’ explanation of “drawing out evil humours” was wrong. But that did not make penicillin mould ineffective. In fact it was better, after processing, than the purely synthetic drugs.

African scientists are not seeking a poor substitute for ARVs. They recognise their value and some have to use them. What they are seeking is something better and in the meantime they insist their patients should have access to the best on offer today. If South Africa adopted a similar enlightened approach, South Africans would benefit immensely from wider access to existing ARV drugs, and the research resources of South Africa would bring forward the day when it would be possible to either find a better ARV drug, or prove their was no such natural drug.

September 2006
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