HERAF

In September, nurses working with the medical NGO, Médecins Sans Frontières - which runs HIV and tuberculosis clinics in the capital, Nairobi, and western Kenya - reported irregularities in the appearance of the antiretroviral Zidolam-N, a combination treatment containing the ARVs zidovudine, lamivudine and nevirapine. The ARVs were found to be falsified versions of a World Health Organization (WHO)-certified generic drug purchased through a distributor endorsed by the Kenya Pharmacy and Poisons Board (KPPB), the country's drug regulatory authority. According to the KPPB, one batch of the fake Zidolam-N, with the number E100766, is marked as manufactured in 2009 and set to expire in May 2013, while a second carries the batch number A9366 with manufacture and expiry dates of June 2009 and May 2012 respectively. The main irregularities included discolouration, mould and crumbliness; the packaging is also of varying quality and the text differs in font and colour from the genuine drug.

Certified, generic versions of Zidolam-N distributed in Kenya are manufactured by Hetero Drugs Limited, based in India. WHO's investigations found that Hetero's batch number E100766 had been manufactured and controlled according to WHO-recommended specifications and was of acceptable quality and had not been supplied to Kenya.  "We have asked all patients with the said drugs to return them to clinics so we can ascertain if they are the fake ones and supply the patients with fresh drugs," said Jacinta Wasike, director of surveillance and inspection at the KPPB. The KPPB estimates that 16,340 batches of the counterfeit drug have been released, 15,000 of which have now been returned.

"We are tracking down some of the patients who may have received them but haven't returned them," Wasike said. "The samples of the drugs which were recalled have already been sent to laboratories... Once the results are known, we will be able to know any side-effects they might have on the patients and what remedies to take to minimize these side-effects, if any."

WHO describes a counterfeit drug as one that is deliberately and fraudulently mis-labelled with respect to identity and/or source. Counterfeiting can apply to both branded and generic products. Representatives of people living with HIV in Kenya have castigated the KPPD for allowing the counterfeit drugs to filter into the supply chain and jeopardizing their treatment. "It is very scary, especially with a disease whose treatment calls for strict adherence to a regimen," said Nelson Otuoma, coordinator of the Network of People Living with HIV and AIDS in Kenya (NEPHAK).

Senior officials say the government is investigating how the drugs found their way into the country, and is looking into strengthening surveillance systems.  "Investigations are being carried out by relevant authorities, but as a government we take very seriously issues of treatment of HIV and AIDS. Loopholes at times do exist but when we learn our lessons, we work to seal them," said Anyang Nyong'o, Minister for Medical Services.

NEPHAK's Otuoma accused the government's drug procurement system of being riddled with corruption, and said unless this issue was addressed; the risk of fake drugs penetrating the market would remain.
Health experts say it is crucial for the government to urgently address the situation in order to allay patients' fears and retain the confidence of HIV-positive people in the government's ability to provide them with effective care. "News of fake drugs might affect treatment, not just in the possible side-effects but in the sense that patients might shy way from taking drugs because they don't know who or what to trust," said Alan Mabeya, a doctor at Kenyatta National Hospital, the country's largest referral facility.

Uganda won plaudits in the early days of the epidemic for the aggressive stance taken by President Yoweri Museveni; the country lowered its HIV prevalence from 18% in the early 1990s to about 6 % in 2000. However, several setbacks - including corruption scandals, frequent treatment shortages and accusations of a misguided prevention programme - have undermined its progress.

"Uganda's HIV fight is like a stunted child who once upon a time crawled, stood up, took a few steps but was never able to run," said Milly Katana, a long-term activist and one of the inaugural board members of the Global Fund to fight HIV, Tuberculosis and Malaria. "And the way things are going, the child may go back to crawling." Katana, who discovered she was HIV-positive in 1995 and went public with her status soon after, says while the injection of millions of dollars saved lives through treatment, it also commercialized the industry, leaving it open to abuse by those not truly interested in defeating the epidemic.

"When we started we had a genuine passion for fighting HIV, but now people do it as a job, a way to earn a living, and are less interested in people living with HIV, in understanding what it will take to end the epidemic," she said. Katana added that Museveni, who once faced HIV head-on and stood with the activists, appeared to have changed his stance, embracing prevention programmes that did not emphasize condom use and openly questioning evidence-backed prevention techniques such as medical male circumcision.

For Major Rubaramira Ruranga, executive director of the National Guidance and Empowerment Network of people living with HIV/AIDS in Uganda, the lack of proper coordination at the top of the HIV response is largely responsible for the disorganization visible in the rest of the sector. "Who is responsible for HIV in the country? Is it the Uganda AIDS Commission? Is it the Ministry of Health? Is it the President's Office?" he asked. "We need to have a single body that is able to call people to order, to steer the response effectively; for instance, HIV is going up again in Uganda and we need to know why, but who can tell us?"

He also noted that while the country had strong policies to fight HIV, they rarely reached the implementation phase.  "The national strategic plan is full of good ideas, but where is the change? For instance, a lot has been said about mainstreaming HIV, but it has not gone beyond the rhetoric," Ruranga said. "We need to set benchmarks and have mechanisms that work towards achieving them."  He further noted that HIV decision-making had happened at a high level, leaving out grassroots communities and therefore often missing out on their needs.

"HIV became an office business with lots of workshops, largely in the capital," Ruranga said. "As a result, the needs of the most important people - young people in particular - have been mishandled, and while there is a lot of talk about HIV, there has been little effort to ensure the population understands important issues, such as HIV discordance.

"There has also been a failure to promote a healthy understanding of ARVs [antiretroviral]. People think it's a panacea and have become complacent about their behaviour," he added. "[They] don't realize that along with ARVs come a number of other complex conditions - cardiovascular disease, lipodystrophy [a condition involving the redistribution of body fat] and so on, some of which can be debilitating."

Rev Gideon Byamugisha has been living with HIV since 1992, and was one of the first religious leaders to publicly announce his status; he is a founder member of the International Network of Religious Leaders Living with and Personally Affected by HIV/AIDS, which, since its formation in 2006, has attracted more than 4,000 members from 48 countries.  Byamugisha says Uganda has failed to keep up with the new methods of handling the epidemic.  "We are still talking about ABC [Abstinence, Be faithful and correct and consistent Condom use], which focuses on sex - but what about the 21% of new infections that occur through mother-to-child transmission?

"'Be faithful' clearly has not worked, since marriage is where most new infections are occurring - the issue should not be faithfulness, but sex with someone whose HIV status you are aware of," he added. "Medical male circumcision is not moving as fast as it should and we have yet to make any moves on treatment as prevention.... we need to take note of the new dynamics and adopt them."  The country needed to shake off the complacency that had set in following the early successes, he said. "Uganda is a prisoner of its own success - we are like a heavyweight boxing champ who gets the belt and then relaxes," he said.

SOURCE: IRIN NEWS

Edited By: HERAF STAFF

In the resolution passed during the 5^th session of the 2^nd Pan African Parliament held on 3^rd-14^th October, in Midrand, Johannesburg, South Africa, PAP members reiterated that maternal, newborn and child health is critical to overall human and social development in Africa. It also calls for high-level parliamentary support to accelerate implementation of a plan on policy and budget support towards maternal, newborn and child health, agreed by Chairs of Finance and Budget committees of national parliaments in October 2010.

In July 2010, the African Union heads of states and governments made far-reaching commitments towards maternal and infant health at a high-level summit held in Kampala, Uganda. The latest PAP resolution combines integrated implementation of African maternal, newborn and child frameworks with the United Nations Secretary-General`s Global Strategy for Women and Children's Health, launched in 2010 to accelerate progress toward the achievement of the Millennium Development Goals.

According to the United Nations, 7.6 million children under the age of five and approximately 350,000 women die each year of pregnancy-related causes, most of which are preventable. Underlining the need for accelerated global action, UN Secretary-General Ban Ki-moon said, "We must, therefore, do more for the newborn who succumbs to infection for want of a simple injection, and for the young boy who will never reach his full potential because of malnutrition."

Health experts and campaigners said parliaments have a significant role to play in reinvigorating policy and budgetary support towards maternal and infant health in Africa. Commending the Pan African Parliament Resolution, Rotimi Sankore, Secretary of the Africa Public Health Parliamentary Network, stated: "We welcome this landmark resolution by the Pan African Parliament, which is a significant step towards African parliamentary action to help end the tragic annual loss of an estimated 4.2 million lives of African women and children. The resolution strongly complements the African Union Commission-led Campaign for Accelerated Reduction of Maternal, Newborn and Child Mortality in Africa (CARMMA), launched in 31 countries over the last two years."

Dr. Carole Presern, Director of The Partnership for Maternal, Newborn &Child Health, underlined that "This PAP resolution demonstrates the vital and positive contribution that parliaments globally can make to saving and improving the lives of women and children, and in particular the commitment of African parliamentarians to their constituents".

With this resolution, five senior members from each of the 54 African Union member states have pledged to work alongside speakers and relevant committees of national parliaments, to implement the PAP resolution on maternal, newborn and child health. A partnership involving the Africa Public Health Parliamentary Network, the United Nations Population Fund (UNFPA), and the global Partnership on Maternal Newborn & Child Health (PMNCH) has worked closely with the Pan African Parliament in the lead-up to this resolution.

Around 1.5 million Kenyans are estimated to be living with HIV, or about 6.3 % of the adult population. Prevalence of the disease in Kenya is such that only sub-Saharan neighbors South Africa and Nigeria have more HIV-positive citizens. While analysts say the country has achieved some measure of success in reducing infection rates over the past decade, they estimate that only around 60% of Kenyans have been tested for HIV. NASCOP is hoping to have over 80% of the population tested by 2013, and is considering new methods to achieve that goal.

Earlier this week, Kenya's Daily Nation reported that the country could adopt new hospital procedures which mandate HIV testing for adults seeking treatments for illnesses such as malaria. The same procedures would require testing for children seeking any medical treatment.

Mandatory testing for HIV is generally viewed by rights organizations as a violation of privacy and an open invitation for discrimination. Martin Wood, a spokesperson for British HIV organization Avert, says the push for mandatory testing in Kenya is admirable but misguided and could end up hurting more patients than it helps. "If they're in a situation where it's compulsory that they are going to have an HIV test when seeking medical treatment," he says, "people may actually not go seeking that treatment because they're scared of disclosure of their HIV status."
The problem of social stigma, he explains, could raise public alarm about the proposed testing plans.

Kenya previously attempted to increase HIV testing through its Voluntary Counseling and Testing (VCT) program. VCT centers were opened throughout the country to provide Kenyans with safe locations for testing, but experts -- including NASCOP Director Dr. Peter Cherutich say the risk of being viewed as promiscuous prevented many women from accessing services.While education levels within the country have increased in recent years, positive HIV status could threaten a person's social standing or employment if their status is made public. And according to Asunta Wagura -- the executive director of the Kenya Network of Women with AIDS (KENWA) -- many communities in Kenya still regard positive-status with fear and misunderstanding. Wagura says that if the program should take shape, post-test counseling for those who do test positive should also be made available. Her organization has called on government officials to provide more access to treatment services for Kenyans living with HIV and AIDS in the past.

But fears of mandatory testing in Kenya are premature, as Kenyan law currently bans such practices. According to Dr. Andrew Suleh, National Chairman of the Kenya Medical Association, Kenya's HIV and AIDS Prevention and Control Act (HAPCA) would have to be amended to allow mandatory testing. "If somebody has malaria, why would you refuse treatment because you have not tested for HIV?" he says. "It doesn't make sense."

Suleh says Kenya's primary goal should be early testing of citizens. Instead of waiting for someone to voluntarily test themselves once they feel sick, he says, NASCOP can do more to stop the spread of HIV by catching new infections early. One interim solution, he says, would be to strongly encourage HIV testing when offering routine treatments for illnesses such as Malaria while allowing patients to opt out. Because any new approaches would have to be aligned with Kenyan law, however, the nation's battle with HIV will continue to be waged strictly on a voluntary basis.

SOURCE: VOA NEWS

Edited by HERAF Staff