Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
The Associated Press - November 16, 1999
Shaun Benton
Giving perhaps the most detailed explanation yet of her reasons, Manto Tshabalala-Msimang told Parliament the nation's health policy rests on the "affordability and appropriateness" of treating people with HIV or AIDS.
The government must "ensure that we provide the people in our country who are living with HIV/ AIDS with treatment that is not only clinically effective in dealing with the progress of the disease but also cost effective, in terms of what we can afford," Tshabalala-Msimang said.
There has been a major debate on AIDS treatments in South Africa, with researchers and AIDS activists calling on the government to provide AZT to HIV-infected mothers to prevent transmission to newborns. Activists also have called for the anti-retroviral drug to be provided to rape victims.
President Thabo Mbeki told the legislature on Oct. 28 that there was significant evidence the drug was dangerous, a claim scoffed at by many researchers in South Africa and abroad as well as U.N. AIDS officials.
AZT is one of the oldest and most established AIDS drugs and researchers consider it a significant weapon in preventing mother-child transmission. It is approved in South Africa, the United States and scores of other countries.
South Africa has one of the world's worst and fastest-growing AIDS problems. Tshabalala-Msimang said Tuesday that up to 4 million South Africans are infected with the virus that causes AIDS, compared to a previous government estimate of 3.6 million. That amounts to nearly one-tenth the population.
Providing AZT, along with other drugs in the usual combination therapy, to all infected South Africans would far exceed the entire health budget, she said.
Tshabalala-Msimang also cited studies on the effectiveness of preventing mother-to-child transmission, noting that AZT reduced the risk for only a small number of newborns because up to three-quarters of babies born to HIV-positive mothers did not get the disease anyway.
"We don't know which babies will be in the healthy 75 percent, so we have to give the drugs to all mothers with HIV/AIDS," she said. Exposing so many healthy babies to potentially toxic drugs was not justified, she said.
But John Moore, an AIDS researcher at Rockefeller University in New York, said AZT's toxicity to infants is poorly supported by evidence, and that treating children with AIDS is much more expensive than paying for AZT to prevent infection.
"She simply doesn't understand what she's talking about," he said. "There's a moral issue. If you can prevent some (children) from getting a death sentence, then you should."
South Africa's health ministry is reviewing AZT's safety, a review manufacturer Glaxo-Wellcome says is unnecessary.
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