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Mandela Says AIDS Led to Death of Son

Health Activists Praise Ex-President’s Openness

By Craig Timberg

Washington Post Foreign Service
Friday, January 7, 2005; Page A10

JOHANNESBURG, Jan. 6 — Former South African president Nelson Mandela
announced Thursday that his son, Makgatho Mandela, 54, had died that morning
of illness related to AIDS, and he urged other families to speak openly about
the toll of a disease that has ravaged South Africa but is still widely
regarded as a taboo topic.

Mandela, though 86 and increasingly frail, has mounted a highly public
crusade against AIDS in the past several years. He called reporters to his
suburban home to make the announcement just hours after Makgatho, a lawyer and
father of four, died at a nearby hospital.

“My son has died of AIDS,” Mandela said, ending weeks of
speculation that Makgatho had the disease. He compared his son’s illness to
his own struggles with tuberculosis and prostate cancer, and he asked all
South Africans to treat AIDS as an “ordinary” disease rather than a curse for
which “people will go to hell and not to heaven.” His only other son died in a
car accident in 1969.

Mandela, who won the Nobel Peace Prize for his battle to end apartheid,
has acknowledged doing too little to combat AIDS during his presidency from
1994 to 1999. Since then, however, he has repeatedly urged people to seek
testing and treatment and also promised to be open if any member of his family
died because of AIDS.

“That is the only way of making an ordinary illness ordinary instead of
following those who are not well-informed,” he said Thursday. More than 5
million South Africans are infected with the AIDS virus, HIV — the largest
number of cases in a single country — and at least 1,000 a day die from
complications of AIDS, according to the United Nations. Like Mandela, other
African leaders have also become increasingly forthright about the need to
combat AIDS despite cultural resistance to public discussions of the disease.

However, the country’s current president, Thabo Mbeki, rarely talks
about AIDS and has done little to promote countermeasures. He became embroiled
in controversy several years ago for suggesting that factors other than HIV
cause AIDS. After being reelected in April, he mentioned the disease only in
passing during his inauguration.

A spokesman for the Mandela family, Isaac Amuah, said in a phone
interview that the immediate cause of Makgatho’s death was complications from
a gallbladder operation. But he said that AIDS was a contributing factor and
that Mandela was determined to portray the death as resulting from AIDS to
demystify the disease.

Mandela’s announcement was immediately applauded by AIDS activists and
political leaders in a country where the disease is widely stigmatized. Shame
and fear remain major barriers to treating AIDS, even where effective drugs
are available, according to doctors and researchers.

Death announcements in newspapers routinely refer to someone having
suffered from “a lengthy illness” or pneumonia, instead of disclosing that a
person had AIDS. Victims of AIDS are sometimes said to be cursed by
witchcraft, and in some communities they are shunned.

“For senior people to be brave enough to involve their entire families
is the only way to beat stigma,” said Francois Venter, an AIDS physician in
Johannesburg .

African leaders have shown increasing willingness to talk about AIDS and
its toll on their families. A onetime political rival of Mandela’s, Mangosuthu
Buthelezi, has spoken publicly about the deaths of two of his children from
AIDS. Zimbabwe’s president, Robert Mugabe, revealed an AIDS death in his
family. And Zambia’s former president, Kenneth Kaunda, has spoken openly of
the death of his son from an AIDS-related illness in 1986.

The eagerness of Mandela and others to discuss the disease in recent
years has made Mbeki’s silence all the more pronounced, although on Thursday
Mandela declined to answer a reporter’s question about Mbeki’s handling of
AIDS.

“There’s an enormous contrast,” said Zackie Achmat of the Treatment
Action Campaign, South Africa’s most prominent AIDS activist group. Of Mbeki’s
reluctance to confront the issue, Achmat added, “It adds to the stigma. . . .
It denies a name to the illness of people.”

The government’s slow response to the spread of HIV-AIDS has sparked
widespread criticism among health experts. Until last year, the public health
system did not provide antiretroviral drugs, which can reverse the
deterioration caused by AIDS. Antiretrovirals are gradually becoming
available, but most victims wait to seek treatment until they are too sick to
benefit from them.

Makgatho, whose wife, Zondi, died of pneumonia in 2003, had been
receiving antiretroviral treatment for more than a year, said Amuah, his
brother-in-law. The medicine appeared to restore Makgatho to full health, but
he deteriorated abruptly in the days after a gallbladder operation on Nov. 30.
Mandela, who learned of his son’s AIDS diagnosis last year, canceled several
public events to be at his bedside in recent weeks.

“He had other medical problems,” Amuah said. But AIDS was “a
contributing factor” in his death. “We cannot deny that.”

Makgatho was one of two sons of Mandela and his first wife, Evelyn. The
other son, Madiba Thembekile, died in a car crash in 1969 while his father was
in prison, serving a sentence that would stretch to 27 years for his role as a
leader of the African National Congress.

Mandela is also the father of four daughters, one of whom died as an
infant.

Makgatho kept a relatively low profile as the eldest son of an
international icon. Mandela said little about his personal relationship with
his son at the news conference, but in his autobiography, “Long Walk to
Freedom,” Mandela speaks affectionately about discussing politics with his son
and explaining the nature of racial oppression.

Also at the news conference was Makgatho’s son Mandla, who described his
father as strong and loving. “We were very proud to have a man such as our
father to father us,” he said. “He has been the pillar of our strength.”

 

Research
Flawed on Key AIDS Medicine
Bush Had
Planned Its Use in Africa

 

By John Solomon

Associated Press
Tuesday, December 14, 2004; Page A14

Weeks before President Bush announced a plan to
protect African babies from AIDS, top U.S. health officials were warned that
research on the key drug was flawed and may have underreported thousands of
severe reactions, including deaths, government documents show.

The 2002 warnings about the drug, nevirapine, were serious enough to
suspend testing for more than a year, let Uganda’s government know of the
dangers and prompt the drug’s maker to pull its request for permission to use
the medicine to protect newborns in the United States.

But the National Institutes of Health, the
government’s premier health research agency, chose not to inform the White House
as it scrambled to keep its experts’ concerns from scuttling the use of
nevirapine in Africa as a cheap solution, according to documents obtained by the
Associated Press.

“Everyone recognized the enormity that this decision could have on the
worldwide use of nevirapine to interrupt mother-baby transmission,” NIH’s chief
of AIDS research, Edmund C. Tramont, reported March 14, 2002, to his boss,
Anthony S. Fauci, director of the National Institute of Allergy and Infectious
Diseases.

The documents show that Tramont and other NIH officials dismissed problems
with the nevirapine research in Uganda as overblown and were slow to report
concerns to the Food and Drug Administration.

NIH’s nevirapine research in Uganda was so riddled with sloppy
record-keeping that NIH investigators could not be sure from patient records
which mothers got the drug. Instead, they had to use blood samples to confirm
doses, the documents show.

Less than a month after Bush announced a $500 million plan to push
nevirapine across Africa to slow the AIDS epidemic, the Department of Health and
Human Services sent a nine-page letter to Ugandan officials identifying
violations of federal patient-protection rules by NIH’s research.

Nevertheless, NIH officials said they remain confident after re-reviewing
the Uganda study and other research that nevirapine can be used safely in single
doses by African mothers and children to prevent HIV transmissions during birth.
But they acknowledged their Uganda research failed to meet required U.S.
standards.

As a result, NIH recently asked the National Academy of Sciences to
investigate its science in the case and has spent millions in the past two years
improving its safety monitoring and record-keeping.

One lesson derived from a closer review of the Uganda research is that
even single doses of nevirapine can create instant resistance, meaning patients
may not be able to use the drug or others in its class again when their AIDS
worsens, Lane said.

Lane said NIH officials were aware in spring 2002 about the impending
White House announcement on nevirapine but did not tell presidential aides of
the problems because they were confident, even before reviewing the Uganda
research, that the underlying science was solid.

The White House — though unaware of the NIH concerns — also remains
confident in Bush’s $500 million plan in 2002 to send nevirapine to Africa. Bush
approved $2.9 billion for global AIDS fighting next year.

Senate Finance Committee Chairman Charles E. Grassley (R-Iowa) has asked
the Justice Department to investigate NIH’s conduct. In a letter released
yesterday, Grassley said he was compelled to do so by “the serious nature of
these allegations and the grave implications if the allegations have merit.”

HIV Increasing Faster Among Women Than Men,
Report Finds

By David Brown

Washington Post Staff Writer
Wednesday, November 24, 2004; Page A03

The epidemic of human immunodeficiency virus infection is growing more
rapidly in women than in men in almost every part of the world, according to a
new report.

The “feminization” of AIDS appears to reflect a maturing of the
epidemic, suggest the authors of the annual AIDS update prepared by the United
Nations, the World Health Organization and the World Bank. More and more
seemingly low-risk women, many of them married, are being infected by men who
acquired the virus through high-risk behavior years ago.

The trend is most advanced in sub-Saharan Africa,
where the AIDS epidemic began and home to more than half the world’s
HIV-infected population. Women there now make up 57 percent of people living
with the virus.

From 2002 to 2004, the percentage of infected women rose or stayed the
same in all regions.

“This is an emerging pattern. . . . This has profound implications,” said
Peter Piot, a Belgian physician and epidemiologist who heads UNAIDS. “We have to
put women at the heart of the response to AIDS if we want to stop this
epidemic.”

The evolving risk to women is a main theme in the 87-page report that
paints a mosaic portrait of the global AIDS epidemic.

In all, 39.4 million people are infected with HIV now, up from 37.8
million last year. About 3.1 million died of AIDS-related causes in 2004, out of
about 55 million deaths from all causes worldwide.

About 25.4 million people in sub-Saharan Africa are infected, about 7.4
percent of all adults. The Caribbean has the next-highest prevalence, with
440,000 people infected, 2.3 percent of all adults. The prevalence is below 1
percent in both China and India, but the epidemic in those areas is expanding
and could become explosive.

The growing proportion of infected women reflects the cumulative effect of
many risks. They include the fact that women and, in particular, teenage girls,
are more physiologically vulnerable than men; the inability of many women to
require their partners to use condoms; the infidelity of husbands and the
high-risk behavior of other male partners; the exploitation of young women by
older men, especially in southern Africa; and rape and other forms of sexual
coercion.

In South Africa, Zambia and Zimbabwe, women ages 15 to 24 are three to six
times as likely to become infected as young men. In the Caribbean, the risk for
young women is twice that of men.

Marriage is no protection against infection —
and in some places appears to increase the risk.

In India, where about 5.1 million are infected, women account for
one-quarter of new HIV cases. Among those who test positive at prenatal clinics,
90 percent say they are in long-term, monogamous relationships. In a study of
young women in Kisumu, Kenya, and Ndola, Zambia, married teenage girls were more
likely to be infected than unmarried, sexually active ones.

African Americans now account for 72 percent of
infections among women in the United States. A recent study of a low-income
section of New York found that women were twice as likely to be infected by a
husband or long-term lover as by a casual sex partner.

In some places, however, the plight of women is improving, according to
the report, which draws on national reports and dozens of epidemiological
surveys.

For example, the percentage of infected women at prenatal clinics in
Uganda and Kenya fell from 13 percent in 1998 to about 9 percent in 2002. At
clinics in Ethiopia, it dropped from 14 percent to 12 percent. While the reason
for that trend is not certain — and probably reflects the cumulative effect of
many prevention messages — it appears to be real.

“It cannot be a burning out of populations at high risk because it is
really happening,” Piot said in a teleconference yesterday.

UNAIDS and WHO are gathering data on who is receiving access to AIDS drugs
as life-extending antiretroviral therapy is finally reaching people in poor
countries. Preliminary evidence suggests that women are getting drugs less often
than men are.

Piot said he was recently at an AIDS clinic in the Ethiopian capital of
Addis Ababa. One-third of the patients were women, even though they account for
half of HIV-infected Ethiopians. There is a small charge for treatment, and many
women either do not have the money or cannot get it from their husbands, he
said.

Karen Stanecki, a biostatistician who helped prepare the report, said the
French medical organization Doctors Without Borders has a higher percentage of
women in its treatment programs because they are free.

“But if you look at centers that have fee-for-service, even when it is
minimal, you immediately see more men,” she said. “It’s a real issue in terms of
getting women into treatment.”

Piot said that to fully address the AIDS epidemic, societies must address
such issues as the laws governing property ownership and inheritance by women,
as well as sexual norms under which older men believe it is acceptable to have
sex with teenage girls in exchange for buying them school uniforms.

Microbicides — substances that can kill HIV during intercourse and that a
woman could use without a partner’s knowledge — will also be essential, he
said. Three types are now undergoing final testing in humans.

The report noted that “there has been a sea change” in the amount of money
spent on AIDS treatment and prevention in the developing world. In 2001, it was
$2.1 billion. This year, it will be $6.1 billion — half of it raised by
developing nations and the rest provided by donors.

Multivitamins Slow AIDS Effect in Study

African Patients Had Deficient Diets

By David Brown
Washington Post Staff Writer
Thursday, July 1, 2004; Page A03

People infected with the AIDS virus who take multivitamins every day have
a slightly slower progression of their illness, researchers are reporting today.

The findings will be most useful in the
developing world, where an effort is underway to treat millions of HIV-infected
people and vitamins could be an easily implemented first step.

The effect is not dramatic but is probably enough to warrant a
recommendation that people infected with HIV take vitamins if their diet is
potentially deficient, some experts said.

Supplements “might buy time to allow people to go longer before they
develop symptoms that require antiretroviral treatment,” said Lynne Mofenson,
chief of AIDS activities at the National Institute of Child Health and Human
Development. The institute paid for the study, whose results appear in today’s
New England Journal of Medicine.

The beneficial vitamins were in the B family, as well as vitamins C and E.
Curiously, vitamin A — which has huge health benefits in undernourished
children — was of no help, and was possibly harmful, in HIV-infected adults.

The new information comes from a study in the east African nation of
Tanzania that began in 1995. About 1,000 pregnant women who were infected with
HIV agreed to participate in an experiment to determine whether vitamin
supplements could reduce mother-to-child transmission of the virus. Pregnancy
increases the body’s demand for vitamins, and many of the women were marginally
nourished to begin with.

They were randomly assigned to take vitamin A, multivitamins with vitamin
A, multivitamins alone or a placebo. The vitamin doses were six to 10 times the
U.S. government’s recommended daily dietary intake.

The study found that multivitamins alone decreased by about 40 percent a
baby’s chance of dying soon after birth — mostly by reducing prematurity and
low birth weight — but the multivitamins did not cut the chance of acquiring
HIV during birth or through breast-feeding. Vitamin A, however, increased the
risk of acquiring HIV, and its use in the study was stopped when this became
clear. Those findings were reported several years ago.

The women in the study continued taking supplements after they delivered
and were observed until the summer of 2003 — an average of about six years for
the survivors.

Over the whole period, 25 percent of the women taking multivitamins
progressed to late-stage AIDS or died, compared with 31 percent of those taking
the placebo. This means that for every 100 women taking multivitamins for six
years, the lives or health of six would have been preserved, compared with 100
women not taking vitamins.

Those numbers, however, do not fully reflect the benefit of multivitamins,
said Wafaie W. Fawzi, a researcher at the Harvard School of Public Health, who
headed the study.

For example, supplements (minus vitamin A) reduced a woman’s risk of
progressing to moderate AIDS, or of developing oral ulcers and painful
swallowing, by 50 percent. Supplements raised a person’s CD4-cell count — a key
measure of immune status — by 48 cells per milliliter of blood, and slightly
lowered the amount of HIV circulating in the blood.

In all, the effects of multivitamins were comparable to what was achieved
by taking AZT alone in studies done during the 1980s when that was the only
antiretroviral drug available.

It is not yet known whether multivitamins have an additional benefit for
people already on optimal three-drug therapy, or whether multivitamins are
beneficial in populations in which there is little nutritional deficiency.

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