Inter Press Service - Wednesday, February 10, 1999
Christina Stucky

''We feel very bad about the decision. It's very unfair,'' says a woman - one of an estimated three million South Africans living with HIV.

''If there was a new gun that the government wanted to purchase for South Africa then they would have done it and found the money for it,'' she adds as others around her nod in agreement.

''The government is only thinking of those who are not infected and they reject those who are infected,'' says another. ''This (providing free drugs) would have decreased the number of babies born with HIV'' - the virus that causes AIDS. They were among 25 pregnant women who sat awaiting consultation in the perinatal unit at the Chris Hani Baragwanath hospital recently.

All are HIV positive. And each hopes to be one of the lucky few who will receive the expensive AZT treatment, funded privately, to prevent their unborn child from being infected with HIV.

The unit, under Dr Glenda Gray and Dr James McIntyre, is involved in a United Nations study with 1,700 women in Africa who are being treated with two drugs - AZT and 3TC - that are known as antiretroviral (ARV) drugs in medical terminology.

The private donation - by a hospital in the United States - will allow for some 30 South African women to receive AZT to reduce the risk of mother-to-child transmission.

AZT is considered an effective means to reduce the 'vertical transmission' of HIV - from mother to new-born child - but it is too expensive for most people in developing countries, prompting the South African department of health's decision.

The issue of access to expensive AIDS drugs such as AZT in developing countries remains an area of deep concern for health activists, and the South African move has set off a wave of outrage among people living with HIV, AIDS activists and nongovernmental organisations.

''It's the only hope I have to save my child,'' says a woman expecting her first child. ''I want to see this child grow up.''

Two of the 25 women at the hospital say they are willing and able to contribute to the cost of AZT. The others say they would pay if they could.

But the government says it is so strapped for cash that it cannot even accept an offer by the pharmaceutical giant Glaxo- Wellcome to supply AZT at 70 percent below the market price.

''People can advance all sorts of arguments but the government won't make a commitment that it can't sustain. The bottom line is that the government does not have the money,'' says Vincent Hlongwane, spokesman for health minister Nkosazana Zuma.

The department of health will only reverse its decision if funds became available to expand it to all affected women in the country.

''If there is a windfall from somewhere, then the government might reconsider its decision,'' Hlongwane says. ''Governments have to take difficult decisions and this is one of them.''

Just how difficult the decision has been can be gauged from the fact that in 1998, an estimated 100,000 babies were born with HIV in South Africa - up from 65,000 in 1997.

And the figure is expected to rise, given that between 20 and 25 percent of pregnan t women entering the public health sector test HIV positive. For many NGOs working in AIDS, the 'bottom line' argument - that of cost - does not hold water. ''It's an unacceptable decision,'' says Morna Cornell, director of AIDS Consortium, an NGO.

Cornell says two costing studies conducted in South Africa showed that administering AZT to pregnant HIV positive women in the last four weeks of their pregnancies a nd during labour could help cut costs that would otherwise be incurred in long-term treatment.

''It costs about Rand 600 (102 dollars) per woman for the intervention and about R3500
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