The buzzing of a single mosquito is enough to break a good night’s sleep.
So imagine when that same sound is multiplied a hundred times – it can at best be described as eerie.
Especially when these mosquitoes are in a white mesh cage, in a vacuum-sealed laboratory, and it’s around feeding time.
It is at this opportune moment that Lizette Koekemoer, dressed in a red jersey and white lab coat, sticks her hand into the cage.
While most would squirm at the thought of dozens of mosquitoes making a blood meal of your arm, Koekemoer hardly seems to notice. For her, feeding mosquitoes is as normal as breathing; she has done it so many times she no longer gets itchy from the bites.
“When you are working on them, you learn to appreciate them as a living organism. When you put a mosquito under a microscope, they are actually beautiful. I think people laugh when I tell them I work on mosquitoes and I get paid for it,” says Koekemoer.
For 23 years, Koekemoer has been at the forefront researching these insects across Africa. She is part of the Malaria Entomology Research Unit on the 10th floor of the Faculty of Health Sciences building at the University of the Witwatersrand in Johannesburg.
Koekemoer’s passion goes beyond the laboratory to barbeques where she gets excited to tell you what species you’ve just squashed on your leg, having been bitten more times than most she would know.
The reason we are here today, in this sealed laboratory with Koekemoer’s arm in a cage and mosquitoes sucking her dry, is to talk about a mosquito called Anopheles vaneedeni, discovered by her team on the Makhathini Flats, in northern KwaZulu-Natal (KZN).
“Anopheles vaneedeni has been known about since 1977, it has never – before now – been identified as a malaria-carrying vector in nature,” says Koekemoer.
Up until now it was thought two other mosquitoes, called anopheles arabiensis and anopheles funestus, were the main vectors of malaria transmission. Vectors are living organisms that can transmit infectious diseases between humans or from animals to humans.
It is not just a new carrier species that has Koekemoer worried. On the rise are mosquitoes with an increased resistance to insecticides.
According to the scientist, conventional insecticide-based mosquito control methods, such as bed nets and repellents are now becoming redundant.
“A mosquito’s whole body is designed to keep it alive. If you have one female that has formed a resistance, when she lays eggs, you then have gene resistance going all over the place. You need to monitor this and then move on to a new insecticide to kill those ones.”
While these methods may have proven to be effective tackling funestus, which prefers to feed on humans indoors, it means arabiensis and now vaneedeni can never be completely eradicated. This is because both arabiensis and vaneedeni snack on people outdoors.
“All malaria species are active from dusk to dawn. That’s their peak period. As soon as the sun goes down, they start feeding. People socialize at night, when it’s warm. They don’t go to bed. Bed nets only protect you when you are sleeping. They don’t protect you when you are outside cooking and socializing,” says Koekemoer.
Sterilized males to combat malaria
Back in the lab, it is Koekemoer’s job to come up with ways of controlling malaria vectors. One of the team’s more radical solutions is sterilizing males with radiation.
“We’ve got a gamma radiator. So it’s fast and quick – 60 seconds. We put the pupae in a radiation chamber, put them on a jig and then one minute later, they are sterilized.”
Called the Sterile Insect Technique (SIT), Koekemoer wants to build a rearing facility that will pump out 50,000 sterilized males per week. Once nuked, these sterile males are reared and released into the wild to mate with wild females.
“At a small scale, it works really well. The key to this research is female mosquitoes mate only once in their lifetime and if the male is sterile, she will not produce viable eggs. It’s like birth control… In the lab we have up to 96% reduction in progeny,” says Koekemoer.
It has taken seven years of research to get to this point. Once built, Koekemoer estimates they would need R1.5 million ($113,000) to R2 million ($150,000) per year for SIT to run successfully.
“The thing to remember is a lot of research is done in colonized mosquitoes, in a controlled environment in a lab set-up. It’s difficult when you take this into the field, when your situation is a lot more complex and there is more than one species of mosquito,” says Koekemoer.
SIT was first used to control screwworm fly in America in the 1950s.
“It hasn’t been done with malaria, because malaria is complicated. Countries that are affected by malaria are also often not politically stable and financial resources are limited,” says Koekemoer.
The threat of new species?
Although vaneedeni’s emergence is worrying, it’s not yet time to panic.
“To put it into perspective, we collected a large number of species. So percentage wise, it’s not high. Out of the 3,000 we have collected, we had one KZN sample that was infected,” says Koekemoer.
Vaneedeni is also considered a minor vector because the mosquito prefers to feed on livestock rather than humans.
The question the team are trying to answer is why now? One theory they have is because of the changing environment in KZN. At the time the team found the mosquito, the area was drought-stricken.
“We need to look at the bigger picture of the environmental impact. Was it a once-off because it was so dry? That’s what we need to determine. Your environmental factors influence everything. Because there was drought, the impact on the number of cattle available, or the availability of water might have diminished, which is their preferred host and sites. If you are the only blood source, then the mosquito has no choice but to come to you and you could get affected,” says Koekemoer.
The field site is naturally isolated, between a mountain range and the ocean, in the Mamfene district 60kms from Sodwana and close to the town of Ndumu. A team member collects mosquitoes twice a week throughout the year. The mosquitoes fly into clay pot traps and are then catalogued by species.
“The fact that we now know about vaneedeni means we can target our research towards knowing more about this vector’s behavior,” says Koekemoer.
Until effective controls for outdoor mosquitoes are developed, eliminating local malaria transmission in southern Africa will be extremely difficult.
“Thanks to other malaria control measures, the number of cases is down to around 9,000 per year from over 60,000 in 2000, but it has proven hard to bring the insect population – and infection rates – down any further using the traditional method of indoor residual spraying,” says Koekemoer.
“There are countries that have resistance to all the classes of insecticides. There are only four classes approved by the World Health Organization for mosquitoes. In some countries, there is resistance to all four classes. It highlights the need to invest and start looking into alternative control methods.”
Coming up with new methods is a race to diffuse a ticking time bomb.
“These genes will eventually move into our borders whether it is the mosquito or the parasite, it’s only a matter of time, it will come into South Africa. You need to be one step ahead. If something happens, what’s Plan B? ”
Thanks to a buzzing mosquito in a pot and a little radiation therapy, scientists are a step closer to solving the malaria malaise. Until then, it’s sleepless nights for them.
Facts About Malaria
Malaria is a life-threatening disease caused by parasites transmitted to people through the bites of infected female Anopheles mosquitoes.
According to the latest WHO estimates, released in December 2016, there were 212 million cases of malaria in 2015 and 429,000 deaths.
The WHO African Region carries a disproportionately high share of the global malaria burden. In 2015, the region was home to 90% of malaria cases and 92% of malaria deaths.
In 2015, 91 countries and areas had ongoing malaria transmission.
Between 2010 and 2015, malaria incidence among populations at risk (the rate of new cases) fell by 21% globally. In that same period, malaria mortality rates among populations at risk fell by 29% globally among all age groups, and by 35% among children under 5.
Vector-borne diseases account for more than 17% of all infectious diseases, causing more than one million deaths annually.
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?
Is lack of access to safe abortion clinics creating a market for dangerous alternatives?
Clandestine clinics offering illegal abortions are one of the prime causes of unnecessary maternal deaths across Africa. The lack of facilities for safe procedures makes the statistics worse.
When the pain started, I called him. I begged him for help.I was bleeding so much. The pain became more and more severe. I could not sit,or stand or lie down. I could not move. He told me not to contact him again,that it was not his problem. He told me to go to hospital if I have problems. After that, I never got hold of him again.”
This is the story of Megan Naidoo (not real name), the survivor of an illegal backyard abortion procedure. Naidoo was seven weeks pregnant when her boyfriend forced her to have an abortion.
She lived with him and her father in a small two-bedroom flat on the outskirts of Kimberley in the Northern Cape province of South Africa. There are not many institutions providing safe abortions in Kimberley and Naidoo was afraid of shaming her Muslim father.
So, she took a bus to Johannesburg in search of a way out of her desperate situation. She had only about $144 for the trip. Her boyfriend gave it to her when he put her on the bus to Johannesburg and told her to return with a clean body.
As she walked through the city searching for someone to direct her to a designated facility, she came across a flyer, stuck to a lamppost. The flyer was advertising safe and painless abortions. At first, she did not realize what the flyer suggested. Then, she saw more flyers decorating electricity boxes, lamp posts, traffic lights and sidewalk walls; they were everywhere around her. “Safe 30-minute abortions, no pain guaranteed” the flyers beckoned her; “Phone ‘Dr Nick’ to make appointment”.
Although she was afraid of judgment, she managed to make the call. Back home in Kimberley, her family would have, in God’s name, stopped her from killing an innocent baby for selfish reasons. This is also what the nurse said to her when she first approached the local hospital in Kimberley for help.
But, this was not the reaction she got from the quack, ‘DrNick’, whose number was on the flyer. He told her there was nothing to be scared of and that he would make sure “everything is out” and she would have no pain at all.
She met Dr Nick in front of a dilapidated building entrance on Rissik Street, in Johannesburg’s gritty central business district. He told her to hand over the cash in an unnoticeable way.
Fortunately, she had set aside about $50 prior to their meeting. He handed her four tablets; two to put under her tongue, the third one was a suppository to be inserted immediately. He told her she would start to bleed after four hours and instructed her to then take the last tablet. She might experience a little pain, he advised, but nothing more than normal period pains. He told her to phone him if she needed him and then he left.
With nowhere else to go, she returned to the bus station. She took the tablets, and locked herself in the cubicle of a public toilet, near the station.
Four hours later, intense pain began. Six hours later, she started bleeding. The pain grew more intense with time. Naidoo phoned Dr Nick but he told her to go to hospital.
He also instructed her to tell the hospital staff that she had been to Marie Stopes, an international non-governmental organization (NGO) that provides safe abortion services. The third time she phoned, Dr Nick’s phone was switched off and he never answered again.
Naidoo had eventually bled out pieces of her uterus when she was found by the bathroom cleaners who assisted her, in the seventh hour of the severe pain.
They took her to a nearby clinic where health workers were unwilling to assist and reprimanded her that she deserved the pain because of what she had done. The cleaners then took her by taxi to the Charlotte Maxeke hospital nearby. A gynecologist on duty said that Dr Nick’s tablets forced Naidoo into induced labor that eventually lasted 10 hours.
She is one of thousands of women across Africa who nearly died at the hands of illegal abortion providers.
In South Africa, reportedly, only 7% of the country’s health facilities provide abortions. This is due to the lack of trained staff and the conscience objection right given to all South Africans by the Constitution,which enshrines the freedom of conscience, belief and opinion.
Often times,women are chased away from hospitals due to hospital managers being against abortions. Access to safe abortions is hampered as often, there are fewer facilities that provide abortion services to women in their second trimester.
In Africa, only Cape Verde, South Africa and Tunisia permit abortions without restrictions as to reason.
As a result, the influx of pregnant women from across the continent seeking safe abortions, adds to the increased need for designated abortion facilities.
To top that, various African NGOs that have been providing the service were recently choked by American president Donald Trump’s implementation of the Global Gag rule.
This ruling caused all funding for safe abortion facilities, across the developing world, to dry up completely.Hundreds of NGOs and outreach programs providing services and information, in especially poor countries across Africa, had to close their doors and halt awareness campaigns. Also, any NGO receiving United States-aid and funding is not allowed to co-operate with an NGO if the latter is pro-abortion.
This means that pro-choice women in countries such as Malawi and Zimbabwe have nowhere to go to have safe abortions. In Zimbabwe, family planning clinics that provided various services including safe abortions, had to close down. Not only did this result in a lack of medical services in rural parts of Zimbabwe, women can no longer get their contraceptive medication from these clinics.
In Zimbabwe, Zambia, Botswana, Mauritius and Namibia,abortion is only available in certain circumstances. In Seychelles, Tanzania, eSwatini (formerly Swaziland), Malawi and DRC, abortion is only available in extremely limited circumstances. Abortion is totally outlawed in Lesotho, Angola and Madagascar.
By all estimates, the more African states fail female citizens, the more money is pocketed by fake doctors and other backyard abortion providers. The more money is spent in this underground market, the more backyard providers are attracted to the trade.
According to Whitney Chinogweny, Head of Communications and Public Relations at Marie Stopes Sandton in South Africa, 52% to 58% of abortions in Africa are performed by illegal abortion providers, contributing to 12% to 15% maternal deaths across the continent. Without sufficient funding, NGOs cannot create awareness around the dangers of illegal abortions.
Sometimes illegal providers overdose women, giving them mixtures of laxatives, aspirin and medication used for stomach ulcers. At times,backyard doctors remove the foetus using household equipment like wire hangers and fire tongs.
Once these con artists have taken their victim’s money, they usually disappear, never to be found again. They cannot be tracked or traced. They change phone numbers and change locations.
If African governments do not amend abortion policies and facilitate the establishment of designated institutions, NGOs will continue to be forced to deal with the challenges weighed down by limited resources.
J&J Loses Bid to Have $4.7 Billion Talc Verdict Set Aside, Vows to Appeal
Johnson & Johnson failed to persuade a Missouri trial judge to set aside a July verdict awarding a record $4.69 billion to 22 women who blamed their ovarian cancer on asbestos in the company’s Baby Powder and other talc products.
The healthcare company faces thousands of lawsuits over the safety of talc in its Baby Powder, a fixture of its consumer products division that has been core to J&J’s reputation as a family friendly company.
The trial was the first in which plaintiffs claimed that asbestos fibers in J&J’s talc caused ovarian cancer. It relied on unsealed internal company documents detailing J&J’s alleged knowledge of asbestos contamination since at least the 1970s.
The company, which says its Baby Powder does not contain asbestos and is safe, in a statement said the failed motion was merely a formal step required before appealing the verdict.
“The same judge has denied similar motions on prior verdicts in his court that were ultimately overturned by the appellate courts. We are confident this verdict will also be overturned on appeal,” J&J said.
Judge Rex Burlison in the ruling on Wednesday said the jury’s decision and the large award of punitive damages was justified based on J&J’s “particularly reprehensible conduct” as evidenced during trial. He denied the company’s request to overturn the verdict, saying the women had presented sufficient evidence to support the jury’s verdict.
A jury in July awarded $550 million in compensatory damages and $4.14 billion in punitive damages.
Reuters on Dec. 14 published a special report detailing the company documents that sent J&J shares tumbling. They have dropped more than 13 percent since Friday, wiping out more than $45 billion in the company’s market value.
Shares on Wednesday were off about 2 percent at $127.88.
Mark Lanier, the women’s lawyer during trial, in a statement said plaintiffs were pleased with Burlison’s decision.
The women and their families said decades-long use of baby powder and other cosmetic talc products caused their illness. They allege the company knew its talc was contaminated with asbestos since at least the 1970s but failed to warn consumers about the risks.
While plaintiffs in the long-running litigation in the past had claimed talc itself causes ovarian cancer, plaintiff lawyers in recent months shifted their claims to allege asbestos in the talc causes mesothelioma, a cancer closely linked to asbestos exposure, and ovarian cancer.
J&J denies that its talc products ever contained asbestos and says decades of studies and regulatory assessments show its talc to be safe.
Missouri’s appeals court has overturned two prior ovarian cancer talc verdicts against J&J on technical legal grounds, saying the decisions could not stand following a 2017 U.S. Supreme Court decision limiting where companies can be sued for personal injuries.
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The company in its September motion made a similar argument, telling Burlison that the women, the majority of whom were from out-of-state, had no right to sue in Missouri.
J&J also said Lanier during the trial “substituted proof and evidence with misleading and inflammatory graphics,” including an image depicting J&J pushing a woman off a cliff into ovarian cancer.
But Burlison in his Wednesday ruling said the cases rightly belonged in Missouri court due to J&J’s connection to the state.
More than 9,700 talc lawsuits, the vast majority of those J&J faces, allege asbestos-laced cosmetic talc caused ovarian cancer, while a smaller number claim its use led to mesothelioma. -Reuters
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