Professor Hoosen ‘Jerry’ Coovadia is an expert in the area of mother-to-child HIV and Aids prevention. He shares his reflections on South Africa’s drastic turnaround in terms of approach to that area since it last hosted the International Aids Conference 16 years ago. Kamcilla Pillay spoke to him before this year’s conference
Professor Hoosen Coovadia – who is based at the Wits University affiliated Maternal Adolescent and Child Health Systems (MatCH) – is an internationally renowned and leading South African researcher in maternal and child health and has led ground-breaking research in mother-to-child transmission of HIV.
His MatCH profile says he leads a programme of research on maternal, newborn and child health. It focuses on implementation of prevention of HIV transmission from mothers to their infants, maternal health and postnatal care of infants, integration of health delivery services and contributes to national and global policies on the delivery of effective child health services.
He also holds the positions of emeritus professor of paediatrics and child health and emeritus Victor Daitz professor of HIV/Aids Research, at the University of KwaZulu-Natal, and is associate scientific director at Caprisa.
“Aids 2000 was a landmark event. It had a general prevailing atmosphere that cannot be touched for a multitude of reasons.”
Nobody had experienced an epidemic like HIV, he said.
He talked about the Black Death (bubonic plague) in the 14th century and how, despite it being an “enormous catastrophe”, wiping out a third of Europe’s population at the time, it had been completely different to the HIV/Aids pandemic.
“This epidemic (Aids) was quite different, really devastating but, unlike the plague or smallpox, it was insidious; you could have the infection for eight years and you could look as good as heaven and it wouldn’t show; it was lying latent and could be spread before you even knew you had it.”
He came across his first case in the late 1980s while working at King Edward Hospital.
“I knew nothing about the disease and couldn’t diagnose it at first. In children it was especially severe. But still I thought this was not my disease; this is a white, gay disease suffered by people in California. I was dead wrong.”
Within a few years, he said, about 70% of the paediatric wards were filled with HIV positive children and those with Aids.
“The wards were overwhelmed and there was very little research. We also didn’t have the resources and no help from other cities. We were a black hospital and a black medical school: nobody cared about us.”
He said there was a need for PCR (polymerase chain reaction) tests – for testing the viral load of HIV positive people, as well as testing babies born to HIV positive mothers – at the time.
“It was very hard to come by these costly tests and on top of this Thabo (Mbeki, South Africa’s president at the time of the conference) started disputing the scientific evidence.”
Coovadia said: “You must know what your limits are: it would be like assigning me to oversee the Square Kilometre Array (SKA) project when I know nothing about it. But he wanted to tackle everything, even though he didn’t know science.”
Mbeki, he said, was keen to have SA be the one to discover the cause of the virus and the treatment for it, even though the best researchers were elsewhere.
“They made the announcement that they had discovered the treatment for HIV. I’ll never forget it: to my mind scientifically, it was impossible. The so-called scientists said they had found a substance that could kill HIV in the test tube called Virodine.”
This, he said, turned out to be an industrial strength solvent.
“They would have killed a lot of people had they been let loose on the public.”
At the same time, the country’s administration believed that antiretrovirals were “poison”.
“UN experts said that they were life-saving, while we were here talking about using onions and garlic and all these other nonsensical things. We sacrificed a lot of lives.”
Coovadia looked at nevirapine (which worked to reduce mother to child transmission) in particular because he was in paediatrics.
“At that time the rate of transmission was between 32 and 34%, which is huge. But now it is under 2%, and is almost eliminated. The 2% could be those mothers who chose not to use it, but it is certainly not because of a lack of efficacy on the part of the drug.”
The administration at the time, he said, had prevented the treatment of the infected children then so was responsible for the transmission of the disease which in babies at that time was fatal.
“We could have prevented more than 300 000 deaths. If they (the government) were anywhere else, they would be facing charges of genocide.”
The then health minister, Manto Tshabalala-Msimang, who has since died, also advocated the use of natural “remedies” like beetroot and garlic.
“At another conference in Toronto in 2006, the SA stand looked like a farmers’ market, strung with carrots and onions. People were actually laughing at us.”
Another incident, a debate staged by the government at the time, sought to get the views of dissident scientists versus what were then dubbed “conventional” scientists.
“We got nowhere. This was no way to ‘sell’ the science. You have got to prove it.”
He and several other academics then decided to write a letter to Mbeki, outlining the science and breaking down their arguments.
“His response was weak, cherry-picking facts to support his arguments. He pointed out that there was risk to using the ARVs, but there is risk in everything. In this case the benefits outweigh these risks. If you thought that way, you wouldn’t even take aspirin or penicillin.”
The conference in 2000 brought together experts from all over the world, some of whom were openly hostile to the government and its representatives.
“One of the delegates, whose presentation was the first, said in the first sentence of his first slide that poverty did not cause Aids. He received a standing ovation.”
Coovadia said the conference bore the Durban Declaration, signed by 5 000 doctors and scientists, affirming HIV as the cause of Aids. It was drafted in response to prevailing attitudes of Aids denialism in the country at the time.
The breaking point, he said, came when those in power could not fight the evidence.
“There was pressure from the rest of the world and the scientific integrity of the findings was never challenged. It was a victory for science.”
He said the country still had a long way to go.
“But still, it is nowhere near where it was. We have the largest antiretroviral therapy programme in the world. Yes, we have crappy public service but there is something moving.”
He said Cuba was the first country to eliminate mother to child transmission.
Other countries to do the same included Thailand, Belarus and Armenia.
“Those countries are developing like ours but they have managed to do it. Cuba was virtually strangled by the US for many years but they have managed to eliminate it.”
It was self-evident, he said, that a country needed a good health care system.
“Cuba has got a social health service, so I think SA needs to learn that we need a better national heath care system.
“There are many detractors, but it is all nonsense: we need it to help the poorest of the poor.
“The private sector is not the answer and is overpriced.”
He also said the country had a long way to go in terms of development.
“A lack of education, health services and social cohesion all stand in the way of HIV eradication.”