Treatment Action Campaign News, 23 June 2000.

* Global March for Treatment Access on 9 July 2000 commences at 15:00
outside the Durban City Hall

* TAC-MSF Satellite conference on treament access begins at 09:30 and ends
at 13:30 in Durban City Hall, 9 July 2000

* On 11 July 2000, Agenda launches its latest issue: “AIDS: Global concerns
for women”

* TAC sends letter to William C. Steere, CEO of Pfizer demanding immediate
price reduction on Fluconazole
(see article in main body)

* TAC holds demonstrations outside Pfizer headquarters in Pietermaritzburg.
Over 150 attend.

* TAC will hold a demonstration against Pfizer in Johannesburg on Monday, 26
June 2000.

* Report from Woza Internet on Pfizer's offer (See article in main body)

* Report on Minister of Health's position on Pfizer offer (See article in
main body)

* d4T becomes 85% cheaper in Thailand, a further addition to the
overwhelming evidence that drug patents are resulting in higher prices
elsewhere (see article in main body).

* International Labour Organisation (ILO) report on effect of HIV/AIDS in
workplace. (See article in main body)

* Gauteng Provincial Legislature rejects DP bill to introduce AZT at
clinics. (See article in main body)

* SA Govt. launches 5 year AIDS plan. (See article in main body)

* Costa Gazi vows to continue dispensing NVP. (See article in main body)

* US court rules in favour of HIV+ claimant against insurance companies (See
article in main body)

* WEF report on the need for debt relief for African countries so that they
can tackle HIV.

(Thanks once again to Anna Weekes for her help in putting together the
news.)

----------------
Letter from TAC to William C. Steere, CEO of Pfizer

Dear Mr. Steere

IMMEDIATE PRICE REDUCTION FOR FLUCONAZOLE

The Treatment Action Campaign (TAC) has learnt from sources inside your
company that Pfizer has limited its offer of free fluconazole for
cryptococcal meningitis for people with HIV/AIDS who cannot afford the drug
to two and a half years. This limitation coincides with the expiry of your
patent. In addition, you have excluded other countries from this donation
and you refuse to negotiate a significant price reduction.

As you are aware, the South African government can import fluconazole for
less than R2.00 per 200mg capsule. TAC supported by the trade unions,
religious bodies and civil society organisations demand that you lower your
price to less than R4.00 per 200mg capsule and provide an appropriate
equivalent for infants and children with HIV/AIDS.

TAC accepted your donation in good faith and as an indication that you are
willing to negotiate a price reduction. We also indicated that our Minister
of Health should accept your donation. We have been misled.

Pfizer leaves us no option but to take public action against your company
and to mobilise international public opinion against profiteering. Every day
’s delay in a significant price reduction costs lives. Finally, we request
that you lower your price to less than R4.00 per 200mg capsule before 29th
June 2000 or that you issue a voluntary licence to allow the importation of
the generic equivalent of Diflucan--fluconazole.

Yours faithfully

Zackie Achmat (TAC Chairperson) Promise Mthembu (TAC Executive)

cc Dr. Manto Tshabalala-Msimang, Minister of Health; Dr. George Flouty,
Medical Director, Public Health Programs, Pfizer; Barry Smith, CEO, Pfizer
South Africa; Lodewijk J.R. de Vink, CEO, Warner-Lambert; Gordon Knapp CEO,
Warner-Lambert South Africa

----------------------
Pfizer limits scope of donation of HIV drug in South Africa
WOZA Internet (Johannesburg)
June 21, 2000
By Marjolein Harvey

(copied for fair use)

Johannesburg - The international medical aid agency Medecins Sans Frontieres
(MSF, also known as Doctors without Borders) admonished Pfizer on Wednesday
for not making good on its promise to provide fluconazole (brand name
Diflucan) for free to people with HIV/AIDS in South Africa.

"The offer of the drug for free by Pfizer recently has now been limited for
use in the rare brain infection, cryptococcal meningitis, which means that
oral thrush and life-threatening oesophageal candidiasis, which are much
more common, will not be included," Coordinator of MSF's Essential Medicines
campaign, Tobi Casper, told SABC radio on Wednesday.

He says that Pfizer has also put other conditions on the drug.

"Under the South African patents Act, the health minister can request a
compulsory licence. This would in effect force Pfizer to hand over its
patents on fluconazole to government," says Casper, adding that this would
allow government to bring in the drug from Thailand, where it is sold at
about R1.80 as opposed to SA's R29 per daily dose.

Casper explains that countries like Thailand have no strict patent system
and are therefore enabled to either produce essential medicines locally
under generic names or shop around the world for the best price. SA does
have a very strict patent system and is not as able to follow Thailand's
example.

"However, under the SA Patents Act there are a number of remedies which can
allow generic manufacturing to flourish here as well," says Casper.

As negotiations proceed with the South African government on the details of
how the donation will be structured, the highly restrictive nature of the
offer is becoming clearer, according to MSF in a statement on Wednesday.

"The cumbersome conditions that Pfizer is imposing on its much-publicised
offer to provide fluconazole for free to people with AIDS is disappointing,"
said Eric Goemaere, MSF SA. "Most outrageous is Pfizer's attempt to
structure this donation like a clinical trial, adding onerous reporting and
training requirements. South African physicians are experienced
professionals and it is patronising to require special training for routine
treatments.

"South African physicians are currently diagnosing opportunistic infections
that can effectively be treated by fluconazole, but are unable to do so
because of the price."

In the ongoing negotiations between government and Pfizer, the company has
placed other significant limitations and restrictions on the proposed
donation.

Contrary to the initial demand, the donation is being restricted to
cryptococcal meningitis, which means that oral thrush and life-threatening
oesophageal candidiasis will not be included. The company has also put a
time limitation on the offer.

If the South African government is not satisfied with Pfizer's proposal to
increase access to fluconazole, it could decide to issue a compulsory
license, granting the right of production or import to one or more
producers/suppliers.

As Health Minister Manto Tshabalala-Msimang explained at a World Health
Organisation (WHO) conference this week, compulsory licensing is a crucial
tool to make HIV/AIDS drugs more widely available.

Generic fluconazole is currently sold for about R1.80 (daily dose for
cryptococcal meningitis) in Thailand. If Pfizer was to grant a voluntary
licence to government to import or manufacture quality fluconazole the South
Africans would be able to independently meet the needs of AIDS patients who
have both cryptococcal meningitis and candidiasis.

Cryptococcal meningitis is a fungal infection of the brain that, if left
untreated, is fatal within two months. In South Africa the government pays
R29 for a daily dose, a price which the government can not afford to pay.

"South Africa is facing one of the world's most acute AIDS epidemics with
more than 10% of the population infected with HIV. More than 100 000 people
died here of AIDS last year," said Goemaere.

"It is unacceptable that Pfizer still refuses to sell this product at an
affordable price in poor countries, or to let others have the legal right to
do so."

Sales of Diflucan were more than R6 billion in 1999. MSF continues to
support local NGO Treatment Action Campaign (TAC)'s initial request: Pfizer
should reduce the daily price of Diflucan in South Africa to below R4 or
issue TAC a voluntary licence to allow generic competition to reduce prices
to affordable levels.

Pfizer has also rebuked similar requests from other countries around the
world.

MSF is conducting an international campaign to improve access to essential
medicines in poor countries.

http://www.africanews.org/south/southafrica/stories/20000621/20000621_feat16
.html

----------------------
Minister dismisses Pfizer speculation

(copied for fair use)

SA IS still negotiating with US drug company Pfizer about its plans to
donate a life-saving antifungal medicine to SA AIDS patients, says Health
Minister Manto Tshabalala-Msimang.
She also rejected speculation that government was likely to spurn Pfizer's
offer to donate its drug Diflucan to thousands of suffering from AIDS.

But Tshabalala-Msimang said yesterday that government was concerned about
the sustainability of the offer. "We have not rejected it. We're still
negotiating," she said.

"We need to have a very good contract because we don't want a new Pfizer CEO
to come in and stop the supply of the medicine.

"It's those technicalities we need to work out," she said.

Pfizer agreed in April to give away Diflucan.

This followed pressure from the Nobel Prize-winning Medicins Sans Frontieres
organisation and AIDS activists.

The Wall Street Journal reported this week that SA might decide in the next
two weeks to reject the offer.

The newspaper said government believed the offer was too restrictive to be
of much benefit to the many thousands of people who needed it.

But Tshabalala-Msimang said: "We want to tighten the relationship between us
and Pfizer, so we are still negotiating the offer." She said government was
also concerned that the offer only applied to treatment of AIDSrelated
meningitis.

Government wanted it broadened to include other infections.

Diflucan, also known as fluconazole, costs about $13-17 for a daily dose. It
helps control cryptococcal meningitis, a brain infection that can be fatal
for patients with weakened immune systems. It must be taken daily for life
to control the condition.

SA has one of the world's highest rates of HIV infection. Almost 5-million
people are believed to be HIV-positive.

An estimated 27-million people in developing countries in sub-Sahara Africa,
Asia and South America are infected with HIV, but most are too poor to pay
for AIDS drugs.

Tshabalala-Msimang said at a news conference on Wednesday that African
countries were determined to fight for parallel importation of cheaper AIDS
drugs and also for some of the medicines to be manufactured locally. This
will make them more widely available.

"We are going to fight the battle and I'm sure that we will win the battle,"
she said.

African countries plan to enlist help from other developing regions.
Reuters.

http://www.bday.co.za/bday/content/direct/0,3523,643649-6099-0,00.html


----------------------

d4T becomes 85% cheaper in Thailand
- Tido von Schoen-Angerer

Stavudine - d4T is now produced generically in Thailand at US$ 0.54 - 0.76
per day (depending on body weight). This is more than 85% cheaper than the
current brand name price in Thailand (and more than 90% below the US price).

Unfortunately Bristol-Myers Squibb has been engaged in heavy lobbying
efforts over many months to prevent generic production.There is no patent on
d4T in Thailand but d4T had market exclusivity based on a regulation that
automatically gives market exclusivity during post marketing surveillance
(here called Safety Monitoring Program). This arrangement was imposed on
Thailand by the US Trade Representative when Thailand was under "special
301" review in 1993, i.e. before TRIPS was even signed. Market exclusivity
for d4T expired last year with the completion of the Safety Monitoring
Program but Bristol-Myers Squibb attempted to get further protection and has
been trying to discredit the quality of generics.

These lobying efforts have to be seen in contrast to the recent press
releases of the 5 drug companies (including Bristol-Myers Squibb) to reduce
drug prices in cooperation with UNAIDS. At least for this particular company
it shows that the reduction of drug prices (if it ever will take place) is
not genuine but a response to generic competition and activist pressure.
Total world wide sales of d4T (Zerit) had exceeded $ 1.1 billion by 1998.
Mind that this is another drug that was not developed by the industry...

Tido von Schoen-Angerer, MD
Medecins sans frontieres Thailand
Email: msfdrugs@asianet.co.th
---------------------

June 7, 2000
New ILO report warns of HIV/AIDS 'catastrophe' for workers and employers

(Copied for fair use)

Geneva, Switzerland (ILO News) - In the first study of its kind, the
International Labour Office (ILO) warns of catastrophic consequences of
HIV/AIDS for workers and employers worldwide, projecting a severe decline in
the size and quality of the workforce in a number of countries over the next
20 years.

"Surveillance information indicates that sub-Saharan Africa is the worst
affected area and needs to be the focus of urgent action," the report
entitled "HIV/AIDS: a threat to decent work, productivity and development",
said.

"Data and trends from other regions, however, indicate that effective and
large-scale preventive interventions are required to avoid similar
catastrophes elsewhere."

The report is to be discussed at a Special High-Level Meeting on HIV/AIDS
and the World of Work, to be held on June 8 at the Organisation's 88th
International Labour Conference in Geneva.

Addressing the plenary session will be the President of the Republic of
Namibia Sam Nujoma, ILO Director-General Juan Somavia, UNAIDS Executive
Director Peter Piot and Founder of the National Women's Alive AIDS Network
of SA, Mercy Elizabeth Makhalemele.

The meeting will also see the formal signing of a ILO/UNAIDS Cooperation
Framework Agreement.

Severe impact in hard-hit countries

Based on an analysis of population data from Botswana, Cameroon, Ethiopia,
Cote D'Ivoire, Haiti, Kenya, Malawi, Mozambique, Namibia, Nigeria, South
Africa, Tanzania, Thailand, Uganda and Zimbabwe, the ILO said there would be
about 24 million fewer workers in those countries alone in the year 2020 as
a result of the AIDS epidemic.

In eight African countries with HIV prevalence rates higher than 10% of the
adult population - Botswana, Kenya, Malawi, Mozambique, Namibia, South
Africa, Uganda and Zimbabwe - the ILO study said the labour force in the
year 2020 will be an estimated 10 to 22% smaller than it would have been if
there had been no HIV/AIDS - or about 11.5 million fewer.

The percentage declines by country were: Botswana (21), Kenya (15),
Malawi(13), Mozambique (19), Namibia (22), South Africa (17), Uganda (12)
and Zimbabwe (21).

In the case of countries with HIV prevalence rates below 10% of the adult
population - Cameroon, Cote D'Ivoire, Ethiopia, Haiti, Nigeria, Thailand and
the United Republic of Tanzania - the labour force is expected to be between
3 and 9% smaller (except in Thailand, where the difference is just over 1%)
than it would have been without HIV/AIDS, or a total of about 12.5 million
fewer persons.

Percentage declines by country were: Cameroon (4); Ethiopia (5), Haiti (4),
Cote d'Ivoire (7), Nigeria (3), Tanzania (8), and Thailand (1).

The report also says HIV/AIDS will have a significant impact on the
composition and quality of the labour force in those countries in terms of
age, skills and experience, while creating more child labour and unravelling
hard fought gains in the advancement of women.

"Age and sex distribution of the labour force will change, due to the rising
number of widows and orphans seeking a livelihood and the large proportion
of people with AIDS in the age group 20-49 years, resulting in early entry
of children into the active labour force, the early withdrawal of people
with AIDS and the retention of older person in the labour force due to
economic need," the report said.

The report notes that the labour force projections provide some indication
of the lowering of the average age of the labour force due to the impact of
HIV/AIDS.

Even assuming the same labour force participation rates, the median age of
the labour force in high prevalence countries would be reduced by as much as
two years by the year 2020, implying an increasing proportion of younger age
groups in the labour force, as well as a reduction in the quality of the
labour force in terms of education, training and experience.

Impact on employers

The report said AIDS-related illnesses and deaths of workers affect
employers by increasing costs and reducing revenues.

The impact of HIV/AIDS will require more spending by employers for
healthcare, burial, training and recruitment of replacement employees.

In addition,the epidemic is expected to lead to a reduction in revenues due
to absenteeism caused by illness or attendance at funerals, as well as time
spent caring for persons with HIV/AIDS or training of people to replace
those who have become sick or who have died.

"In view of these factors, some companies have already begun to hire or
train two or three employees for the same position, if it is feared that
employees in key positions may be lost due to AIDS," the report says.

"Employees can also be replaced by importing labour from neighbouring
countries, at the risk of creating a bigger immigrant sub-population, which
is often more vulnerable to HIV infection."

The ILO response

"As we enter the new millennium, there is admittedly belated, yet growing
understanding that HIV/AIDS is very much a problem for the world of work,"
the report said.

"The numbers of workers living with HIV/AIDS have, or will, depending on the
country, become a major cause for concern for all employers, in enterprises
and organisations of all sizes."

The report outlines a series of measures that can be taken by its tripartite
social partners to increase their efforts against the further spread of
HIV/AIDS in the world of work, including increasing awareness and advocacy
for preventing the spread of HIV and providing protection and support for
those living with HIV/AIDS; development of preventive and protection
programmes for workers and employers; gathering and analysis of additional
data on HIV/AIDS; and the development of new legislation and policy for
HIV/AIDS.

The ILO said it would collaborate closely with UNAIDS and its co-sponsors in
prevention and support activities, but could bring its special status as a
tripartite organisation involving workers' and employers' organisations as
well as governments to the campaign against AIDS.
http://www.iclinic.co.za/jun00/aidswork7.htm
---------------
The Star    21/6/00

Gauteng rejects bid for AZT

June 21 2000 at 01:07AM

By Khathu Mamaila

The Gauteng Provincial Legislature rejected by 41 votes to 13 a DP motion to
enable the health department to provide pregnant women with AZT to reduce
mother-to-child transmission of HIV.

In his motivation, DP MPL Jack Bloom said studies had shown that AZT could
prevent mother-to-child transmission by about 50%.

"There is a very, very high price to be paid for every month of unnecessary
delay. My estimate, based on 150 000 births every year in Gauteng, is that
about half of the 10 000 HIV-positive babies born each year in this province
could be saved."

Rejecting the motion, ANC MPL Dr Ram Salojee said: "If we as a province
unilaterally introduce the regimen, we will be faced with the consequences,
as is happening, with the termination of pregnancy (and) large-scale
cross-border flows. Political opposition parties have continuously condemned
our department of health. Will they then condone the use of over-expenditure
of funds, beyond the allocated budget?" he asked.
http://www.iol.co.za/news/sa_newsview.php3?click_id=6&set_id=1&art_id=ct2000
0620230705174K510304
---------------
Daily Mail and Guardian and SAPA        20/6/00

Govt launches five-year HIV/Aids plan

OWN CORRESPONDENT, Johannesburg | Monday 7.00pm.

The government's five-year strategic plan aims to minimise the impact of
HIV/Aids on society, Health Minister Manto Tshabalala-Msimang said at the
launch of the project in Johannesburg.
She said the "robust" dialogue surrounding the issue of Aids is encouraging,
but much more needs to be done.
President Thabo Mbeki stirred controversy in medical circles recently when
he suggested that dissident views on the causes and treatment of the disease
be given attention.
Tshabalala-Msimang said the plan will strive to increase access to voluntary
HIV/Aids testing and counselling. A culturally appropriate information,
education and communication campaign will also be developed.
The plan is divided into several areas including prevention; treatment; care
and support; human and legal rights; and monitoring, research and
surveillance.
It will promote safe sex, uplift the treatment and management of sexually
transmitted diseases and improve access to voluntary HIV/Aids testing and
counselling.
Treatment, care and support services in health facilities and communities
will be provided. Facilities to care for HIV/Aids infected children and
those orphaned by the disease will also be increased.
Vaccine development will be encouraged and alternative treatment options
investigated.
A number of indicators will be put in place to monitor South Africa's
overall response to the illness. The general trend of the disease would be
measured according to the prevalence of HIV/Aids amongst woman who attend
ante-natal clinics as well as those below the age of 18.
The number of sexually active woman using condoms and the number of school
leavers who are HIV/Aids educated will among others determine the success of
the prevention plan.
Msimang said they had deliberately chosen to focus on education because it
is effective and cheap. "The biggest constraint we face is money."
She urged those who can afford to purchase their own condoms to do so,
saying the cost of providing free condoms is at least R20 million.
South Africa will host the 13th World Aids Conference in Durban from July
10. --Sapa
http://www.mg.co.za/mg/za/news.html#aids
---------------
Gazi vows to keep giving drug

(Copied for fair use)

By Zamuxolo Feni

EAST LONDON -- Cecilia Makiwane Hospital public health head Costa Gazi says
he will not stop providing the drug Nevarapine to HIV-positive women even
though it has not yet been approved.

He said he was prepared to face the wrath of the provincial Health
Department over this.

Health Department permanent secretary Siphiwo Stamper said earlier that a
policy on the use of anti-viral drugs at both national and provincial levels
was still being formulated.

Gazi's determination to prevent the transmission of the deadly HIV virus
from mother to unborn baby is manifested by his personal contribution of
R1200 a month to buy Nevarapine.

Gazi is providing the drug to 19 Mdantsane-based clinics and eight in rural
areas.

He said that most foreign medical experts and health organisations agreed on
the effectiveness of the drug.

Gazi said 20 percent of pregnant women in his clinics are expected to carry
HIV.

He said he was extremely grateful when a United States-based health
foundation donated thousands of dollars towards his efforts to provide
Nevarapine.

It could not be denied that primary health care services were on the verge
of collapse as less money was being channelled into them.

Gazi believes that the credibility of Nevarapine has been proved worldwide
and that the government should not make excuses against its use.

http://www.dispatch.co.za/2000/06/20/easterncape/GAZI.HTM
------------
Court upholds Aids disability claim



New York - California's highest court ruled on Monday that a policyholder
who developed Aids cannot be denied disability coverage, even though he was
HIV positive when he applied for the policy.

Ruling 7-0, the California Supreme Court reversed two lower courts, which
had sided with Paul Revere Life Insurance Company. The court concluded that
the insurer couldn't deny coverage for a pre-existing condition after the
policy has been in place for two years.

"If you have a disability insurance policy and it doesn't specifically
exclude a condition by name, ... then what the court said is, after you've
had the policy for two years, it (the insurer) cannot deny coverage based on
a pre-existing condition,'' explained Jon W. Davidson, a supervising
attorney with the Lambda Legal Defence and Education Fund, which represented
plaintiff Mark Galanty.

A number of consumer advocacy, disability rights and women's health
organisations submitted friend-of-the-court briefs in siding with Galanty.

Davidson said the case has broad implications for people with disabilities
as well as the insurers that offer that type of coverage. Say, for example,
a woman has genetic testing for breast cancer. "Would an insurance company
try to argue that you knew you had the genes for cancer?" asked Davidson.
"Would they try not to cover it?"

At deadline, an attorney for Paul Revere could not be reached for comment.

Galanty, a 52-year-old Studio City, California, resident, was HIV positive
when Paul Revere sold him a disability policy in 1989. He submitted a claim
for Aids-related disabilities in 1994, which the insurer initially began to
pay.

But after investigating the claim, the insurer denied coverage based on a
provision limiting coverage to disabilities caused by "sickness or disease
which first manifests itself after the Date of Issue and while Your Policy
is in force'' and a provision excluding coverage for pre-existing
conditions.

The case turns on a provision of the California Insurance Code, called the
"incontestability clause, and Paul Revere's own attempt to limit the
definition of disability. The insurer argued that Galanty's HIV status was
manifested long before the policy went into effect and therefore was not
covered.

But the court concluded "the incontestability clause bars Paul Revere from
denying coverage for Galanty's disability, whether or not the causative
sickness first manifested itself before the policy's date of issue.''

"What it really means is if you buy disability insurance, at what point
should you have peace of mind that the insurance is secure...and they're not
going to look for something in your background for a reason not to pay,''
Davidson said.

Similar incontestability provisions exist in almost every state, and courts
are split over how to interpret them. The California Supreme Court went the
way of a majority of cases, Davidson said.


http://livenews.24.com/News24/Health/0,1113,2-14_874719,00.html

---------------------
Africa needs debt relief to tackle AIDS - WEF

By MARIAM ISA

(copied for fair use)

Durban (Reuters) - Africa urgently needs debt relief to allow its
governments to tackle AIDS and other pressing human needs, the Davos-based
World Economic Forum (WEF) said in a report released on Wednesday.

Key factors to boost economic growth had not yet been addressed, and growth
rates across Africa were too slow for the crucial investments in health,
education and infrastructure needed to raise living standards, the WEF's
Africa Competitiveness Report 2000-2001 said.

"It will do no good for Washington, London, Paris and Berlin to preach to
Africa about governance, if these centres of power in the rich countries
fail to support Africa's reforms with urgently needed debt cancellation and
greatly increased financing," a report summary said.

"In the end, we believe strongly in Africa's Renaissance, but we believe
that it will be the product of a combination of forces: the vigour of
African society, an increasingly democratic African policy, and the goodwill
and urgently needed financial support of . . . the world community."

The 290-page report, released at the start of a three-day WEF summit on
southern Africa, covers 29 countries and takes in responses from more than 1
800 companies.

Researchers from the WEF and the Centre for International Development at
Harvard University helped compile the report, which follows a similar one in
1998.

Uneven progress in recent years

African policy makers across much of the continent had forged ahead with
reform programmes, which have underpinned a return to economic growth. But
their experience since 1996 displayed a very uneven record, the report
noted.

Some countries were enmeshed in war and internal conflict while others had
experienced enormous natural disasters, such as floods, droughts and
outbreaks of epidemic disease.

But the report saw the spread of AIDS and the HIV virus as the main threat
to the African economy, saying it was likely to hamper badly-needed foreign
direct investment and burden government budgets with extreme pressures in
coming years.

"Firms' profits will fall, due not only to rising costs but to shrinking
sales, since many participants in the labour force can no longer earn
salaries and wages," it said.

Around two thirds of the 22 million people infected with HIV live in Africa,
according to the World Health Organisation.

Debt relief seen as too stingy

In a separate chapter on debt forgiveness for poor countries, the report
criticised the process as "too slow, too stingy, and too arbitrary".

To date, fewer than 20 percent of highly-indebted poor countries had been
considered for debt relief, and only a handful had seen even a fraction of
what was promised, it noted.

"In the future, decisions over the extent of debt relief should be made in
view of a detailed assessment of real social needs," it said. "If the
resources were freed up and successfully redirected toward basic human
needs, there could be significant improvements in human welfare."

For instance, Ethiopia spent 1.6 percent of overall gross domestic product
on health, versus 6.6 percent for the United States. This amounted to $3 per
capita, versus $4 093.

Debt relief would allow more money to be spent on health and more realistic
long-term budgeting, but would almost certainly need to be augmented by
increases in official development aid, the report said.

In its competitiveness rankings, Tunisia ousted Mauritius as the top
performer since 1998, with the latter slipping to second place. Botswana
remained in third place, with few changes in the top seven countries. South
Africa is in seventh place.

Two notable losers were Kenya and Zimbabwe, with Kenya sliding eight
positions to 22nd place, and Zimbabwe down two to 23rd.

"Both countries have political leadership that has stayed in power for more
than 20 years, and both countries are fraught with growing internal
dissension and demands for further democratisation," the report said.

http://www.woza.co.za/reuters/jun00/aids21.htm