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Treatment


 

 

 

 

 

 

 

 

 

Treatment - General

How is HIV/AIDS Transmitted
Testing  for HIV/AIDS
HIV/AIDS is a manageable disease
What are antiretroviral drugs and how do they work?
Types of Antiretroviral Drugs
Drug Resistance
Side Effects

Treatment in South Africa

The costs of providing treatment
The benefits of providing treatment
A clash between civil society and government
Initiatives on Access to drugs

Story Ideas

Contacts and websites


Treatment – General

How is HIV Transmitted

»  Acquired Immune Deficiency Syndrome (AIDS) is caused by an infection by a virus called the Human Immunodeficiency Virus (HIV).

»  HIV is transmitted primarily through:

o      Unprotected sexual intercourse

o       Mother-to-child during pregnancy, childbirth and via breastfeeding,

o       Blood transfusions (although this is rare as most blood is screened or tested prior to being provided to patients)

o       Unsafe care practices including transfusion of unscreened blood

o      Blood contaminated needles, syringes, razor blades, and other sharp instruments, and through the use of unsterilised needles by injecting drug users.

Testing for HIV

»   HIV infection can only be diagnosed through undertaking HIV tests which detect antibodies produced by the body as it tries to resist the virus. The antibodies are produced within 3-8 weeks after infection. The period following infection but before antibodies become detectable is known as the widow period.

»  Testing for HIV/AIDS is to be accompanied by pre – and post-test counselling.

Types of Tests

o   Rapid Tests: A rapid test takes less than 10 minutes to provide a result. These tests have an internal sample addition control that validates each test run. In most instances a positive result is indicated by the appearance of a clearly visible dot or line.

o   Enzyme-linked immunosorbent assay (Elisa Tests): Most commonly used type of test for screening is more expensive than the rapid tests requiring skilled technical staff, equipment maintenance, and a steady power supply.

o   Confirmatory Tests: Initial positive results cannot be regarded as conclusive and should be followed up with cofirmatory tests such as the Western blot and Line immunoassays which determine whether an initial positive result correctly indicates an HIV infection.

o   Testing using whole blood, dried bloodspots, saliva or urine: Are particularly useful for research with hard to reach populations such as sex workers and injecting drug users and people opposed to giving blood on religious grounds. Samples can be collected in situations such as in a bar or on the street. These tests are sufficiently sensitive for surveillance but should be followed up with confirmatory tests.

»  An HIV test may be undertaken through private doctors, at public (i.e government) clinics and hospitals, or at laboratories. In some urban areas tests can be undertaken at the AIDS Training and Information Centre (ATIC).

»   In South Africa the standard test used is the Rapid Test. If the test is positive this is followed up by confirmatory test, which utilises the Elisa Test.

HIV/AIDS is a manageable disease

»  There is no cure for HIV/AIDS but it is increasingly a manageable disease.

»  It is possible for people living with HIV/AIDS to lead a productive life by following a healthy high-protein and high-kilojoule diet, managing stress levels, practicing safer sex i.e. by using a condom and treating opportunistic infections early. (see factsheet on Living Positively)

»  Antiretroviral drugs do not cure  HIV/AIDS but they do prolong the lives of those infected with HIV.

What are antiretroviral drugs and how do they work?

»  Antiretrovirals (ARVs) are the primary method of treating HIV. These drugs inhibit either of the two enzymes that are essential for HIV replication, namely, reverse transcriptase and protease.

»  To understand how antiretroviral drugs function, one has to understand how the virus works. HIV enters the blood stream and targets specific cells in the immune system called T-helper cells. T-helper cells have a protein called CD4 on its surface which the virus attaches to in order to enter the cell.

»   Once inside the reverse transcriptase enzyme enables the copying of viral RNA (ribonucleic acid) into viral DNA (deoxyribonucleic acid) which then joins the human DNA. The cells now produce viral RNA which assembles and buds out of the host cell to form a new virus.

»  The progression of HIV/AIDS is monitored by theCD4 test and the Viral Load test.

o   The CD4 test measures the amount of CD4 or T-helper cells in the blood. The strength of your immune system is a good predictor of how you will fight infections.

o   The Viral load test measures the amount of HIV in the blood in every milliliter of blood. The higher the viral load the faster the progress to AIDS.

»  ARVs slow down the production of HIV and give the body a chance to build up its CD4 cell count which, in turn, helps the body fight against opportunistic infections.

»   It has been found that taking one drug (monotherapy) at a time may have short term effects, but HIV quickly becomes resistant to it. This is because as said earlier the virus replicates at different stages and so a combination of drugs that work at these different stages is more likely to work and therefore less likely to cause resistance. Therefore, more than one antiretroviral drug needs to be taken at a time for it to be effective over a long term.

»   The term Highly Active Antiretroviral Therapy (HAART) is used to describe a combination of three or more anti-HIV drugs.

Types of Antiretroviral Drugs

»  Antiretroviral drugs (ARVs) can be classified into 3 main classes. They are:

o   Nucleoside Analogue Reverse Transcriptase Inhibitors (NRTI’s), target the HIV protein reverse transcriptase preventing the translation of viral RNA into viral DNA (e.g. AZT, ddl, ddC & 3TC).

o   Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI’s slows the reproduction of HIV by interfering with reverse transcriptase, an important viral enzyme. This enzyme is essential for HIV to incorporate its genetic material into cells. NNRTI drugs include: Nevirapine, delavirdine (Rescripta), efavirenza (Sustiva).

o   Protease Inhibitors (PI’s) that target the HIV protein Protease and blocks it so that a new virus cannot assemble in the host cell and be released.

Drug Resistance

»   Because HIV reproduces itself so rapidly, sometimes mistakes are made. These are called mutations. This means that the new virus differs slightly from the original one. Because the antiretroviral drugs target certain strains of HIV, other strains like the mutated ones, will not be affected by these drugs and they become drug resistant. They are also able to produce more strains that are unaffected by drugs.

»   It is therefore vital that the drugs be taken exactly as prescribed.

Side Effects

»   Possible side effects to the drugs include anemia (a decrease in red blood cells), diarrhoea, nerve problems and hepatitis (inflammation of the liver). Only a minority of people develop side effects and generally they can usually be treated.

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Treatment in South Africa

The costs of providing treatment

»  Over the past two years, much progress has been made to reduce costs of ARVs and make drugs more affordable. However ARVs remain unaffordable to the majority of households in South Africa whose mean median income is less than R1 400.00 ($164.00) and unemployment is estimated at 37%.

»  As of January 2002, the cheapest triple-combination HAART Regimen available in South Africa comprising Didanosine, Stavudine and Efavirenz was R539.95 per month. This regimen is often not an appropriate prescription for patients. Another commonly prescribed regimen Zidovudine, Lamivudine and Nevirapine costs R1 160 per month. The cost of both exclude VAT at 14% and a R65.00 prescription fee.

»  Assuming that at some point in the epidemic two million people would access a publicly available treatment programme, the antiretroviral drug costs alone for the cheapest regimen would amount to R16.8 billion or nearly 60% of the 2001/2002 health budget. It is estimated that to pay the full price for anti-retroviral therapy would cost R70 billion a year by 2010, thus almost tripling the public health care budget.

»  Providing generic drugs could reduce the costs of providing antiretroviral drugs by up to 30%. In Thailand the government is offering Stavudine, Lamivudine and Nevirapine in one pill at US$ 27.66 approximately R235 per month. MSF imports generic AZT, Lamivudine and Nevirapine at R460 ($54.11) per month from Brazil for its pilot project in Khayelitsha. If South Africa were to produce its own generic versions of the drugs this could further reduce the costs of the drugs as it may insulate drug prices against exchange rate volatility and cover shortfalls that are likely to result from massive demand if a public treatment programme is implemented.

The benefits of providing treatment

»  Treatment complements prevention there is evidence to suggest that counseling modifies sexual behaviour reducing transmission rates.

»  The provision of treatment provides people with an incentive to utilize voluntary counseling and testing.

»  Treatment will easen the burden on the hospital services. Research commissioned by the Department of Health indicates that an estimated 628 000 admissions to public hospitals were for AIDS Related illnesses, amounting to 24% of all hospital admissions. This places a huge strain on hospital staff and services. The cost of hospitalizing people living with HIV/AIDS in public facilities is estimated to be have cost R3.6 billion in 2001 or 12.5% of total public health budget. Treatment also alleviates the impact on HIV/AIDS on health workers where it is estimated that 30% of student nurses were HIV positive and 15% staff nurses and 10% of doctors.

»  Providing treatment will reduce the number of orphans. In the absence of treatment it has been estimated that approximately 5.7 million children will have lost at least one parent by 2014. This may result in increased juvenile crime, lower literacy levels, and an economic burden on the state. It will also place a burden on the state to provide foster child grants and care for an increasing number of orphaned children.

»  The most critical benefit of providing treatment and prevention are the lives saved and the prevention of human misery.

A clash between civil society and government

Does HIV cause AIDS Debate

The debate on the causal link between HIV/AIDS is in many ways intertwined with arguments concerning the use of antiretrovirals. This debate was sparked when it was learnt that President Thabo Mbeki, had contacted David Rasnik, a known dissident to request his views on the causal link between HIV/AIDS. It resulted in the formation of the Presidential AIDS Panel which brought together experts from both sides of the argument. This Panel failed to reach any consensus on the causal link between HIV/AIDS, the reliability of HIV testing and the efficacy of treatment.

Cooperation on reducing the prices of drugs

»  While government and civil society have been at loggerheads over the provision of anti-retroviral treatment, in particular in relation to the prevention of mother to child transmission and more recently regarding universal access to antiretroviral drugs, they have in the past collaborated to enforce access to cheaper antiretroviral drugs.

»  The civil society efforts around access to treatment has been largely led by the Treatment Action Campaign. Launched on 10 December 1998 its objectives are to campaign for greater access to treatment for all South Africans living with HIV by raising public awareness about issues surrounding the availability, affordability and use of HIV treatments. TAC is chaired by Zackie Achmat, who is HIV positive and has made an inspiring stand with his decision not to take anti-retroviral drugs until they are made freely available to all South Africans.

»  Access to drugs needs to be understood in the context of the World Trade Organisations (WTO) and the Agreement on Trade-related Aspects of Intellectual Property Rights (TRIPS). TRIPS obligates WTO members to offer minimum standards for protection for patents, copyrights and trademarkes. In the development of TRIPS it was argued that it would result in research and development but instead it resulted in considerably higher prices.

»  In April 2001, the Pharmaceutical Manufacturers Association (PMA) withdrew its case against the South African government following international political and public pressure. The PMA and its 39 companies sued the South African Government in 1998 objecting to provisions in the Act No 90.1997, Medicines and related Substances Control Ammendment Act of 1997 centering around provisions made in the act that would enable the Minister to permit the use of generic drugs rather than brand name drugs by authorizing parallel importing, compulsory liscensing, or generic production.

o   Generics: Generic drugs are copies of brand-name drugs where the patent has expired or are being made under compulsory license.

o   Parrallel Importing: Means a brand name drug already sold iin South Africa is simultaneously imported from another country where it is sold cheaper. Parallel imported drgs are theoretically the same as the brand product and may even come from the same plant.

o   Compulsory Liscensing: Allows a patent holder to be forced to allow others to produce its product. Compulsory licensing is sanctioned by the World Trade Organisation under certain conditions such as patent abuse or in cases of national emergency. means to provisions in the won the court action against the pharmaceutical industry allowing the government to issue compulsory licenses to local companies to produce and import generics.

During the court case government and civil society collaborated with the Treatment Action Campaign being admitted by the court as a friend of the court. However, since the conclusion of this court case government has not finalized regulations that will enable it to utilise the cost-containment measures provided for in the law. Furthermore there has been little action from government to make treatment available. In addition government continued to cite concerns relating to toxicity and resistance as its reason for its reluctance to provide ARV treatment. This despite the fact that 12 anti-retrovirals had been added to the WHOs Model List of Essential Medicines which is an indication to countries that these drugs should be considered efficacious, safe, and cost effective.

Legal Battle to Prevent Mother to Child Transmission

»  An acrimonious legal battle has ensued between the TAC and the South African Government, and 8 provincial governments regarding the provision of Nevirapine to pregnant women to prevent the transmission from mother to child (PMTCT) ensued. The Western Cape Government was not petitioned as it was already rolling out the provision of Nevirapine for PMTCT. The Pretoria High Court  on 14 December 2001 ruled in favour of the TAC the state "make Nevirapine available ... in public health facilities" that are not part of the pilot sites "where in the opinion of the attending medical practitioner, acting in consultation with the medical superintendant concerned, this is medically indicated, which shall at least include that the woman concerned has been appropriately tested and counselled." This decision of the court was appealed by the Government who requested for the matter to be placed before the Constitutional Court to decide on whether the judiciary could issue orders concerning matters of policy.

»  This appeal was granted by the Pretoria High Court. In April 2002, the Constitutional Court issued an interim order compelling government to provide Nevirapine in institutions where it had the capacity to do so. This was followed by a ruling of the Constitutional Court in favour of the Treatment Action Campaign. The legal campaign embarked upon by government was regarded by many as a delaying tactic in providing Nevirapine for PMTCT. In addition government has still not accepted a 5 year offer of free Nevirapine from the manufacturers Boehringer Ingelheim although the provinces of the Western Cape, KwaZulu-Natal and the Free State have accepted this offer. The TAC is currently monitoring the implementation of the ruling of the Constitutional Court and has already summonsed the Provincial MEC for Health in Mpumalanga, Ms Manana, for failing to comply with the order.

Rape and Post Exposure Prophylaxis

»  While the legal battle for the provision of treatment for PMTCT ensued, the South African Law Commission in December 2001 included in its review of the Sexual Offences Act that government was compelled to provide post-exposure prophylaxis (PEP) to rape survivors.

Government turn around but words not met by action

»  In a statement issued on 17 April 2002 Government announced that it was intensifying the campaign to prevent HIV infection. Government reiterated that its programme was based on the premise that HIV causes AIDS. It acknowledged that anti-retroviral treatments can improve the condition of people living with AIDS if administered at certain stages in the progression of the condition and in accordance with international standards. Government also announced that it would provide PEP to rape survivors.

»  In June 2002, a National Treatment Conference took place organized by the TAC and COSATU. This Conference resulted in the development and adoption of a National Treatment Plan. The plan proposes a "triangle" of interventions, with HIV prevention and improved treatment of other sexually transmitted diseases at the base and anti-retroviral drugs and home-based care at the apex. The plan calls for a strengthened SA National AIDS Council, with a permanent secretariat and proper resources to monitor the implementation of the plan.

»  This plan was submitted to the National Economic and Development Labour Council (NEDLAC) on 20 August 2002 who established an AIDS Subcommittee to oversee the negotiations on the plan.

»  A reapproachment between government and the TAC seemed imminent in October 2002 following a meeting between the government, led by the Deputy President, Jacob Zuma and the TAC. Zuma signalled the importance of the National Economic, Development and Labour Council (Nedlac) process under way to develop a "framework agreement" for a national HIV/AIDS treatment plan, and agreed that it should be presented to Sanac. However, Zuma did express concern over the TAC, World AIDS Day deadline for the adoption of a treatment plan.

»  Just prior to World AIDS Day 2002, indications were that government would sign the National Prevention and Treatment Plan following negotiations in NEDLAC. However, government continues to refuse to sign the National Prevention and Treatment Plan which has been developed by the National Economic and Development Labour Council (Nedlac). The TAC will undertake a protest march to Parliament on Friday, 14 February 2002, to protest against governments refusal to sign the Nedlac agreement. This march coincides with the opening of Parliament by President Thabo Mbeki.

Government stalls while preassure is maintained on the pharmaceutical companies

»  To date government has not indicated whether it will purchase locally produced generic versions of ARVs for distribution through the public health care system. Aspen Pharmacare, a South African generic producer has been granted voluntary liscences by the following pharmaceutical companies:

o   Boehringer Ingelheim to produce the drug Nevirapine this drug is used to reduce the risk of mother-to-child transmission and as part of HAART.

o   GlaxoSmithKline (GSK) for the provision of AZT and 3TC. In terms of the license agreement with GSK, Aspen is obliged to pay 30% of the net sale price to non-governmental organisations dealing with HIV/AIDS.

o   Bristol Myers Squibb (BMS) for the production Stavudine and Didandanosine.

The provision of these liscences places Aspen in a position to provide a cocktail therapy for HIV/AIDS at reduced prices. At present Aspen has made application to the Medicines Control Council for the approval of some of its generics.

»       The Treatment Action Campaign and National Association of People living With HIV/AIDS (NAPWA) continue to place pressure on the pharmaceutical industry to reduce the cost of antiretrovirals in South Africa. Both have focused their campaigns on the undertaking of protests to protest against excessive pricing by the pharmaceutical companies. The TAC has also recently lodged an application with the Competitions Board while in December NAPWA held a protest at the offices of GlaxoSmithKline in South Africa.

Initiatives on Access to drugs

A number of national and international efforts are being undertaken to make treatment more readily available these include:

» WHO-UNAIDS Access to Care Initiative – Initiated in May 2001, this initiative is a joint effort between the United Nations and six pharmaceutical companies with products, research and development portfolios in HIV/AIDS. This initiative includes dialogue with the pharmaceutical companies to make high quality medications (including generics) more affordable in low- and middle-income countries; and technical collaboration with countries to expand their capacity to deliver care, treatment and support. As of May 2002, 39 countries had completed, or were close to completing, national care and treatment plans, most with technical assistance from the UN. Nineteen African, Caribbean and Latin American countries had reached agreements with manufacturers on significantly reduced drug prices. Individual companies have have agreements with another four countries- Botswana, Chad, the Democratic Republic of the Congo and Malawi. In 19 countries, as of May 2002, more than 27 000 people had gained access to antiretrovirals. South Africa decided that it would only participate in this programme if negotiations were conducted on a regional level through the SADC, whose Health Committee is chaired by the Minister of Health in South Africa.

»  National Economic and Development Labour Council. (Nedlac) Business government, AIDS activists, labour unions, religious leaders and community organisations are currently engaged in negotiations aimed at developing a national HIV/AIDS prevention and treatment programme.

»  Medicins Sans Frontieres (MSF) and the Treatment Action Campaign are operating a pilot project on the provision of antiretrovirals in Khayelitsha. The objectives of the pilot project are  to demonstrate the following:

o   Technical Feasability: Standardised regimen, monitoring and staff training

o   Acceptability: Adherence, Treatment Literacy, awareness

o   Affordability: cost savings and cost effectiveness

o   Impact on Health Services: Dedicated service, TB-HIV links, impact on prevention

Currently there are over 350 patients on ARVs being provided with AZT, 3TC and Nevirapine, an additional 3 000 patients are being treated for opportunistic infections. The objectives The programme is definitely having an impact, as recent research by the Centre for AIDS Development and Research (Cadre) found that Khayelitsha was the township that had the highest percentage of residents who had been for an HIV test.

»  The Treatment Action Campaign (TAC) is working through clinics, HIV support groups and the private sector to prepare people living with HIV for treatment, both of opportunistic infections (such as TB and thrush) often associated with HIV and ARV’s.

»  Private Sector Initiatives Several South African corporations have developed programmes to provide anti-retroviral medicines to HIV positive workers. These include AngloGold, AngloAmerican, De Beers and Old Mutual, Vodacom, Multichoice, BP, Daimler Chrysler,Abbott and Alexander Forbes have been providing the drugs for some time already. Anti-retroviral treatment programmes being undertaken by companies vary with some companies providing drugs to workers while employed by the company. Others provide the drugs to employees and their dependents, and intend to continue provision after the employee leaves the company. See factsheet on HIV/AIDS in the World of Work for more information.

»   Tshepang (which means ‘to have hope’), is a joint initiative by The South African Medical Association (SAMA) and the Nelson Mandela Foundation. It is designed to provide free antiretroviral treatment (ART) to 9 000 public sector patients at 18 treatment sites countrywide. The estimated cost of this programme is R80 million, which SAMA hopes to raise from national and international sponsors.

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Story Ideas

»  While a number of initiatives are being undertaken to increase access to treatment the amount of people receiving treatment is very low. Why are so few people gaining access to treatment? What have been the lessons learned from programmes providing treatment?

»  The debate on access to treatment has focused primarily on the use of antiretroviral drugs with very little attention paid to the costs of testing, especially concerning CD4 cell count and viral load testing. CD4 counts and viral load tests allow for more precise health management. What are the costs of these tests and what actions are being undertaken to make these tests more affordable?

»  Government has often cited that their concerns regarding antiretrovirals are that they are toxic and complicated to administer. In Khayelitsha the MSF and TAC have been providing drugs to people in resource poor settings. What is the evidence from these projects relating to these issues? Speak to people receiving treatment and also to those who are not receiving treatment to find out what their experiences have been?

»  Pharmaceutical companies are undertaking drug trials in South Africa. What trials are being undertaken? What are the ethical guidelines governing those trials? What benefit is there for those participating in these trials especially concerning continued provision of treatment at the conclusion of the trial?

»  Aspen Pharmacare has been provided with voluntary licences by some of the pharmaceutical companies to produce local generics of their drugs? How far has Aspen progressed in the development and the approval of these drugs? Has government indicated that it will procure these drugs through Aspen?

»  What are the social implications involved in allowing communities to play a role in deciding who is allowed to take ARVs

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Contacts and websites

Government

The Department of Health
Name: Dr Nono Simelela
Tel: (012) 312 0121
Fax: (012) 326 2891
Email: simeln@health.gov.za
Website: www.health.gov.za

Name: Jo-anne Collinge
Chief Director: Communications
Tel: (012) 312 0713
Fax: (012)312 0690/ 312 0694
Email: collij@health.gov.za
Website: www.health.gov.za

Civil Society

Treatment Action Campaign (TAC)
Nathan Geffen, Manager
Tel: (021) 788-3507
Email: Nathan@tac.org.za
Website: www.tac.org.za

Medicins Sans Frontieres (MSF)
Marta Darder, Co-ordinator
Tel: (021) 364 5490
Email: msf.sa@mweb.co.za
Website: www.msf.org

Perinatal HIV Research Unit (PHRU)
Dr James McIntyre / Dr Glenda Grey / Dr Avye Violar
Tel: 11 989 9700

Fax: 11 938 397
Email: violari@mweb.co.za
Website: www.hivsa.com

Professional Bodies

South African HIV Clinicians Society (See Medical Practitioners)
Name: Penny Penhall
Tel: (011) 453 5066
Fax: (011) 453 5059

Email: sahivsoc@iafrica.com

South African Medical Association
Dr Kgosi Letlape, Chairperson of SAMA
Tel: 012 481-2037

Mobile: 082 881 295
Email: kgosil@samedical.org

International Organisations

World Health Organisation (WHO)
Chris Powell
Tel: +41 22 791 4509
Email: powellc@who.int
Web: www.who.int

Joint United Nations Programme on HIV/AIDS (UNAIDS)
Anne Winter/Dominique de Santis
Tel: +41 22 791 4509
Email:
wintera@unaids.org

desantisd@unaids.org
Web: www.unaids.org

Joint United Nations Programme on HIV/AIDS (UNAIDS)
Dr Catherine Sozi
Tel: 012 338 5307
Email: csozi@un.org.za
Web: www.unaids.org

World Trade Organisation (WTO)
Hans-Peter Werner
Tel: +41 22 739 5286
Email: peter-werner@wto.org
Website: www.wto.org

Medical Practitioners – Supplied by the SA HIV Clinicians Society

Contact: Dr Des Martin
Tel: (011) 453 5066
Fax: (011) 453 5059
Email: desm@iafrica.com

Name: Dr Steve Andrews
Secretary: Simona
Tel: (021) 510 1569/81
Fax: (021) 510 1590
Email: steve@iafrica.com

Name: Prof Raziya Bobat
KwaZulu/Natal
Tel: (031) 260 4355
Fax: (031) 260 4388
Email: bobat@nu.ac.za

Name: Prof Gary Maartens
W Cape
GS: (021) 404 9111
ID Unit: 021) 406 4346 (IDUnit)
Fax: (021) 406 6896
Email: gary@curie.uct.ac.za

Name: Prof Robin Wood & Dr LG Bekker
Tel: (021) 402 6393
Fax: (021) 425 2021
Email: docrob@iafrica.com

Name: Dr Koleka Mlisana
Tel: (031) 260 4562
Fax: (031) 260 4566
Email: mlisanak@nu.ac.za

Dr Leighton McDonald
Tel: (011) 777 8000
Fax: (011) 787 0772
Email: lmcdonald@mhg.co.za

Pharmaceutical Industry

Pharmaceutical Manufacturers Association of South Africa (PMA)
Mirryena Deeb, Chief Executive Officer
Maureen Kirkman, Head Scientific and Regulatory Affairs
Tel: 011 805 5100
Fax: 011 805 5105
Email: kirkman@sapma.co.za

Abbott Laboratories SA (PTY) LTD
Tel:
011-494 7000

Aspen Pharmacare
Linda Pretorious, CEO
Tel: 011 239 6100
Fax: 011 239 6111
Email: pretoriusl@aspenpharma.com
Website: www.aspenpharma.com

Involvement in HIV/AIDS: Generic Manufacturer. Been provided voluntary lisences by Bristol Meyers Squibb, GlaxoSmithKline and Boeheringer Ingelheim to produce generic versions of their HIV/AIDS antiretrovirals.

Boehringer Ingelheim (PTY) LTD
Kevin McKenna
Tel: (011) 886 1075
Fax: (011) 886 3205
Email: MCKENNA@jnb.boehringer-ingelheim.com
Website: www.boehringer-ingelheim.com

Involvement in HIV/AIDS: Producers VIRAMUNE (active ingredient nevirapine). Has offered Viramune for the management of MTCT free for the next five years. Presently only the Provincial Governments of KwaZulu-Natal, Free State and the have accepted this offer. Aspen Pharmacare has been given a license toproduce a generic version of VIRAMUNE in South Africa. The license is a royalty-free, voluntary, non-exclusive license covering the public sector of all countries of the SADC region.

Bristol-Myers Squibb (PTY) LTD
Vicky Baker,Simeka Communications
Tel: 011 712 9600
Email: viccy.baker@adcorp.co.za
Website: www.bms.com/aboutbms/founda/data/index.html

Phangisile Mtshal, Programme Manager: Secure the Future
Tel: 011 456 6441
Phangisile.mtshali@bms.com
Website: www.securethefuture.com

Involvement with HIV/AIDS: Producers of Stavudine and Didandanosine. BMS also funds the Secure the Future Initiative a five-year, $100 million commitment aimed at finding sustainable and relevant solutions for the management of HIV/AIDS in women and children, and provide resources to improve community education and patient support. BMS has also provided a voluntary license to Aspen Pharmacare.

GlaxoSmithKline (PTY) LTD
Michael Vogt, Strategic Brand Manager for HIV
TEL: 011 313 6000 (Tracey)
FAX: 011 313 6111
Website: www.gsk.com

Involvement with HIV/AIDS: Producers of combivir, AZT, Lamivudine, ziagen. Voluntary liscence provided to Aspen Pharmacare for production of generic version of AZT and combivir.

MSD (Merck Sharpe & Dohme)
Karin Hintze
TEL: 011 655 3000
FAX: 011 655 3180
Email: Karin_hintze@merck.com
Website: www.merck.com

Involvement in HIV/AIDS: Produce Crixivan and Stocrin. Also participates in the WHO-UNAIDS Access to drugs initiative.

Pfizer Laboratories (PTY) LTD
Tanya Elston
TEL: 011-320 6151
FAX: 011-884 8409
Email: Tanya.elston@pfizer.com
Website: www.pfizer.com

Involvement in HIV/AIDS: Has provided free Fluconazole indefinitely to patients attending government hospitals and clinics. Fluconazole is used in the treatment of opportunistic infections such as Cryptococcal Meningitis a painful, life threatening

Roche Products (PTY) LTD
TEL: 011-974 5335
FAX: 011-392 2338

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