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南アフリカ共和国のARV治療計画の現状

IRIN(Integrated Regional Information Network)から2月11日配信されたニュース「SOUTH AFRICA: TAC calls for stronger political leadership」JOHANNESBURG, 11 February (PLUSNEWS)骨子紹介です。

昨年11月に発表された南ア政府の"Operational Plan for Comprehensive HIV and AIDS Care"(包括的HIV/AIDSケア実施計画)の核心であるARVの供給が遅れていることに対し、TAC(Treatment Action Campaign、治療行動キャンペーン)が声明を発したというニュースです。

ニュースの内容は、次の通りです。

  • 昨年11月に発表された南ア政府の"Operational Plan for Comprehensive HIV and AIDS Care"(包括的HIV/AIDSケア実施計画)の核心であるARVの供給が遅れている
  • 南アで現在ARV治療を必要としているHIV陽性者は50万人以上いると見られる。そのうち西ケープ州の1500人のみが治療計画によるARV処方を受けている。
  • TAC議長ザッキー・アハマットによると、西ケープ州は政治的指導力を発揮しているが、他州は違う。
  • 西ケープ州政府があげた成果の一つとして、ARVの価格引き下げがある。月額R900 and R1,800 (US $128 and $256) だったのを R380 ($54)まで引き下げさせた。
  • 昨年8月、財務省は50万人以上がARV治療を必要としていると報告している。また、2003-04会計年度に38万8000人が新たにエイズを発症すると見積もられている。
  • TACのスポークスパーソン、マーク・ヘイウッドは「政府自身の見積もりが上記のようなものであるのに、政府の対応はあまりに遅い」と語った。
  • 11月にプランが発表されてから2カ月、昨年8月の財務省・保健省レポートから5カ月、さかのぼって財務省・保健省によるARV治療に要するコスト検討委員会設置から18カ月が経つのに、西ケープ州の1500人しか治療を受けていない、とヘイウッドは強調した。
  • TACは3月21日の人権デーに、裁判提訴などの行動を取ることを検討していると明らかにした。
  • 専門家チームと一緒に治療計画の進行状況を調査・検討して、特段の理由もなく、計画が遅滞していることが明らかになったら、計画の緊急実施を迫る法的行動をとる、とヘイウッドは警告した。
  • また、ムベキ大統領が国会演説およびラジオでのライブ・インタビューで表明したエイズに関する見解についても注視していることを明らかにした。

[This Item is Delivered to the "PlusNews" HIV/AIDS Service of the UN's IRIN humanitarian information unit, but may not necessarily reflect the views of the United Nations. For further information, free subscriptions, or to change your keywords, contact e-mail: Plusnews@irinnews.org or Web: http://www.irinnews.org/aidsfp.asp . If you re-print, copy, archive or re-post this item, please retain this credit and disclaimer. Reposting by commercial sites requires written IRIN permission.]
Copyright (c) UN Office for the Coordination of Humanitarian Affairs 2004

このニュースの転載・転送の際には、IRINの要請に従って、上記コメントを添付してください。

上記で紹介されているTAC(Treatment Action Campaign)の声明を、以下転載します。

President Mbeki Misrepresents Facts and Once Again Causes Confusion on HIV/AIDS

11 February 2004

The TAC has strongly welcomed the governmentユs operational treatment plan for HIV/AIDS of November 2003. We also welcome the efforts being made by some provincial governments, including Kwazulu-Natal, Gauteng and Western Cape, to implement this plan. Overall, we recognize that there has been tangible progress by government in improving policies, budgets and plans to prevent and treat HIV infection.

However we are alarmed that this progress and the efforts of national and provincial government health departments and officials are being undermined by inaccurate comments by President Mbeki and Minister of Health, Manto Tshabalala-Msimang.

On the evening of 8 February 2004 an interview with President Mbeki was broadcast live on SABC television and radio. Regrettably, his comments on HIV/AIDS contained serious factual misrepresentations. This and his single mention of "AIDS", in passing, in his State of the Nation address to Parliament on February 6th 2004 suggest that he still he refuses to accept the seriousness of the epidemic. We are concerned that this is causing confusion in the public and despair among people with HIV/AIDS and health professionals. The publication of the Operational Plan increases the need for leadership ミ rather than reduces it.

The President stated that no studies have been done using death data to determine AIDS deaths and that the only reliable death statistics we have are for road accident deaths.

This is untrue.
There have been two studies examining death registration data to determine mortality due to AIDS. Both were conducted by state institutions, Statistics South Africa and the Medical Research Council(see footnote 1). The Statistics South Africa report was commissioned by Cabinet. Both studies demonstrate the increased and massive mortality due to HIV. Their findings are included in a recent publication of the Health Department titled 'Health Statistics'.

Another government endorsed study, the Impact of HIV/AIDS on the Health Sector(see footnote 2), found high AIDS mortality among health-care workers and estimated that 13% of health workers deaths from 1997 to 2001 were HIV-related. The study found that the HIV "epidemic has an impact on the health system through loss of staff due to illness, absenteeism, low staff morale, and also through the increased burden of patient load."

In response to a question on his silence on AIDS, President Mbeki stated that his doctors informed him that diabetes is also an epidemic. He then questioned why no-one talks about diabetes, suggesting that AIDS unfairly dominates debate on health-care to the detriment of other diseases.

This too is misleading: the Presidentユs choice of diabetes as an example of a disease neglected in debate is unfortunate. Drugs for treating diabetes are heavily overpriced; there should be a campaign for their reduction. But unlike HIV (until November 2003), diabetes is treated in the public health sector. However, the President should be aware that according to an initial investigation into the burden of disease estimates in South Africa released in 2003 by the MRC, AIDS was responsible for 39% of lost life-years in 2000 -- more than the next 10 worst diseases. Diabetes is the 12th worst disease and is responsible for slightly more than 1% of lost life-years. The two diseases are incomparable in scale.

President Mbeki stated that few countries 'can hold a candle to South Africa's HIV/AIDS programme'.

A number of developing countries do much better than South Africa when it comes to HIV prevention and treatment, often with far fewer resources. And certainly, the political leaders of many much poorer developing countries do better than South Africa in their public messaging. With its relative wealth and more sophisticated public health care infrastructure, South Africa should be leading the response in Africa to HIV/AIDS, but it is not.

Currently, South Africa treats approximately 1,500 people in its public sector, who are not on drug trials, paying for their own medicines or being sponsored. Throughout South Africa, fewer than 40,000 people are on treatment. South Africa now has a competent implementation plan on paper, but its roll-out is being delayed.

By contrast:
* Brazil's government treats over 100,000 people and has less than a quarter of South Africa's HIV infections. Its prevention and treatment programmes are incomparably better than South Africa.* Botswana is treating approximately 15,000 and Cameroon approximately 7,000 people.

TAC believes that confronting HIV, and mitigating its impact on the progress of our country, demands that we are truthful with ourselves and that we enter into genuine partnerships for HIV prevention and treatment.

The continued failure of the President and Minister of Health to deal appropriately or caringly with the epidemic is undermining the delivery of decent health-care to millions of poor people. This is one of the most important challenges facing South Africa; the President and Minister of Health must lead not confuse and obfuscate.

Footnote 1: See http://www.statssa.gov.za/Archives/Publications/Causes%20of%20death/Causes%20of%20death.pdf and http://www.mrc.ac.za/bod/complete.pdf

Footnote 2: See http://www.hsrcpublishers.co.za/index.html?e-lib.html~content

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