In September, South Africa became the third country on the continent to pass a ruling favoring cannabis. Last month, Canada fully legalized its use. The world of business and medicine is slowly awakening to its benefits, weeding fact from fiction.
House of Tandoor, a trendy rooftop bar that pulsates with life on the weekends, with reggae music, dancers and cannabis smokers disappearing under thick clouds of smoke, is as quiet as a church when we visit on a Monday morning.
It is situated on Rockey Street in the vibrant, often-chaotic suburb of Yeoville in Johannesburg. This area is a hub for expatriates and small business owners plying their trade at informal markets.
Inside the bar at House of Tandoor on this September day is a tall, elderly man with a long beard, lost in the pages of a newspaper and smoking a joint.
It has been two weeks since the Constitutional Court in Johannesburg decriminalized the personal consumption of cannabis in private spaces.
In this small suburb, cannabis has always been an open secret, savored not-too-discreetly in the smoky beer dens and even openly on the streets. Regulars swear this is where you find the best cannabis in town.
For 23 years, the tall man with the beard at the bar named Eric Mpobole has been a cannabis activist in South Africa. He is the co-owner of House of Tandoor.
“Here in Yeoville, this is a ganja village. It has been so for two decades. So for the government to decriminalize [ganja]… we decriminalized it a long time ago,” he tells FORBES AFRICA, exhaling smoke.
More than two decades ago, Mpobole started out at House of Tandoor as a sound engineer and DJ, with Langa Mradu.
In 2002, the two took over the place turning it into a hotspot for people wanting to sway to reggae music, indulge in a game of pool, and smoke a joint (rolled cannabis) or two.
Born and bred in the township of Soweto in Orlando East, to Rastafarian parents, Mpobole had his first taste of cannabis at the age of 13.
“I didn’t become Rastafarian, I was born Rasta,” he says.
The 50-year-old firmly believes cannabis (also called weed, dagga, ganga or marijuana) has helped keep him healthy.
Last year, he planted cannabis seeds, and they grew into a plantation he now calls the “plantation of God”.
This is in a bushy fenced-off area, located a 10-minute drive outside of Johannesburg’s central business district; he does not tell us where it is. He shows us a video of the plantation on his phone and you see four-meter-tall cannabis plants.
A few days before we meet him, he had harvested them for medicinal purposes. With the new ruling in South Africa, he plans to grow more cannabis at a bigger location.
Mpobole is hopeful the next step will be the commercialization of cannabis.
“We need to educate them [people] on how to grow, how to process it and how to take it to the market,” he says.
“If I was there in the decision room, I would suggest one thing, that why can’t we treat marijuana like any vegetable or any fruit?” he says, as he lights up yet another joint, and gets down to some pressing matters.
A new freedom?
In the afternoon, on a balcony at House of Tandoor, a group of men in dreadlocks sit relaxed under plumes of smoke, listening to the mellow tunes wafting in, and watching the hustle and bustle of Yeoville’s colorful streets below.
They are basking in the dawn of a new era, smoking cannabis in their own space without fear of the police.
It’s a new kind of freedom.
Mradu, the co-owner of House of Tandoor, is one of the men on the balcony.
He wears a beanie, dark shades and a psychedelic t-shirt with a graphic of Bob Marley smoking cannabis.
Before the ruling, Mradu says he had been arrested and detained by the police for possession of cannabis too many times to count.
“To me, ganja has been legalized, [but] it has been free all my life, because even if I get arrested, you find the same thing in prison.
“I even smoked in the prison cells, why must I be scared of the police?”
Mradu has been an advocate of cannabis ever since he was a boy growing up in the Eastern Cape province of South Africa.
He says he does not drink alcohol or take any drugs.
“People are saying no to ganja because they don’t know what it is,” he says, crushing a bud of cannabis in his palm, then delicately placing it on brown rolling paper. He licks the sticky end, carefully rolls the blunt in between his thumb and index finger and then strikes a match.
It lights up and he proceeds to take a deep puff, then deliciously exhales the smoke.
“The government should legalize ganja, but they have to teach people to know what is ganja, what does ganja do to a human being. They need to have programs on television and newspapers on what is ganja,” he reiterates.
Underneath his seat is a plastic bag with dozens of “bankies” (weed stuffed into transparent bank coin bags).
He says the strands of cannabis come from the neighboring Kingdom of eSwatini that locals refer to as Swazi Gold or Green House. It is grown in the Hhohho region in a wet and warm forest-filled town in the north called Piggs Peak.
Some of the weed smoked in South Africa allegedly also comes from Lesotho in the mountainous northeastern Mokhotlong district or from the rural outskirts of South Africa in Pondoland in the Eastern Cape.
It is an illicit market hard to track.
According to the UN’s World Drug Report 2018, there were 151 countries that reported cannabis drug seizures between 2012 and 2016.
This means that the illicit market for cannabis consumption or trade is a thriving market that is still under the radar.
Cannabis has been illegal in South Africa since the early 20th century when the prohibition of the sale of cannabis came to pass.
In 1922, a period marked by extreme apartheid laws, regulations were issued under an amended Customs and Excises Duty Act that criminalized the possession and use of “habit-forming drugs” including dagga.
It also prohibited the cultivation and sale of the plant.
“This period in South African history [1850 to 1925] is marked by the rise of the segregationist state and the entrenchment of racist laws. It is argued that the prohibition of cannabis in South Africa was an almost inadvertent result of attempts to scientifically justify colonial oppression,” states researcher and historian Craig Paterson in his master’s thesis for Rhodes University in 2009.
In Prohibition & Resistance: A Socio-Political Exploration of the Changing Dynamics of the Southern African Cannabis Trade, c. 1850 – the present, he examines the trade of cannabis in South Africa after its prohibition.
In the 2018 ruling, the Constitutional Court found that the criminalization of cannabis (and its history) was characterized by racism as it was used by many indigenous South Africans and was not as harmful as historically argued.
Not entirely off the hook
In South Africa alone, statistics reveal that in 2015 – 2016, possession of cannabis made up a staggering 65% of all drug-related crimes recorded by the South African Police Service’s (SAPS) annual crime report.
These were people who were either caught in possession of or trading cannabis.
Police spokesperson Brigadier Vishnu Naidoo from SAPS says “that drug [cannabis] is hardly ever imported. Most of the time, it is exported. Most of it is grown here, in and around the country”.
Although cannabis has been decriminalized to an extent, it does not mean cannabis users are entirely off the hook.
The Constitutional Court ruling does not mention the quantity of cannabis that qualifies as personal use and what qualifies as ‘dealing’.
“All I’m saying to people is they must interpret the ruling on their own. What we have done as an organization is we have given guidance to our police officers on how to conduct themselves,” says Naidoo.
He tells FORBES AFRICA that some arrests have been made even after the ruling; these were people found in possession of cannabis in a public space or ‘dealing’ it.
The dagga couple
On the outskirts of Johannesburg, in Lanseria, is a couple who have dedicated their lives advocating for cannabis.
A few days before their interview with FORBES AFRICA in September, they had cops at their door wanting to search their home.
On the Thursday morning we meet them, they are in their lodge, called the Jazz Farm, with a garden featuring plants of all kinds. Three dogs lie in the living room with not a care in the world.
The cannabis oil they make at home has become daily medicine for one of their pups suffering from arthritis.
In their living room, adorned with colorful art, a coffee table is the resting place for bongs, containers filled with cannabis, and lighters.
Myrtle Clarke, 53, and Julian Stobbs, 58, call themselves “the dagga couple”.
The pair who worked in South Africa’s film and media industry have been cannabis smokers for over 30 years.
But it was 2010, the year they got raided and arrested for the possession of cannabis, which triggered their fight for the rights of cannabis users.
At 2AM on a cold August morning that year, police were banging on their kitchen door. Stobbs opened it with nothing on but his underpants when six guns were stuck into his face.
“Have you got illegal drugs in this house?” the cop shouted.
The couple said yes and proceeded to show the police their stash.
They searched their home without a warrant, taking anything and everything related to cannabis, from books to bongs to buds.
They were convinced the couple were running a syndicate drug lab.
“We were totally in shock,” says Clarke, denying the allegations.
The police found no evidence of a drug lab, only cannabis that the couple consumed themselves.
After being detained by the police in their home for five hours, they were taken to the police station not far from their home for questioning, and kept in a shabby, smelly holding cell.
At 4PM the next day, they were released after a R1,000 ($70) bail.
They were charged with the possession of cannabis.
Their court appearance was supposed to take place early 2012, but was postponed.
In the meantime, they studied a book titled Cannabis Human Rights And The Law, given to them by a friend, and learned about the rights they have as cannabis users.
“There’s only a crime if there’s a victim, and [cannabis] is this victimless crime thing,” Clarke says.
In a turn of events, they went from being plaintiffs to defendants.
Instead of facing charges, the couple sued seven different government departments for human rights violations.
They claimed that the plant should be completely legalized to grow, buy, sell and use for recreational or medicinal use.
A year later, in 2013, they registered an NGO called Fields of Green for All aimed at reforming South Africa’s cannabis laws.
Their postponed trial eventually happened in August 2017.
However, nothing was concluded as “the court proceedings went over time”.
The couple are still awaiting a new date for the trial but in the meantime are doing everything they can to challenge South Africa’s cannabis laws.
They were invited as keynote speakers at the SA Drug Policy Week 2018 in October in Cape Town to enlighten and educate attendees on the use of cannabis.
In their kitchen, on the counter, is a large transparent jar with dozens of cannabis buds.
“Look at that, how can that be illegal, look how beautiful it is. It’s God’s gift. You think God made a mistake?” says Stobbs.
“Cannabis is just part of my persona, and I’m the proof that it doesn’t make you stupid or lazy, and we have achieved what we have achieved by being daily cannabis users.”
“It has been a fight because it’s very difficult to get people to take you seriously. But now that we’ve got the judgment, they will listen to us, at last,” adds Clarke.
The couple wish they could settle down and retire in their lodge but they want to continue the fight.
Next on their agenda? To achieve complete cannabis legalization in the country.
‘Marijuana ruined my life’
Critics of the cannabis ruling are concerned its legalization will cause more harm than good.
Twenty two-year-old Micheal Mojapelo has been clean off cannabis for four years now and has dedicated his life to helping drug abusers based in South Africa.
He is dressed in an orange shirt barely covering the tattoos on his left arm, and a green cap adorned with buttons, when we meet him.
He was only 12 years old when he first tried cannabis.
“The first time I smoked marijuana, I wanted to be cool. And then I found that marijuana did for me what I could not do for myself. Which is basically make me feel better about myself. It made me feel confident. It gave me self-esteem. But that’s because I have a disease of addiction,” he says, his voice thick with emotion.
And only when he turned 18 did his life change for the worse. In high school, he mixed with the wrong people and experimented with other drugs.
“I ended up dealing, and it wasn’t just marijuana. I used to deal crack cocaine, I used to deal kat. And I ended up living in a crack house,” he says.
As a result, he failed his matric year.
Reality sunk in and he was forced to make a decision to change his life for the sake of his family.
Making the decision to go to rehab, Mojapelo stopped smoking completely.
“I stopped because smoking marijuana ruined my life,” he tells FORBES AFRICA regretfully.
He checked into the Crossroads Recovery Centre, a drug rehabilitation center based in Johannesburg, where he met with Taku Mhonyera, who owns the branch and is the head of treatment.
“When he came to rehabilitation, he was just lazy. [His addiction] took away the motivation and life was passing by. That’s the whole point of this kind of stuff, so it’s sad to see when it’s in that form, you know,” says Mhonyera.
Mhonyera has dealt with over a thousand clients and drug abusers but he says cannabis abusers only make up a small percentage of them.
“When people end up in treatment, specifically because of marijuana, it’s very sad to see, because someone goes up and they can’t actually come down,” he says.
Despite the way the plant affected Mojapelo’s life, he is hopeful one day he can launch his own business to support his child. He wants nothing to do with the cannabis industry.
“The risks of cannabis are many. It is addictive and may lead to dependence and withdrawal. Intoxication may cause disturbances in levels of consciousness, perception or behavior,” says psychiatrist Hemant Nowbath, a member of the South African Society of Psychiatrists (SASOP) based in the coastal KwaZulu-Natal province of South Africa.
“People who use cannabis have higher risks for depression and anxiety. Cannabis may also cause psychosis and lower the age of the onset of schizophrenia. Cannabis could impair cognitive functions leading to poor school performance and diminished achievement,” he adds.
“Motor coordination may be impaired leading to an effect on driving ability and the increased risk of injury. Acute cardiovascular effects including myocardial infarction and strokes may occur.”
Nowbath is concerned the new ruling could lead to greater abuse of cannabis, increase the rates of addiction, and aggravate the medical, psychosocial and psychiatric problems caused by it.
“In a country like South Africa marked by inequality and economic disparity, the vulnerable will be more significantly affected by these problems,” he adds.
The Constitutional Court has given parliament two years to update the legislation relating to marijuana to be in line with its ruling.
The next big business?
Since the September ruling, some businesses in South Africa are looking at innovative ways to cash in.
In Durban, a craft brewery called Poison City Brewing has created Poison Cannabis IPA and Durban Poison Cannabis Lager.
On its website, the company says that the Poison Cannabis IPA beverage contains hemp or Cannabis Sativa flavor, aroma and oils, while the Durban Poison Cannabis Lager contains no THC.
Tetrahydrocannabinol (THC), the key principal psychoactive constituent of cannabis, is what gets one high.
The company, which was launched in March 2015, currently retails the drinks at select stores and on its website. The beers were launched in September.
Internationally, multi-billion dollar beverage brand Coca-Cola has also been looking closely.
“Along with many others in the beverage industry, we are watching the growth of this ingredient in functional wellness beverages around the world. The current discussion had in North America was purely exploratory,” says the company in a statement to FORBES AFRICA.
But just how much is the global cannabis industry worth?
It is estimated that by 2022, the legal spending of cannabis in the rest of world would be $32 billion.
This was cited in The State of Legal Marijuana Markets, Sixth Edition, a report published by Arcview Market Research in partnership with BDS Analytics, a company that produces cannabis industry market trends and consumer insights.
“We are talking about an industry in which $12.9 billion will be spent this year,” Tom Adams, Managing Director of Industry Intelligence for BDS Analytics, tells FORBES AFRICA.
That’s up from $9.5 billion last year.
“There are lots of fast-growing industries, but I have never seen anything like this,” he adds.
News reports say Canopy Growth Corporation, a medical marijuana company in Canada, received $4 billion at the end of 2017 after an investment by Constellation Brands, maker of Corona beer.
Canopy Growth generated $54 million in revenue. Weed stocks surged as Canada prepared to legalize marijuana in October and Canopy Growth climbed more than 14%, hitting a record high of $57 a share.
All eyes are on Canada as it legalized recreational marijuana last month, becoming the second country in the world to do so after Uruguay.
Says Shane MacGuill, Head of Tobacco Research at market research provider Euromonitor International, in a press statement soon after the legalization of cannabis in Canada: “This full, (almost) no-holds-barred legalization of recreational cannabis – the first of its type in the world – is a historic landmark in the rapidly developing global debate.
The evolution of the Canadian market – and in particular its economic, excise and societal impact – will be closely monitored internationally by those looking for ballast on both sides of the policy conversation.
It also shifts the spotlight on to the next markets weighing liberalization moves – the neighboring US, Australia and some EU member states to name just a few of a what is set to become a rolling tide of legalization.”
Legalizing marijuana ‘edibles’ are next on Canada’s agenda according to a report by Bloomberg.
Despite cannabis being still illegal in many parts of the world, Adams says it is “a massive existing consumer product category”.
If countries opt to fully legalize cannabis and regulate its trade, he says there will be enormous economic benefits.
These include employment and business opportunities, health benefits, investments, and a line of by-products such as edibles, vape pens, and more that can have a multiplying effect.
“There’s an opportunity reached out into every field to capitalize on the fast-growing legal industry,” says Adams.
Adult-Use Over Medical-Use
Currently, many of the countries with partially-legalized cannabis have been reaping the benefits of medical marijuana.
It is estimated that by 2022, legal adult-use spending on cannabis will reach $20.9 billion, while medical spending will hit $11.2 billion. This $9.7 billion difference is in spite of the fact that medical-use is legalized in more countries than legal adult-use.
“Even with the broadening of medical programs around the globe and strong medical sales, adult-use markets are expected to outpace medical-only markets by the end of this year,” the report says.
The illicit cannabis market, which remains untraceable, could potentially increase the value of the cannabis industry.
With its legalization, governments would also need a legal structure in place to ensure that it becomes a fully-functioning economy.
“You can have legalization, but if you don’t have regulation as well, the economic benefits just don’t appear,” says Adams.
Closer home, African countries have the best climate to grow cannabis.
“Much of Africa has the perfect climate for growing cannabis and economic situations that allow it to do it very cheaply because the labor costs are very low and therefore, this is a phenomenal opportunity for economic development for a lot of African countries,” he says.
However, only three countries on the continent have legalized the growing of cannabis to some extent, namely Zimbabwe, Lesotho and South Africa.
Based on Paterson’s 2009 report, “It is hard to estimate either the quantity of cannabis produced in southern Africa or the monetary value of its trade.”
Many are not willing to disclose the numbers.
“In reality, very few people involved in the southern African cannabis trade have managed to dramatically improve their standard of living. Usually, they have only managed to supplement their income, or to create a limited source of extra income,” he says.
Additionally, locally-produced cannabis is done at a low price. This means that even the wholesalers and large-scale dealers of cannabis do not derive an exceptionally large income from it, he says.
However, according to Aadil Patel, National Head of the Employment practice at Cliffe Dekker Hofmeyr, a commercial law firm in South Africa, if Africa were to achieve full legalization of cannabis, this would result in many employment opportunities.
Because the South African climate is favorable for growing cannabis, “one can imagine the jobs that could be created through cannabis farms”, he tells FORBES AFRICA.
“The establishment of such farms will have a knock-on effect and create other employment opportunities related to the fields of business (including buyers, sellers, advertisers and other entrepreneurs), medicine and religion,” he says.
In terms of where the future of cannabis may go, Adams believes complete legalization around the world is sure to happen and it is only a matter of time.
But until then, those operating in the illicit market will be the only
On a global scale, investors are silently monitoring the growing trends of what could be the next big emerging market.
It would be interesting to see, much like many of Africa’s natural resources, whether a small hairy green cannabis bud would light up the African economy.
Cannabis is widely debated to have different medical benefits.
Researchers have shown the chemical compounds in marijuana have medicinal applications. According to Medical Cannabis Dispensary, a South African online resource for medical marijuana, cannabis could assist people suffering with the following diseases.
1.Alzheimer’s: Studies have shown that marijuana may be effective in inhibiting the progression of this disease through a variety of biological mechanisms.
2.Cancer: Some doctors prescribe the use of marijuana as an aid to help combat the disease and mollify the effects of chemotherapy. “Studies have also shown a positive effect in regards to inhibiting tumor growth in leukemia and breast cancer as well as the invasion of cervical cancer, liver cancer, brain cancer and lung cancer cells,” says the Medical Cannabis Dispensary.
3.Arthritis: Studies have shown that medical marijuana has the ability to reduce joint inflammation and related pain symptoms.
4.Glaucoma: The use of medical marijuana can not only help stop the damage caused by intraocular pressure, but can also help reverse deterioration of the optic nerve.
5.HIV: Medical marijuana is effective in treating the symptoms caused by many HIV medications, including nausea, lack of appetite, nerve pain, anxiety, depression and insomnia.
6.Pain relief: One of the most common uses of medical marijuana is for the treatment of chronic pain. Cannabinoids, the medical compound found in marijuana, has pain-relieving (analgesic) properties.
What does it mean to be HIV-undetectable or to have a suppressed viral load?
With medication and technology, science is increasingly improving the lives of people living with HIV and reducing new infections.
On August 8, 2018, a day before Women’s Day in South Africa, 23-year-old Saidy Brown observed six years of being on antiretroviral (ARV) treatment.
We meet Brown in her hotel room in Benoni in the East Rand in the South African Province of Gauteng.
She sits still, reflecting on her life after a long and busy day. She has just returned from a group meeting with other young HIV activists.
Her t-shirt is unapologetic and as loud as her activism. “HIV POSITIVE #TEST & TREAT,” it reads. In the dim light of her room, she recollects her dark journey to becoming an HIV activist.
Brown was diagnosed with HIV at birth. However, she only found out she had it at the age of 14.
Brown grew up in a small town called Itsoseng in the North West Province of South Africa. In June 2009, while attending a youth day event, Brown and some of her friends decided to get tested for free.
The eager teen received some pre-counselling from one of the nurses.
“I remember getting into that room and the lady asked me two questions, ‘what would you do if you find out that you are HIV negative’?”
“I would continue living,” Brown said.
“What will you do if you find out you are HIV positive?”
“I would go out there and educate people living with HIV,” she said to the nurse.
Brown tested positive. Her whole life changed in the space of five minutes.
“After she told me, the first thing I said was ‘how? I didn’t do anything, I am only 14’.”
While her friends were discussing their results, Brown broke the news to them. They were all surprised.
“I then told them ‘no, I’m kidding, I am negative’.”
Brown was ashamed and could not confide in anyone.
“I really wanted to go home and cry. Like, I didn’t even know where I got it from,” Brown says.
She was afraid of what her family, friends and community would think of her. For months, she kept it to herself. But the secret about her health was too overwhelming.
Later that year, Brown joined a drama club. They rehearsed for a play to be staged on World AIDS Day, on December 1. She played the daughter of a woman who was HIV positive.
Little did her peers know that Brown was actually telling her real life story. A few days later, conversations with Brown’s drama teacher got her to divulge her secret.
She later gathered up the courage to confide in her aunt. Her aunt then revealed that Brown’s late parents had indeed been HIV positive.
“I was angry at my aunt for not having tested me earlier on, I was angry at my parents for having died before me knowing, I was angry at God, I was just angry at everyone,” she says.
She turned to writing to cope. The first piece she wrote was titled An Open Letter To HIV.
“I will always remember this line because I paused there and I cried so much. There is a line where I said, ‘because of you I feel less pretty’.”
This marked the beginning of her activism. She shared the letter on social media and it reached thousands.
For 14 years, Brown had lived a healthy life with the disease without any treatment. Brown disclosed her status to close friends and received huge support.
It was only when she turned 18 that her health began to deteriorate. Hesitant to start treatment, Brown thought about the rumors she heard about the side-effects of ARV.
When she went for blood tests, she was told her CD4 count had dropped. According to experts, when the CD4 count drops below 200, a person is diagnosed with Acquired Immunodeficiency Syndrome (AIDS).
“I think that was when reality started kicking in that ‘you need to be on treatment’,” she says.
In 2012, she finally started ARV treatment. Since then, Brown has been living a healthy life
She uses her experience to encourage others living with HIV and to break the stigma. In June 2017, she recited An Open Letter To HIV at the eighth South African AIDS Conference addressing HIV/AIDS and gender-based violence.
She held governments and societies accountable.
The same year, she received the Red Ribbon Foundation Youth for Change HIV/AIDS Activist Award.
In 2018, she was recognized as one of the Mail & Guardian 200 Young South Africans, for her work as an activist.
Brown considers herself an “HIVictor” and reaches thousands on her social media platform spreading awareness about the disease.
“There is life after an HIV diagnosis,” Brown shared with her followers on Twitter.
Today, Brown is HIV-undetectable.
She has been virally suppressed for two years now.
According to a report by UNAIDS in 2018, being undetectable means that the virus is un-transmittable.
This means that people who are HIV positive with an undetectable viral load cannot transmit HIV sexually.
This was proven in 2017.
Dr Sindisiwe van Zyl is a clinician and general practitioner with a special interest in HIV and women’s health.
She also uses her social media to spread awareness on the disease.
“The aim of ARV treatment is to achieve an undetectable or suppressed viral load. What is the viral load? It is the number of HIV copies in the blood. HIV uses CD4 cells to make copies of itself. If one is taking ARV treatment, the efficacy of the treatment is proven by an undetectable viral load. You’re still living with HIV, but you’re taking the treatment so well that the virus cannot make copies of itself,” she tells FORBES AFRICA.
“The viral load blood test tells us when undetectable levels have been reached and it takes 12 to 24 weeks to achieve this,” Van Zyl says.
Three significant studies were done between 2007 and 2016 on sexual transmission of HIV among thousands of couples.
According to UNAIDS: “In those studies, there was not a single case of sexual transmission of HIV from a virally-suppressed person living with HIV to their HIV-negative partner.”
“For many people living with HIV, the news that they can no longer transmit HIV sexually is life-changing. In addition to being able to choose to have sex without a condom, many people living with HIV who are virally suppressed feel liberated from the stigma associated with living with the virus,” UNAIDS says.
However, the stigma still does exist.
A 28-year-old millennial, who requested not be named, tells FORBES AFRICA that she had never heard of what it means to ‘undetectable’.
When asked if she would be willing to have sexual relations with someone who was HIV positive but their viral load was undetectable, she says she is unsure.
“I would but I would be worried because mistakes happen. What if medical practitioners thought it was undetectable but they made a mistake and now my life is at risk,” she asks.
She is not alone in thinking this way.
From a quick social media search, it is evident many users are not well-informed about what an undetectable viral load means.
Some social media users who disclosed to be living with HIV said that even their own doctors had not informed them about what it meant to be ‘HIV undetectable’.
Through hashtags such as #UequalsU and #UndetectableEqualsUntransmittable, awareness around being ‘HIV undetectable’ has spread globally, giving freedom to many HIV positive people to share their status.
“[These are] the hashtags of the century, in my opinion! What does #UequalsU mean? If the viral load is undetectable, then one cannot transmit HIV!” Van Zyl says.
It is such activism that has contributed to the strides in HIV research.
A doctor from the Wits Donald Gordon Medical Centre in Johannesburg agrees.
“I think that’s what makes the HIV space unique. Those activists are crucial… When patients talk, they talk as if they don’t have a voice, but with the activists, they have a voice and they are taken seriously and I think that has also been one of the big drivers,” Dr June Fabian, a nephrologist and clinical researcher at the medical center, tells FORBES AFRICA.
Transplanting to save a life
Two years ago, doctors from the transplant unit at the Wits Donald Gordon Medical Centre performed what is believed to be the world’s first HIV positive liver transplant.
Currently, the center is the only transplant program doing transplants from one living person to another in southern Africa.
The liver of a mother living with HIV was transplanted into her critically-ill HIV negative child.
After the transplant, the child was monitored and the doctors were not able to find HIV within the child’s system.
The child had been on a waiting list for more than 180 days and was frequently admitted for life-threatening complications of end-stage liver disease.
Professor Jean Botha led the procedure.
He was approached by the child’s mother to consider using her as her baby’s donor.
“We have had a case where we proposed the idea but the mom said, ‘I cannot live thinking that I’ll give HIV to my child’, and she said ‘no’, and the baby died,” Fabian, who was a part of the team, says.
It was a very complex situation.
They reviewed the implications of the transplant, consulted with other experts and then spoke to the ethics committee at the University of the Witwatersrand (Wits).
“They came back and said, ‘if you are weighing up this child dying versus giving the child HIV then do it because, obviously, you want to prevent the child from dying’,” Fabian explains.
With the go-ahead, the team proceeded with the operations and assumed that the child would have the virus after the procedure.
But their assumptions were wrong.
“After the transplantation, we saw a seroconversion event. What that means is that the child became HIV positive,” Professor Caroline Tiemessen from the Wits School of Pathology and Centre for HIV and STIs, National Institute for Communicable Diseases, said in a report.
Soon after, they observed that the virus was no longer detectable. They then monitored the child’s antibodies and tested the viral load, however, she said it has remained undetectable since.
They have since not been able to trace the virus within the cells of the child.
“The liver is an immune organ so it’s the liver’s job to kill bugs… so I think in a way we might have struck it lucky with the liver. I don’t know if we can say what happened here is going to happen with a heart, a kidney or a lung,” Fabian says.
Despite not being able to detect the virus, the child was placed under ARV treatment.
Fabian says the only way to know for sure that there is no HIV in the child is if they completely stop treatment.
However, it would be a risk.
In 2017, a similar case was announced where a nine-year-old South African who had been diagnosed with HIV at a month old, received treatment, and then maintained remission after suppressing the virus for almost nine years without the treatment since 2008.
It has been more than a year since the liver transplant took place and both the mother and child are recovering well.
According to Fabian, they plan to continue doing more tests.
HIV Positive: The New Living Donor Pool?
At a time when South Africa is experiencing a shortage of organ donors, this may be a solution to the problem if people living with HIV may be able to donate organs.
In the early 2000s, Fabian’s work dealt with organ transplants and HIV before ARVs were created.
“We started seeing the disease untreated, and there was a lot of kidney disease so that was what sparked my interest and I started a study in the clinic with patients with HIV and kidney disease,” she says.
However, HIV patients back then were excluded from transplantation.
“We were basically throwing away organs from HIV-positive donors because we weren’t using them,” she says.
With a shortage of organ donors, Fabian says they lost 25 children on the waiting list.
According to an article by theSouthAfrican.com, there are around 4,300 people waiting for organ donations in South Africa in need of new livers, kidneys, lungs or hearts.
“The inclusion of HIV-infected people as living donors created the new living donor pool,” say experts from the Wits Donald Gordon Medical Centre.
This means that people like Brown who have been living with an undetectable viral load could be eligible as donors after tests have been done.
As for whether or not HIV-positive patients could potentially become blood donors, more work needs to be done in that field.
At the moment, Fabian does not think it is possible.
“I don’t know if you would put someone on life-long antiretroviral for a blood transfusion. I don’t think the benefit outweighs the risk when you can source blood from non-infected donors and the person isn’t going to die if they don’t get the transfusion,” Fabian says.
The evolution of ARVs
The first ARV treatment trial happened in the 1990s and in 2004, South Africa first rolled out its ARV program to people living with HIV.
ARV treatment has gone from taking several tablets a day to one pill daily.
Now, patients, particularly in South Africa, can receive free treatment.
According to a report on HIV and AIDS financing by the South African Health Review, South Africa has the largest number of persons living with HIV and on ARV-treatment in the world, with this figure scaling up by approximately 400,000 persons per annum.
UNAIDS estimates there are 20% of people on ARV therapy globally.
HIV-related deaths have been decreasing as the number of people receiving ARVs is growing.
In 2008, the death rate was about 220,000 to 260,000 in South Africa.
In 2016, estimates between 96,000 to 140,000 of AIDS-related deaths in the country were reported.
“I think what is underappreciated is how much people’s lives have changed with ARVs and with access to ARVs and how much the science and the funding with ARVs has driven it from being a very complicated regimen to one tablet a day,” Fabian says.
And now, access to obtaining ARVs has become easier and they are getting smaller.
“The tablet is getting smaller and smaller, which is great for storage, great for carrying, makes it cheaper, it’s also easier to swallow,” says Professor Francois Venter, the Deputy Executive Director at the Wits Reproductive Health and HIV Institute.
Last year, South Africa saw the introduction of an ATM which uses electronic and robotic technology to dispense medication.
This allows patients to collect medication without having to queue at hospitals.
On the continent, clinical trials of injectable ARV drugs are currently underway.
This is part of a large-scale trial that will be conducted in six other countries –Kenya, Malawi, Botswana, Zimbabwe, Uganda and Swaziland.
According to a news report in The East African, the aim of the study is to introduce an injection once every two months.
“They are starting to work on a new implant. It is very early days but it is very, very exciting. So instead of taking your ARVs you just get an implant every year,” Venter says.
“ARVs are looking more and more like hormonal contraception … It is like having several choices.”
He predicts that they will become available in the next five to 10 years.
Other new developments include the HIV vaccine trial (please read more on pages 44-47).
As HIV research grows rapidly, Fabian says that other chronic disease studies can gain from its developments.
“If you look at how we manage TB [tuberculosis], there is very little progress that has been anywhere as rapid as HIV, in terms of making treatment accessible and simple for people,” Fabian says.
Venter agrees: “The funny thing is people with HIV are now living longer than the general population in certain spaces.”
A study in the United States found this to be true.
In 2014, an estimated 45% of those HIV-infected were older than 50, amounting to 428,724 people, while 27% were older than 55 and 6% were 65 and older, according to the Centers for Disease Control and Prevention.
However, more work still needs to be done in this regard.
Venter says that technology has significantly aided HIV research.
“There are new ways to measure HIV which are getting more available and the price is coming down,” he says.
“There are also new ways for testing for HIV which are very exciting.”
“Because the cost of antiretrovirals has gone down so dramatically, HIV is actually relatively cheap to treat, compared to diabetes,” he says.
“It also keeps people away from the medical system which is very expensive,” he adds.
Despite the great strides taken to improve HIV treatment, a cure is still nowhere to be found.
“I think we are getting closer [to a cure] with vaccines,” Fabian says, hopeful.
Venter, on the other hand, believes we are still far from discovering a cure.
“I am not particularly hopeful because I think the scientific challenges of it are so hard that I am not sure it is going to be possible, but I hope I am wrong,” Venter says.
He says that there have been large amounts of money diverted to looking for a cure and that we are learning more about the immune system.
“Even if we may not find a cure, we are going to learn a lot about vaccines and the complexity of the human body,” he says.
For now, the importance of spreading awareness is still essential. Activists like Brown and Van Zyl can attest to that.
The world has gone from a deadly epidemic, to undetectable victories and vaccines in three decades.
We are witnesses to history in the making. Where will you be when a cure is found?
Software Pirates Use Apple Tech To Put Hacked Apps On iPhones
Software pirates have hijacked technology designed by Apple Inc to distribute hacked versions of Spotify, Angry Birds, Pokemon Go, Minecraft and other popular apps on iPhones.
Illicit software distributors such as TutuApp, Panda Helper, AppValley and TweakBox have found ways to use digital certificates to get access to a program Apple introduced to let corporations distribute business apps to their employees without going through Apple’s tightly controlled App Store.
Using so-called enterprise developer certificates, these pirate operations are providing modified versions of popular apps to consumers, enabling them to stream music without ads and to circumvent fees and rules in games, depriving Apple and legitimate app makers of revenue.
By doing so, the pirate app distributors are violating the rules of Apple’s developer programs, which only allow apps to be distributed to the general public through the App Store. Downloading modified versions violates the terms of service of almost all major apps.
TutuApp, Panda Helper, AppValley and TweakBox did not respond to multiple requests for comment.
Apple has no way of tracking the real-time distribution of these certificates, or the spread of improperly modified apps on its phones, but it can cancel the certificates if it finds misuse.
“Developers that abuse our enterprise certificates are in violation of the Apple Developer Enterprise Program Agreement and will have their certificates terminated, and if appropriate, they will be removed from our Developer Program completely,” an Apple spokesperson told Reuters. “We are continuously evaluating the cases of misuse and are prepared to take immediate action.”
After Reuters initially contacted Apple for comment last week, some of the pirates were banned from the system, but within days they were using different certificates and were operational again.
“There’s nothing stopping these companies from doing this again from another team, another developer account,” said Amine Hambaba, head of security at software firm Shape Security.
Apple confirmed a media report on Wednesday that it would require two-factor authentication – using a code sent to a phone as well as a password – to log into all developer accounts by the end of this month, which could help prevent certificate misuse.
Major app makers Spotify Technology SA, Rovio Entertainment Oyj and Niantic Inc have begun to fight back.
Spotify declined to comment on the matter of modified apps, but the streaming music provider did say earlier this month that its new terms of service would crack down on users who are “creating or distributing tools designed to block advertisements” on its service.
Rovio, the maker of Angry Birds mobile games, said it actively works with partners to address infringement “for the benefit of both our player community and Rovio as a business.”
Niantic, which makes Pokemon Go, said players who use pirated apps that enable cheating on its game are regularly banned for violating its terms of service. Microsoft Corp, which owns the creative building game Minecraft, declined to comment.
SIPHONING OFF REVENUE
It is unclear how much revenue the pirate distributors are siphoning away from Apple and legitimate app makers.
TutuApp offers a free version of Minecraft, which costs $6.99 in Apple’s App Store. AppValley offers a version of Spotify’s free streaming music service with the advertisements stripped away.
The distributors make money by charging $13 or more per year for subscriptions to what they calls “VIP” versions of their services, which they say are more stable than the free versions. It is impossible to know how many users buy such subscriptions, but the pirate distributors combined have more than 600,000 followers on Twitter.
Electronic Arts’ new game challenges Fortnite
Security researchers have long warned about the misuse of enterprise developer certificates, which act as digital keys that tell an iPhone a piece of software downloaded from the internet can be trusted and opened. They are the centerpiece of Apple’s program for corporate apps and enable consumers to install apps onto iPhones without Apple’s knowledge.
Apple last month briefly banned Facebook Inc and Alphabet Inc from using enterprise certificates after they used them to distribute data-gathering apps to consumers.
The distributors of pirated apps seen by Reuters are using certificates obtained in the name of legitimate businesses, although it is unclear how. Several pirates have impersonated a subsidiary of China Mobile Ltd. China Mobile did not respond to requests for comment.
Tech news website TechCrunch earlier this week reported that certificate abuse also enabled the distribution of apps for pornography and gambling, both of which are banned from the App Store.
Since the App Store debuted in 2008, Apple has sought to portray the iPhone as safer than rival Android devices because Apple reviews and approves all apps distributed to the devices.
Early on, hackers “jailbroke” iPhones by modifying their software to evade Apple’s controls, but that process voided the iPhone’s warranty and scared off many casual users. The misuse of the enterprise certificates seen by Reuters does not rely on jailbreaking and can be used on unmodified iPhones. -Reuters
-Stephen Nellis and Paresh Dave
Earth’s Earliest Mobile Organisms Lived 2.1 Billion Years Ago
Scientists have discovered in 2.1-billion-year-old black shale from a quarry in Gabon the earliest evidence of a revolutionary development in the history of life on Earth, the ability of organisms to move from one place to another on their own.
The researchers on Monday described exquisitely preserved fossils of small tubular structures created when unknown organisms moved through soft mud in search of food in a calm and shallow marine ecosystem. The fossils dated back to a time when Earth was oxygen-rich and boasted conditions conducive to simple cellular life evolving more complexity, they said.
Life emerged in Earth’s seas as single-celled bacterial organisms perhaps 4 billion years ago, but the earliest life forms lacked the ability to move independently, called motility. The Gabon fossils are roughly 1.5 billion years older than the previous earliest evidence of motility and appearance of animal life.
The Gabonese shale deposits have been a treasure trove, also containing fossils of the oldest-known multicellular organisms.
“What matters here is their astonishing complexity and diversity in shape and size, and likely in terms of metabolic, developmental and behavioral patterns, including the just-discovered earliest evidence of motility, at least for certain among them,” said paleobiogeochemist and sedimentologist Abderrazak El Albani of the University of Poitiers in France.
The identity of these pioneering mobile organisms remains mysterious. The fossils did not include the organisms themselves.
The tubular structures, up to 6.7 inches (170 mm long), originally were made of organic matter, perhaps mucus strands left by organisms moving through mud.
The researchers said the structures may have been created by a multicellular organism or an aggregation of single-celled organisms akin to the slug-like organism formed when certain amoebas cluster together in lean times to move collectively to find a more hospitable environment.
“Life during the so-called Paleoproterozoic Era, 2.5 to 1.6 billion years ago, was not only bacterial, but more complex organisms had emerged at some point, likely only during some phases and under certain environmental circumstances,” El Albani said.
In comparison, the first vertebrates appeared about 525 million years ago, dinosaurs about 230 million years ago and Homo sapiens about 300,000 years ago.
The evolutionary experimentation with motility may have encountered a setback relatively soon after the Gabon organisms lived because of a dramatic drop in atmospheric oxygen 2.08 billion years ago.
The research was published in the Proceedings of the National Academy of Sciences. -Reuters
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