Treatment Action Campaign News: September 8 2000 ------------------------------------------------ TAC news is divided into 2 sections, an "In Brief" section, which contains headlines and "BRIEF" descriptions of events, and an "In Depth" section which contains full versions of some of the events mentioned in the "In Brief" section. To subscribe or to unsubscribe, send an email to mailto:subscribe@tac.org.za with subscribe or unsubscribe in the subject field. Regards, Nathan Geffen on behalf of the Treatment Action Campaign www.tac.org.za ################################## IN BRIEF SECTION ---------------- * President Mbeki denies that HIV causes AIDS in Time Magazine. This is the first time he has sided unequivocally with the denialist viewpoint. (See In Depth) * Cosatu has condemned the goverment's AIDS policy. A spokesperson said "We believe that indeed HIV causes Aids and that is not disputable." (reproduced for fair use from the M&G -- See In Depth) * BRIEF: The Minister of Health, Dr Tshabalala-Msimang, in an interview with Radio 702 presenter, John Robbie, refused to acknowledge that HIV causes AIDS. We have the full transcript of this interview. It is available on request. The interview ended acrimoniously. The Minister evaded Robbie's question regarding the causal link between HIV and AIDS and then objected to Robbie referring to her by her first name. At that point an audibly upset Robbie abruptly ended the interview, telling the minister, "Go away. I cannot take this rubbish any longer. Can you believe it? I have never in my life heard such rubbish." * BRIEF: There will be a mother-to-child-transmission prevention picket outside the Western Cape Provincial Administration offices from 12:30 to 14:00 on Wednesday, 13 September. All welcome. Please meet in Wale Street at the Provincial Administration offices, across the road from St Georges Cathedral. * During August, TAC's lawyers sent a letter to the Minister of Health, explaining our vision of how a mother-to-child-transmission prevention programme (MTCTP) should be carried out. Legal action against the MOH is proceeding. (See In Depth) * BRIEF: During August, at a demonstration in Khayelitsha, TAC presented the Western Cape Government with a memorandum calling for a MTCTP programme. * We reproduce an article examining trade union involvement in the struggle against HIV, published in the SA Labour Bulletin. (See In Depth) * We reproduce a table comparing drug prices between the US, South Africa and other countries. Thanks to MSF for the data. (See In Depth) * We reproduce the US market sales of HIV drugs for the year ending Feb. 2000. Thanks to Jamie Love from CPT for sending this. (See In Depth) * Botswana government plans to distribute HIV drugs. (See In Depth) * "No Relief For Locals From Cut In AIDS Drugs Prices" -- an article on HIV prices in Zimbabwe copied for fair use from the All Africa News Agency August 8, 2000. Thanks to CPT for sending this. (See In Depth) * TAC National Executive member, Sharon Ekambaram, reviews the novel, "Deadly Profit" by Patrice Matchaba. (See In Depth) ######################################## IN DEPTH SECTION ---------------- Time Magazine (SA edition) Interview with Mbeki Time: You've been criticized for playing down the link between HIV and AIDS. Where do you now stand on this very controversial issue? Mbeki: Clearly there is such a thing as aquired immune deficiency. The question you have to ask is what produces this deficiency. A whole variety of things can cause the immune system to collapse. Now it is perfectly possible that among those things is a particular virus. But the notion that immune deficiency is only acquired from a single virus cannot be substained. Once you say immune deficiency is acquired from that virus your response will be antiretroviral drugs. But if you accept that there can be a variety of reasons, including poverty and the many diseases that afflict Africans, then you can have a more comprehensive treatment response. Time: Are you prepared to acknowledge that there is a link between HIV and AIDS? Mbeki: No, I am saying that you cannot attribute immune deficiency soley and exclusively to a virus. There may very well be a virus. But TB, for example, destroys the immune system and at a certain point if you have TB you will test HIV positive because the immune system is fighting the TB which is destroying it. Then you will go further to say that TB is an opportunistic disease of AIDS whereas in fact TB is the thing that destroyed the immune system in the first place. But if you come to the conclusion that the only thing that destroys immune systems is HIV then your only response is to give them antiretroviral drugs. There's no point in attending to this TB business because that's just an opportunistic disease. If the scientists...say this virus is part of the variety of things from which people acquire immune deficiency, I have no problem with that. ######################################## Mail & Guardian, South Arica 8 September, 2000 Cosatu slams govt Aids policy by JASPREET KINDRA and GLENDA DANIELS, THE Congress of South African Trade Unions (Cosatu) has called on the government to end its "scientific speculation" about the cause of Aids and concentrate on providing affordable treatment to people infected with HIV. Cosatu also says that providing medication to HIV-positive pregnant women and rape victims is "morally and medically right" - an implicit criticism of the African National Congress government's controversial procrastination over whether to fund such treatment. Cosatu's position on the disease is contained in a document prepared for its national congress on September 16, in which the union federation expresses its concern about the government's stance on HIV/Aids. While the tripartite alliance has come under increasing strain over economic policy, this is the first time an alliance member has taken up the cudgels over HIV/Aids. Elaborating on the document, Cosatu president Willie Madisha said this week: "We believe that indeed HIV causes Aids and that is not disputable." Madisha said Cosatu was also concerned that the government's conservative economic policy would seriously restrict the resources to fight the epidemic. He said the government's macro-economic policy prevents adequate resources being made available for education, prevention and treatment of HIV/Aids. "All this talk and debate about the cause of Aids prevents people from trying to deal with the problem," Madisha said, referring to the debate on the cause of the disease led by President Thabo Mbeki. The resolution notes: "There is scientific evidence to support the efficacy of anti-retroviral drugs in the control of HIV/Aids." The resolution says providing medication to HIV-positive pregnant women makes good economic sense in terms of costs saved on treatment of HIV-positive children. Madisha was coy over whether Cosatu would endorse the call by some of its affiliates to make their support of the ANC in the forthcoming local government elections contingent on ANC candidates' not endorsing privatisation. Madisha said Cosatu has maintained that it will campaign for the ruling party, adding: "But the government must address workers' concerns about privatisation, unemployment, the amendments to the Labour Relations Act and so on, before the election." ######################################## Letter to the Minister of Health 8 August 2000 Dear Minister Tshabalala-Msimang We act on behalf of the Treatment Action Campaign (TAC) and we refer to our previous correspondence, dated 19 July 2000. We are advised by Mark Heywood that Dr Nono Simelela telephonically acknowledged receipt of the letter on Friday 28th July. Our client has instructed us to make the following recommendations and proposals in relation to the immediate implementation by government of a prevention programme on reducing the risk of mother to child transmission of HIV (MTCTP) : Our client firmly believes that a successful MTCTP programme must incorporate certain key elements. These should include access to voluntary HIV testing and counselling that should provide pregnant women with HIV information about all options available to them, including having the child, terminating the pregnancy, the use of anti-retrovirals to reduce the risk of peri-natal transmission and the risks associated with their non-use. Information must also be provided regarding the further health care of the mother and safer sex practices. In light of the arguments raised by the Department of Health regarding the limited resources available, our client suggests that careful consideration be given to a phased implementation of a MTCTP programme, which would initially target at least the five provinces with the highest HIV sero-prevalence rate. The programme should be implemented at a primary health care level in these provinces and should commence within six weeks after appropriate training for health care professionals. This does not preclude provinces with a lower sero- prevalence rate and the necessary resources from implementing a programme or phasing a programme in during the same period. Our client recommends that Nevirapine (NVP) be considered the drug of choice. However, in view of the assessment made by the Medicines Control Council (MCC) that the benefits of AZT outweigh the risks, it is recommended that AZT should be provided in cases where it is not possible to provide Nevirapine. Women should be provided with appropriate counselling regarding the advantages and disadvantages of breast feeding and formula feeding. They should be counselled about the potential dangers of mixed feeding. Formula feed should be provided to all urban and rural sites that have access to clean water. Where pregnant women have no access to clean water, they should be counselled on the necessity to breast feed exclusively. Our client calls upon government to commit itself to an unambiguous and expeditious programme of water provision to these areas. Our client recommends that a programme of monitoring and follow up of pregnant women by the health authorities be incorporated in the MTCTP programme, to ensure that women receive the best health care available, both during and after their pregnancies. Finally, our client believes that the programme should be reviewed every six months to ensure that new scientific developments and programme experiences are included in the programme to improve the services offered to pregnant women with HIV. Our client has instructed us that they would view the implementation of the steps set out above by the Department of Health as a genuine attempt to deal with the problem of vertical transmission of HIV and to resolve the dispute that presently exists between yourselves and them. Our clients has further instructed us to advise that it is willing to assist the Department of Health in any way possible. Yours sincerely Jennifer Joni Attorney cc: Deputy President Jacob Zuma ( Chairperson, SANAC) Dr Ayanda Ntsaluba (Director-General, Department of Health) Dr Nono Simelela, (Chief Director, Directorate of HIV/AIDS and STDs. ####################### Article from the SA Labour Bulletin, June 2000 [Heading: On not being an elite: Unions and HIV/AIDS issues] [Etienne Vlok examines trade unions involvement in the Treatment Action Campaign and the Trade Union Task Team on HIV/AIDS and concludes that trade unions are taking action to benefit their members and the community.] 'Unions are an elite!' This chorus has been repeated so often that unions and their members must know it off by heart now. When I heard how unions are involved in the HIV/AIDS Treatment Action Campaign (TAC) and the Trade Union Task Team on HIV/AIDS, it again showed me how ridiculous the singers of the above chorus are. This is the story of the unions' involvement in HIV/AIDS issues and the successes they have achieved. It is just one example of many, of how unions address broader working class issues. [Subheading: Task Team] The Trade Union Task Team on HIV/AIDS was created at the beginning of 1999 through support from the American Centre for International Labour Solidarity (Solidarity Centre). The three federations, COSATU, FEDUSA and NACTU are all involved but, says Theo Steele, COSATU's campaigns coordinator, 'the federations intend to include the independent unions as well'. The Task Team aims to give support to the labour movement on HIV/AIDS issues and help unions implement their programmes on HIV/AIDS. The different federations chair the Task Team in turn while the Solidarity Centre does the secretariat work. The Department of Health now also participates in the Task Team. Steele believes that this is crucial as the Department has resources and the partnership is in line with President Thabo Mbeki's call. Tumediso Modise, the NACTU educator who deals with HIV/AIDS issues, suggests the motivation behind the Task Team is that the labour movement is better placed than any other structure to educate a variety of people on HIV/AIDS. The Task Team trains shopstewards and organisers who then convey their knowledge about HIV/AIDS to workers and the broader community. 'In this way we also build human resources in the labour movement,' adds Modise. Each federation assists with developing the content of the education programme. [Subheading: TAC] TAC was launched at the end of 1998. It aims to inform the public about the availability and affordability of HIV/AIDS treatments. According to its website, 'the TAC campaigns against the view that AIDS is a death sentence'. It believes treatments exist which can increase the life expectancy of people living with HIV/AIDS (PLWHA) and reduce the risk of such mothers transferring the virus to their children. The problem is that most people in Africa cannot afford medicines 'due to patent laws and excessive profiteering by the pharmaceutical industry'. TAC is a forum of NGOs (like the AIDS Law Project), trade unions and church organisations (such as the Catholic and Anglican bishops). 'We share ideas on dealing with treatment and have experts who talk to us on it,' says Modise, TAC's deputy provincial secretary in Gauteng and the NACTU representative. TAC's objectives are 'to ensure access to affordable and quality treatment for people with HIV/AIDS, prevent and eliminate new HIV infections and improve the affordability and quality of healthcare access'. It wants to do this by building mass TAC-membership and alliances with unions, employers, religious bodies, women, youth and gay and lesbian organisations; targeting pharmaceutical companies to lower the costs of HIV/AIDS medications; targeting government to fulfil its HIV/AIDS obligations. TAC commissioned Modise to visit some healthcare clinics on the West Rand to see whether the clinics were coping with HIV/AIDS, as government claimed. He found that the clinics did not have pre- or post-counselling or proper treatment. This was due to long queues and a lack of staff, proper facilities and medicines. For Modise, pre- and post-counselling is crucial but there is no time for it in the clinics. 'Pre- counselling is important because it helps people realise the benefits of testing. Post-counselling informs them how to behave whether they are positive or negative. NACTU believes pre- and post-counselling is crucial. Government needs to put money into it.' [Subheading: Involvement] Practically, how are the unions involved in TAC? According to Modise, when TAC went to meet the pharmaceutical companies, NACTU and some of its affiliates such as the Transport and Allied Workers Union (TAWU), the National Union of Food, Beverage, Spirits, Alcohol and Wine (NUFBSAW) and the SA Chemical Workers Union (SACWU) attended. NACTU also wrote letters to the companies and encouraged its affiliates to do so, although, admits Modise, 'not all our affiliates did'. NACTU encouraged its members to participate in the protests at the pharmaceutical companies and Parliament. COSATU started to participate in TAC this year, while some of its affiliates have been involved for longer period. Regional committees on TAC already exist in Gauteng, Western Cape and Kwazulu-Natal while other regions are busy forming committees. COSATU's involvement is coordinated by its newly-appointed health, safety and HIV/AIDS policy co- ordinator. According to the treatment phase of its HIV/AIDS activities, COSATU aims to inform its members about the availability of treatment. It will be mobilising its members (particularly those in KwaZulu-Natal) to march in the Global March for Treatment at the July 2000 International AIDS Conference in Durban. NACTU, FEDUSA, Jubilee 2000 and the South African NGO Coalition (SANGOCO) will also be involved. Next on the agenda for COSATU is coordinating its affiliates' participation since affiliates are participating at different levels now. CEPPWAWU is helping to negotiate with the pharmaceutical companies as it organises in that industry. Others that are doing well, according to Steele, are NUM, SATAWU, NEHAWU and SACTWU. 'However,' admits Steele, 'we don't want to give the impression that COSATU has done a wonderful job. Certain pilot projects run by the affiliates are successful but we are still very far from reaching everyone and all the regions. We need to do more, such as implementing programmes and reaching the masses.' [Subheading: Pfizer] The first pharmaceutical company that TAC targeted to lower the price of its medication was Pfizer, the multinational. Pfizer manufactures Diflucan - a medication that is taken for systemic candidiasis and cryptococcal meningitis. A person with systemic candidiasis has thrush in the mouth, throat and stomach. He or she cannot eat or swallow, has diarrhoea and, if untreated, can die within two months. Cryptococcal meningitis is a fungus that affects the brain. Says Steele: 'Thrush is easily treated. One only has to take Diflucan for ten days, but it is too expensive for most people. Thus we decided to target its manufacturer, Pfizer who has a patent.' So how did TAC go about it? It sent a letter to Pfizer demanding that it reduces the price of Diflucan to less than R4 per capsule for people who have systemic thrush or cryptococcal meningitis and cannot afford the drug. The second option given to Pfizer was that it grants a voluntary license toregister imported or locally manufactured generic equivalents of the drug. TAC's research found that the medicine is available in Thailand and India for less than R3 per capsule whereas it costs more than R100 per day to treat cryptococcal meningitis per day in South Africa. Pfizer responded by agreeing to meet TAC to discuss the health problems of the country. It did not respond to the demands submitted. TAC rejected this, saying 'Answer our demands or we will demonstrate'. On the morning of the planned demonstration at Pfizer's offices, TAC received a fax from Pfizer saying that it will provide free Diflucan to people with cryptococcal meningitis. Steele says 'Although we welcome the company's positive response, the fax did not mention providing it for systemic thrush. Why is it only for meningitis? Also, our demand was that the price be reduced and not for a donation. For how long will it be free? A person with meningitis must take the treatment for life.' We requested a meeting with the Minister of Health who had also received a letter from Pfizer. These meetings are continuing. TAC has vowed to continue its campaign against Pfizer until the negotiations for a reduced Diflucan price (for both systemic thrush and cryptococcal meningitis) have been concluded favourably. Modise wonders about Pfizer's motive in providing Diflucan free of charge. He hopes it is the pressure applied by TAC and not the fact that the company is not making money on the product. 'We don't know their real motive. Yet this is a victory for us.' TAC will now start targeting other companies and will also submit demands to the Pharmaceutical Manufacturers' Association. [Subheading: Broader issues] How does a federation get involved in a campaign such as the TAC? How does it decide it has enough resources to become involved in an issue that is not in its traditional domain? Congress resolutions guide COSATU on such issues. At previous congresses the federation adopted resolutions on involvement in HIV/AIDS issues, 'but', says Steele, 'we did not implemented it'. At its 1999 Special Congress, COSATU adopted a new resolution on HIV/AIDS. It has since employed a full-time person to take the resolution forward. The federation saw participation in TAC as a way to ensure its members and the poor have access to proper health care services and treatment. Modise admits that NACTU affiliates do not have many resources but says the federation still expects them to prioritise HIV/AIDS issues. 'They have to plan and prioritise activities. We have to make a contribution.' [Subheading: Building organisation] By being involved in the Task Team and the TAC, unions and federations make a contribution to the broader working class struggle and their members benefit, whether they need medication or are educated on HIV/AIDS. Nevertheless, the federations and unions also benefit from it. According to Modise, 'It builds organisation in many ways. We learn how to work with other stakeholders and learn from them. Training members also builds organisation - if you have a cadreship that is well-informed and have the skills to impart information, then HIV/AIDS will be put on the negotiating table at companies. Well-informed shopstewards and organisers will confront and engage management on how to deal with HIV/AIDS. Our involvement also builds organisation because we can protect members. Also, when our members are involved in the community on HIV/AIDS issues, the community will know that NACTU is involved.' Steele adds that COSATU has learnt from the PLWHA by being involved in TAC. 'We learn from them that we are all affected by HIV/AIDS. COSATU members do caring at home and in the community. Thus, it is critical for us to work with these organisations.' COSATU recently held a workshop especially for its leadership to sensitise them about HIV/AIDS issues. 'If they are sensitised then we can smoothly implement programmes,' continues Steele. [Subheading: An elite] One can understand unionists growing tired of the accusation that they are an elite. When asked his reply, Modise prefers to give examples: 'Some of our members who were retrenched are now in the community and do good work there on HIV/AIDS due to the training NACTU gave them. They visit people with HIV/AIDS, cook and clean for them and take them to the clinics. This shows that we don't just look within our own organisations.' Steele follows Modise's example by pointing to certain examples that debunk the myth that unions are an elite: 'Our affiliates' HIV/AIDS projects benefit the community. For instance, NUM's projects focus on the communities around mines, while SATAWU's projects cover not only drivers but also sex workers in the surrounding areas.' The above (and many other examples) must surely be an indication to the band to stop playing and the stage manager to draw the curtain on the 'Unions are an elite' chorus. ####################### From MSF, prices per capsule: US price (wholesale) SA price "Best" price Diff. betw. US/"best" price Didanosine (ddI) 1.8 0.7 0.5 (Brazil) 68x/98% Efavirenz 4.4 2.4* 2.3 (Brazil) 1.9x/48% Fluconazole 12.2 4.1* 0.3 (Thailand) 40.6x/98% Lamivudine (3TC) 4.5 1.1 0.8 (Brazil) 9x/89% Nevirapine 4.9 3.0* 2.1 (India) 2.3x/56% Stavudine (d4T) 4.9 2.5* 0.3 (Brazil) 16.3x/94% Zidovudine (AZT) 1.7 0.4 0.2 (Braz/Ind) 8.5x/88% Combivir (AZT/3TC) 9.8 1.5 0.7 (Brazil) 14x/93% * implies the price the South African government pays to the pharmaceutical company, which is much lower than the price in the private sector. ####################### Source: Mirasol, Feliza, "New Drug Classes Drive Expanding HIV Market," Chemical Market Reporter, April 17, 2000 (9,18): Leading HIV Antivirals US Market in millions of dollars Reverse Transcriptase Inhibitors 12 mos. ending Feb/00 Combivir $ 478.4 Zerit [d4T] $ 315.9 Epivir $ 260.2 Sustiva $ 178.6 Viramune $ 108.1 Ziagen [Abacavir] $ 107.5 Videx [ddI] $ 78.6 Retrovir $ 55.0 Hivid [ddC] $ 9.7 Rescriptor $ 7.4 Retrovir IV $ 0.7 Total $1,600.1 Protease Inhibitors 12 mos. ending Feb/00 Viracept $ 440 Crixivan $ 234 Norvir [Ritonavir] $ 101 Fortovase $ 80 Agenerase $ 48 Invirase $ 30 Total $ 933 All figures are rounded Source: IMS Health and CMR estimates ####################### Botswana Govt Plans To Provide Free HIV/AIDS Drugs Story Filed: Wednesday, August 09, 2000 5:02 PM EST GABORONE, Botswana (PANA) (Panafrican News Agency, August 9, 2000) - President Festus Mogae of Botswana has said that his government intends to provide free HIV/AIDS anti-retroviral drugs at public health facilities for people living with the virus. Addressing the women's wing of the ruling Botswana Democratic Party, Mogae explained that with the financial support of international organisations like the Melinda and Bill Gates Foundation, the government would soon purchase the drugs and make them available in clinics, dispensaries and hospitals. The drugs would be issued free since the majority of people could not afford to buy them. The president added that it is not helpful to disown or dispute Botswana's alarming HIV/AIDS statistics. Instead, he said, the country would use them to solicit for local and international aid to combat the deadly scourge. A forthcoming UNDP report says that Botswana's HIV/AIDS prevalence rate has reached 36 percent of the population. For a country that is already reputed to have the highest percentage of the epidemic, the report can only mean that there has been a drastic upsurge of infections. Meanwhile, government officials in the central district have blamed transfers for the spread of HIV/AIDS and the alarming rate of marriage break-ups. The officials assert that married couples should work in the same place or locality to avoid promiscuity and curb the spread of the deadly epidemic. They further blamed the government for not talking openly about HIV/AIDS, saying that children should be alerted in advance about the scourge. In addition, the officials said that had the government had foresight when the first case of HIV was detected in Botswana, the country's infection and prevalence rates would not have been as high. ####################### No Relief For Locals From Cut In AIDS Drugs Prices (reprinted for fair use) All Africa News Agency August 8, 2000 By Tim Chigodo In Harare Harare - Zimbabwe AIDS sufferers will continue to pay higher prices for life-saving drugs such as Combivir for another six months despite the world-wide reduction of their prices nearly two months ago. Five of the major international AIDS drug manufacturers, including the giant British-based GlaxoWellcome - the makers of Combivir widely used in combination therapy in Zimbabwe - announced recently that they would slash prices of these drugs to Africa by 80 percent. Their announcement was a reaction to US President Bill Clinton's directive recently that he would waive the prosecution of any manufacturer who infringed American patent laws by making generic versions of AIDS drugs for African countries. Some countries in Africa and Asia such as South Africa and Thailand have over the years been lobbying for the generic manufacture of drugs such as AZT and Combivir to force down prices in poor countries hard hit by the scourge. Prices of the vital drugs were actually just about to go up from about Zim $11,000 ( about Zim $ 44 to the US dollar) a month to $14,000 when the international manufacturers announced the reductions. Combivir sells locally at about $11,000 for a month's prescription. The price reduction by Glaxo, if effected in Zimbabwe, would have meant that the drug would cost about $3,000 for the same monthly prescription. Jonah Mangiza, the chief executive of Geddes - one of the main suppliers of Combivir in Zimbabwe - said although the price reductions had been announced internationally nearly two months ago, local distributors such as his company were still buying them at the old prices. Mangiza said Geddes was not even putting any mark-ups on these as a "social responsibility" and only charged a small handling fee. Vincent Murphy, general manager of Roche Zimbabwe, another supplier of the AIDS drugs, said there were a lot of issues that needed to be addressed before the drugs could be cheaply available in Zimbabwe. "It's not enough to simply donate drugs," Murphy said. He said effective treatment required, among others, infrastructure and a logistical chain that assured continuity of supply and healthcare training to guarantee appropriate use and testing to monitor use. Patient education and support was needed to promote adequate compliance with therapy to prevent drug resistance. It was also necessary that a political and social environment committed to addressing HIV and supporting those infected be put in place. Most of the drugs now used to treat AIDS and related illnesses call for a strict diet and living regime which includes constant monitoring and testing. Zimbabwe, like many other African countries heavily affected by AIDS, does not have adequate testing centres. Murphy said Roche, which produces anti-AIDS drugs available locally such as Hivid and Viracept, had been forced to destroy huge quantities of the drugs it donated to some countries because there were inadequate distribution systems in place. He would not say when his company's products would be sold cheaper in Zimbabwe but that discussions were underway with the United Nations, the World Health Organisation WHO and African governments. ####################### NAME OF BOOK: DEADLY PROFIT AUTHOR: PATRICE MATCHABA PUBLISHER: DAVID PHILIP DATE: 1ST EDITION – 2000 Price: About R60-00 Deadly Profit is a thriller based in South Africa and is recommended as basic reading for any AIDS activist. The plot is predictable, but presents a poweful argument for strengthening the case of those struggling for an informed National Health Care system, as well as the practice of medical practitioners and how they ought to react to the AIDS epidemic. Theoretically the book is a strong tool in the lobby against the Developed countries and the Pharmaceutical Industry internationally, and ruthlessly attacks the role they have played in letting people die mercilessly. The main story line is centered on the extent to which pharmaceuticals would go, in the interest of making profits, to prevent the invention and production of an effective vaccine for the treatment of HIV/AIDS. It even goes so far as to hint that this is not in the interest of the US government. Why should an AIDS activist read this book? For the seasoned activist, the book is predictable but an exciting, easy read. The situations described are familiar from the starry eyed teenager to the party scenes to the scenes in hospitals. The only difference is that some of the characters are the ideal. Hence the soap opera appeal. What a good doctor should be, or how two people should relate in Utopia. The book challenges the notion that all knowledge comes from the north. It is a black doctor who is central in finding a vaccine for AIDS. But all the relationships in the book are heterosexual. A pity. But at the same time it is a good tool in the hand for anyone trying to convince people to take the necessary precautions and practice safer sex. It is brilliant in the way it advocates for a policy to prevent MTCT. The vivid narrative of real life experiences on this aspect of the epidemic is heart wrenching. In a similar way the book raises your knowledge and understanding of a whole range of useful medical terms and practices, but not in a sterile and boring way. An important weakness is that it does not offer any insight into how poor people who are HIV positive die prematurely because they cannot afford treatment for simple opportunistic infections. But in this context it does provide a good commentary how access to antiretroviral treatment has made a difference in the developed countries. Sharon Ekambaram #########################