Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Mail & Guardian (Johannesburg) - February 26, 1999
Charlene Smith
In South Africa, one in five babies is infected with HIV at birth - around 60 000 babies - and most will die painful deaths before the age of two. It would cost a mere R50 per child to buy the drugs that could save many lives.
The test case could be based around a pregnant HIV-positive woman who wants AZT to increase the possibility that her child will be born HIV-negative. Alternatively, or in addition, Cals and Napwa will challenge a decision by the Gauteng Department of Health to halt a research project at Coronation hospital, where the gynaecological department was using the drug on HIV-positive pregnant women to test how effectively transmission rates could be slowed by using AZT in the final month of pregnancy and during the birth. Their method involves a total cost of R400 for the drug to mother and baby.
The most recent research conducted at King Edward hospital in Durban and Chris Hani Baragwanath's HIV perinatal unit - as part of a wider two-year United Nations international study, the Petra study - showed that mother- to-child transmission could be cut by 50% if the drug was administered with another drug, 3TC, at the time of birth and for seven days only, at a cost of R50.
Despite the fact that pharmaceutical company Glaxo-Wellcome is offering AZT to the South African government at 75% below the world price and have offered to hold it at that price for the next five years, Zuma is refusing to make the drug available to hospitals.
At a cost of R50 - basing treatment on the Petra study - it would cost the government around R14-million a year, or at R400 - based on the Coronation model - it would cost R112-million a year.
Most babies born with HIV become extremely ill and will die within their first two years of life after numerous hospitalisations. The cost of daily paediatric hospital care in a state hospital alone is R400; the monthly cost in a hospice such as Cotlands is R2 500 a month. A third of all children being admitted to Gauteng hospitals at present are HIV-positive. Supplying oxygen to children at home has also stretched health services.
Around 70% of the paediatric deaths at a Johannesburg hospital are from Aids, and that particular hospital reports that the strain on its budget owing to Aids in paediatrics is increasing at around 20% a year.
The New National Party provincial government in the Western Cape is currently defying Zuma and making AZT available at clinics in Khayelitsha.
Mark Heywood of Cals said it did not agree with the Department of Health ruling: "Dr Zuma does not understand the issues. These drugs should be given during birth and in the week post-birth.
"While some argue that because of abortion the right to life argument cannot be used, we believe that the issue is different, this is not about a foetus, it is about a baby about to be born. If the mother has continued with the pregnancy, it is a child she desires.
"By presidential decree, pregnant women and children under the age of six are entitled to free health care - this seems to discriminate against those born to mothers with HIV."
Heywood said they were proceeding with caution with the case because they believed it had important implications not just for HIV but for other basic cost-effective treatments that could curtail tuberculosis and pneumonia. Peter Bussy of Napwa said that lawyers had already written to the Gauteng Department of Health asking for reasons why trials at Coronation hospital had been stopped.
Requests for comment from Gauteng MEC for Health Mondli Gungubele were unsuccessful.
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