African Online Services (afrol.com), - February 12, 2001

Premier Peter Marais of Western Cape province is noted for his independent policies, himself being the only province leader not from the governing ANC party. Together with his party, the conservative Democratic Alliance (DA), he doesn't agree with President Mbeki's controversial stand on medical AIDS treatment. His provincial government has assured the first, free treatment programmes in South Africa.

Last month, Marais announced Western Cape was to receive five years of free nevirapine from the German-based pharmaceutical company Boehringer-Ingelheim. This would enable the province to treat between 5,000 and 6,000 HIV positive pregnant women, Marais told the press in Cape Town.

Marais announced the nevirapine would be made available to the 38 maternity facilities where the mother-to-child HIV treatment had been implemented. The anti-retroviral would also be distributed at all 101 baby clinics in the next few weeks.

H l ne Rossouw from the Western Cape government told afrol News the province would receive 5532 doses for the mothers and 5029 doses for the babies over the first contract year. Combining its own efforts and the donation, "the Province will have access to enough Nevirapine for all who need it," Rossouw said.

Boehringer-Ingelheim has offered all developing countries free Nevirapine for use in the MTCT programme for 5 years "with no strings attached," according to Rossouw. Applications are however reviewed according to several criteria.

The receiver has to document it posesses an adaquate programme of health care - especially antenatal care, care of mother and baby and infant feeding strategies - a logistic infrastructure to distribute the drug and a austainability of the programme after the 5 year period. "The Western Cape province's application was approved because it scored very highly on all the above criteria," Mrs Rossouw explained.

The Western Cape province was already committed to providing maternal-to-child transmission (MTCT) drugs to all pregnant women in the province before the Boehringer-Ingelheim deal. This had been also provided for in the province's 2002/2003 budget. "With this approval we will be able to re-direct over R250,000 which would have paid for the drug to the employment of extra staff and counsellors," Rossouw says.

Although the province now will have access to enough Nevirapine for all who need it, the drug will be immediately available to all. According to Rossouw, the drug will be made available according to the Province's roll out programme prioritising areas of high prevalence. "Following a systematic roll out programme will ensure that the women have access to the full package of care which includes Voluntary Counselling and Testing, counselling for feeding options and the free supply of formula for those mothers choosing to formula feed."

Reactions to the Western Cape's deal with Boehringer-Ingelheim have generally been positive, also by the Treatment Action Campaign (TAC), which is leading the campaigns in South Africa to ensure access to HIV and AIDS treatment. The organisation however had a few "reservations".

TAC executive secretary Nonkosi Khumalo told Eric Ntabazalila from the 'Cape Times'; "Donations by pharmaceutical companies usually have strings attached. It's good and we welcome the donation but Boehringer-Ingelheim must provide voluntary licences to generic companies so that there will be competition and the drugs would be cheaper".

Rossouw answers TAC's reservations by maintianing ,"There are absolutely no strings attached to the Nevirapine donation for use in MTCT." The province only had to to provide a progress report to Boeringer-Ingelheim twice a year.

Meanwhile, in Pretoria, TAC has filed a new application at the High Court in the case concerning the right of pregnant women with HIV to have access to Nevirapine on a national scale. TAC is seeking the court to order the immediate execution of an important part of its original judgement, which has been appealed by the national government. The relevant part concerns the order that the state "make Nevirapine available ... in public health facilities."

Asked to comment on the national government's policy on providing free Nevrapine, Rossouw only states; "Health is a provincial competence." Peter Marais has also been careful critisicing the national government directly, but has made it clear there could "be no talk about development when our children are dying of HIV and AIDS."
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