VIIth International Conference on AIDS in Africa By Jason Heyman

For only the third time in its history, the VIIth International
Conference on AIDS in Africa took place in an African city, Yaounde,
Cameroon, from December 8-11, 1992. Previously, the conference has been
held in Europe with sponsorship from European and Canadian health
organizations including the World Health Organization. Two reporters
from AIDS TREATMENT NEWS (this writer and Nancy Solomon) attended in
order to learn about international treatment issues. However, little
treatment information was presented.

The conference took place in what felt like an atmosphere of failure.
Prevention, which was the main topic, has been failing to stop the
rapid spread of HIV in Africa. According to Michael Merson, the
director of the World Health Organization's Global Program on AIDS,
"There have already been over 7.5 million infections in adults [in
Africa] since the start of the pandemic, close to 4 million of them in
women."

A different AIDS virus, HIV-2, was discussed in detail at the
conference. HIV-2 has come to be known as the virus of developing
countries and has not been given the attention that HIV-1 has received.
One interesting difference is that HIV-2 is much less likely to be
transmitted from mother to child.

Prevention vs. Treatment

At a symposium held during the conference by The Wellcome Foundation,
prominent African community activists expressed frustration at the
failure of current efforts to stop the spread of AIDS. One of the most
inspiring speeches was delivered by Sy El Hadj Amadou, the African
Secretary of the International Council of AIDS Service Organizations
(ICASO), who drew a connection between the failure of prevention
efforts and the lack of AIDS treatments available to Africans.
He explained that as a result of the African AIDS community's defeatist
attitude towards access to treatment, and the West's view of Africa as
a lost cause, all anti-AIDS efforts are seen as half-hearted and are
not taken seriously by the public. Prevention tactics, he explained,
must be based on a re-affirmation of life and the promise of hope. Such
efforts are doomed to fail in this climate of neglect. "How can we be
credible in this field if we adopt this defeatist attitude, by
accepting in advance that even if there is an efficient drug against
this disease, the population that we want to educate to change their
behavior won't have access to this medication."

"The fight for better access of the African population to
treatment.....is the only way that we will overcome the problems
created by poverty and lack of resources. Through this we will create a
credible education program, and we will make our message obtainable and
support the population to change their attitude." (Translated from the
French, by the official conference translator).

John Ziegler, M.D., from the University of California San Francisco
Medical Center, spoke on, "The Management of HIV Infection," which
included an "Introduction to Antiretrovirals." To an American observer
it seemed as if he were going back in time to the introduction of AZT,
but AIDS treatment in Africa with pharmaceutical products is almost
non-existent. Dr. Ziegler was in fact looking forward to a time when
basic antiretroviral therapies will be available. "In anticipation of
more effective and cheaper drugs in the near future, studies should
commence in selected centers to define a clinical role for
antiretroviral therapy in Africa."

At the end of the Wellcome symposium one questioner asked if he could
direct a question to Wellcome itself. He asked what they are doing to
make Burroughs Wellcome drugs, specifically AZT and acyclovir,
available in Africa. With some hesitation a Wellcome employee explained
that he was not at liberty to give that information, but that we should
rest assured they are working on it.

The only treatment discussed at any length at the conference was PCM-4,
a little-known alternative treatment made from extracts of pig spleen
and Siberian genseng, Eleutherococcus senticosus; it is being studied
in the United States and in Uganda, and is sold in buyers' clubs and
health-food stores.

The U.S. Agency for International Development (USAID), which controls
all government money spent on AIDS in developing countries, even has
legal guidelines that restrict money to prevention uses only. A USAID
representative, Gordon Murchie, explained that they do support research
efforts abroad, but to take on the issue of treatment "would be a vast
undertaking, comparable to taking over the health care systems of all
the countries concerned."

The World Health Organization is the only international organization
that is currently distributing drugs for the treatment of AIDS, but
according to recent rumors their Essential Drug Program has recently
cut its AIDS drugs for lack of funds. Some of the drugs available
through this program are as basic as acetaminophen and petroleum jelly.
African Traditional Medicine

Traditional African medical practitioners were largely absent at this
conference. Speakers such as Susan Anderson from the World Health
Organization, who discussed community care, spoke about the important
role that traditional healers play in the African health care system,
but these practitioners themselves had no presence on the podium.
Most Africans go first to a traditional healer when they are ill. This
important link has been generally ignored by the Western-oriented
development agencies that are re-creating African health care systems
in the image of European and American ones. With their direct access to
the population, traditional practitioners can have an important role
in education, prevention, and treatment.

One traditional healer, Fokoundang Adam Usumanu, was present at the
conference, and was excited by the prospect of working together with
the formal health care system. Currently he is trying to organize a
group of approximately forty traditional medical practitioners in
Cameroon to pool their knowledge and resources to help treat people
with AIDS.

One of the treatments he uses is yohimbine, which in the United States
is a prescription drug found in the bark of the Corynanthe johimbe tree
and used for treating impotence in men. AIDS TREATMENT NEWS #159
(September 18, 1992) reported on the experiences of two people with HIV
who had positive results using yohimbine for the treatment of fatigue.
This coincidence suggests again that traditional healers have
knowledge of useful treatments, many of which are unknown to western
pharmacists. Fokoundang Adam Usumanu has 30 treatments that he
currently employs.

Comment

One hopeful sign is that African governments are beginning to openly
confront AIDS. The Organization of African Unity, for the first time
in its history, addressed AIDS in its "Declaration on the AIDS Epidemic
-- July 1992." Its treatment goal: "By mid 1993, we will have adopted
a rational AIDS care plan, including essential drugs for HIV-related
illnesses, and a rational plan for family-based or community care and
support of AIDS survivors, including orphans."

At the closing ceremony, Jonathan Mann, M.D., announced the creation of
a new center at Harvard University for the study of health and human
rights. He underscored the connection between these two fields, making
the observation that around the world it has become clear that those
people with power who have their rights generally have their health.
The slow pace with which Africans with AIDS are being given access to
treatment is an example of this.

Although many people in the United States are frustrated by the lack of
effective treatments for many AIDS-related conditions, we should follow
the advice of Sy El Hadj Amadou and make the treatments that we
currently have available to all those who need them. One panelist
remarked that the difficulty of getting AIDS treatments to all
Africans who need it can be put into perspective when we realize that
many cannot even get clean water. Still, we should make the effort
instead of taking the defeatist attitude of powerful groups like USAID.
The success stories that exist offer hope that progress can be made to
stop the spread of HIV and treat those that are already infected. The
Know AIDS Society, in Nairobi, Kenya was started by Joe Muriithi, who
is one of the first Africans to be open publicly about his HIV-status,
and his wife Jane Muriithi. Their work educating their community, with
a special focus on women, is an example of the success some small
groups have had, an example for the large development agencies about
what can work in Africa. And the skills and knowledge of traditional
African healers should not be ignored.

The effective work of small African grassroots organizations like the
Know AIDS Society, and of activists like Sy El Hadj Amadou, shows that
improvements can be made.