Associated Press - Tuesday October 24, 2000
Ravi Nessman, Associated Press Writer

The announcement comes after months of angry debate over the government's often confusing response to the AIDS virus, which infects an estimated 4.2 million South Africans.

The guidelines are "an important step forward for ensuring optimal care for people living with HIV and AIDS," Health Minister Manto Tshabalala-Msimang said at a news conference in Soweto, south of Johannesburg.

Nine booklets detailing the guidelines will be distributed to health workers across the country. Of the nine, the booklet most likely to cause controversy is the one on prevention of mother-to-child transmission.

It recommends giving HIV-positive pregnant women vitamin supplements, treating their sexually transmitted diseases and performing vaginal cleansing during childbirth to help prevent HIV transmission. It makes no mention of anti-retroviral medications, which health experts consider the most effective treatment.

Morna Cornell, director of the AIDS Consortium, said the guidelines make no reference to the "range of anti-retroviral therapies that is extremely effective in preventing up to 50 percent of mother-to-child infections."

"Does this mean that government is absolutely refusing to consider these options?" Cornell asked.

Tshabalala-Msimang condemned the "narrow view" that those drugs were the only way to prevent mother-to-child transmission. She said the government would not offer the anti-retroviral drug AZT because it was too expensive.

The drug Nevirapine, however, is much cheaper, and the government will decide whether to offer it after completing nationwide tests, she said.

"At no time has South Africa said, 'We shall never, never, never give anti-retrovirals to pregnant women,"' she said.

Earlier this year, President Thabo Mbeki drew withering international criticism for associating with dissident AIDS theorists who doubt the existence of the disease or believe it is caused not by HIV but by illegal drugs and AIDS medication.

Health workers complained that Mbeki was hurting efforts to persuade South Africans to take preventive measures.

After repeated refusals to define his beliefs, Mbeki told Parliament last month that, though he believed HIV was not the sole cause of AIDS, the government's policy was "based on the thesis that HIV causes AIDS."

A government-sponsored fact book, to be distributed with the guidelines, says: "HIV is the beginning stage of infection. When the immune system becomes very affected, the illness progresses to AIDS."

Mbeki has reduced his involvement with the issue and the government has launched a $275,000 advertising campaign to clarify that safe sex and abstinence are important weapons against AIDS. It has also agreed to expand its Nevirapine trials.

Nevertheless, the government's response to the AIDS pandemic remains the subject of near daily controversy here.

The opposition Democratic Alliance has promised to provide anti-retroviral medication to HIV-positive pregnant women and rape victims in municipalities where it wins control in Dec. 5 local elections.

The ruling African National Congress has accused the alliance of using AIDS for "political grandstanding."

Last week, the Treatment Action Campaign, an AIDS activist group, said it would ignore patents held by multinational drug companies and import cheap, generic AIDS medication on its own.

The government has resisted pressure to import generic drugs or to license local companies to produce cheap versions of AIDS drugs here.

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