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Good Nutrition No Substitute

By Adriana Stuijt

PRETORIA, South Africa -- Good food is no substitute for anti-retroviral drugs in combating AIDS. That's the finding of an "exhaustive" study by top South African scientists of all scientific research on the links between improved nutrition and the treatment of South Africa's out-of-control epidemics of HIV-AIDS plus tuberculosis (TB).
The panel included nutritionists, immunologists, biochemists, infectious disease physicians, paediatricians, policy experts, epidemiologists and generalists. They warmed that the 'nutrition versus medication'[ debate which was directly fueled by the country's health minister -- particularly in relation to the country's "two major concurrent epidemics" of HIV combined with TB, had resulted in "serious differences" in the approach to public policy dealing with the impact of these diseases.
Health workers have previously warned of the virulent effects of the combination of the twin epidemics of AIDS+TB. This has become particularly problematic in South Africa, with the emergence of extensively drug-resistant TB. XDR-TB+AIDS is a virulent, airborne-transmitted TB+AIDS infection -- incurable, without vaccines, the combination of drug-resistant Tuberculos+AIDS is proving to be so deadly that it kills its victims within twenty days in South Africa.
It is now killing a large number patients in all nine provinces of South Africa. The health minister has however not provided any new death-rates since February 2007, when the death toll stood at more than 650 -- but this was the death-rate before it had started spreading from its original source in KwaZulu-Natal province.
However it is known that at least 3,5-million people have already died of the combination of TB+Aids in South Africa since at least 2003, and that more than 2,5-million of the many millions of AIDS-infected people in SA also are co-infected with TB.
The death rate in SA from these twin-epidemics now is so high that at least two cities -- Durban and Cape Town -- have run out of cemetery space for empoverished black residents -- at least five years earlier than had been anticipated. In Cape Town, some cemeteries are now burying the dead in water-logged soil, while others are carrying out duplication-burials, stacking the dead on top of each other or in upright coffins.
The cemeteries of the giant townships of Khayelitsha and Gugulethu near Cape Town -- which have the highest infection rates -- both are full and its residents now have to travel as far afield as Atlantis some 30 kilometres to the north to bury their dead. Cremation is no option: black South Africans traditionally do not cremate their dead due to their traditional forefather-veneration cults.
The nutrition study was chaired by Professor Barry Mendelow of Wits University and the National Health Laboratory Service, and included Dr Mohamed Ali Dhansay of the Medical Research Council, Dr Clive Gray of the National Institute for Communicable Diseases and Dr Helen Rees and Dr Francois Venter of the Reproductive Health and HIV-AIDS Research Unit in Johannesburg.
The 300-page report, released on Wednesday, follows a study by a 15-member panel of the Academy of Science of South Africa, which started in 2005. The scientists "found no evidence (for the ongoing claims by its recalcitrant Minister of Health) that healthier eating is any substitute for correctly-used medical drugs", said its chief operations officer, Dr Xola Mati.It is likely to contribute to the widespread calls for the firing of Health Minister Manto Tshabalala-Msimang.
The minister no longer publicly rules out the use of antiretroviral medication to treat victims of AIDS as she used to do in the past. However, she is still primarily known - and widely criticised - for her strong over-emphasis on nutrition in battling it.
This has contributed to the ongoing conflict between the minister, health professionals, Aids activists and opposition parties."One of our most important findings has been that nutrition is important for general health, but is not sufficient to contain either the HIV and Aids or the tuberculosis epidemic," said panel member Dr Dan Ncayiyana, editor of the South African Medical Journal.
"The controversies about nutrition have been harmful," said the panel of scientists.
They said the debate on the impact of nutrition on immunity, particularly in relation to the "two major concurrent epidemics" of HIV infection plus TB, had resulted in "serious differences" in the approach to public policy dealing with the impact of these diseases.
The minister of health received a copy of the report two weeks ago - as has the entire government executive council. She has yet to respond to it publicly.The entire report can be read on http://</outgoing.php3?URL_to=http://www.assaf.org.za./>www.assaf.org.za


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