Inter Press Service - November 17, 1999
Sarah Sebalo

The decision, believed to have been significantly influenced by the South African government's position, was very disappointing, Aids NGOs and some medical experts said this week.

The SADC ministers met in Johannesburg early November to review a regional Aids-HIV strategy for the period up to 2003 which was put forward by a task team set up in April.

At the conference, World Health Organisation (WHO) officials presented current evidence showing that AZT and Nevirapine, which is more effective and cheaper than AZT and is being tested in South Africa, cut HIV transmission from mother to child by up to 85 percent.

But the ministers, from the 14-SADC nations, said in a joint statement they were "gravely concerned over the possible side- effects as a result of the toxicity of (AZT and Nevirapine) and the potential development of resistance to these compounds".

This week Health Minister Manto Tshabalala-Msimang told parliament South Africa could simply not afford to give AZT to infected people.

"At current prices, the cost of providing AZT to the estimated 4 million South Africans who are HIV-positive would be 10 times the country's total health budget," she said.

There were also still questions about the drug's safety. "We have absolutely no idea of what the effects are, either short-term or long-term, of using AZT, a known carcinogen, on healthy people. The use of AZT is, at the present time, illegal, apart from it being dangerous," said Tshabalala-Msimang.

Opposition has been mounting to the government's policy on AZT since it was first announced last year by then Health Minister Nkosazana Zuma.

A few weeks ago, President Thabo Mbeki's statements that AZT was unsafe stirred up a controversy locally and internationally.

Shortly afterwards the South African Medical Control Council, which is responsible for the safety of legal drugs, issued a preliminary report saying there were known side-effects to AZT, some potentially serious, but that at the moment the benefits outweighed the risks.

Tshabalala-Msimang said this week the MCC and an independent group of scientists approved by SADC health ministers would be tasked with reviewing AZT again. Opponents of the policy argue that withholding AZT for cost reasons is false economy as the average of 1600 new infections daily here mean an increasing number of HIV-positive newborns and the cost of treating them over an average lifespan of five years will fall mostly on the state.

Professor Alan Whiteside of Durban University's Economic Research Unit says the policy is shortsighted. "The government has not done its sums yet.... If we don't protect these children from infection we will be faced with them demanding care," he said.

An estimate from the University of Cape Town School of Economics found that healthcare provision will cost about 18 times per child what it would have cost for the state to have given AZT to enough women to save that child. The estimate was based on a course of AZT costing R400 -- manufacturer Glaxo Wellcome has subsequently dropped the price for a course to R50 or less. One US Dollar is equal to 6.1 Rand.

"It is certainly very expensive to care for children with Aids but we need a range of interventions - dealing with mother to child transmission is only one of them," Dr Liz Floyd of the National Aids Directorate says.

However, Aids activist Mark Decker counters that the long-term economic cost of Aids must become part of the equation involved in a policy on treatment. "There seems to be a big effort to minimise the cost of the epidemic but we have to start acknowledging the reality of what it will be," he says.

Seven percent of babies born here now are HIV-positive and 22 percent of woman going to ante-natal clinics are infected. In 1991, only about 0,6 percent of the country's 43 million population was HIV-positive.

South African Aids researcher Salim Karim told a meeting of the Commonwealth Medical Association Trust in the port city of Durban last week that the epidemic in South Africa had not yet begun to level off and would definitely worsen. "Thousands of lives could be saved if the government spent R20 million a year on treatment," he said.

The South African Human Rights Commission has called a meeting with Tshabalala-Msimang to probe the issue of whether denying the drug to pregnant women violated their constitutional right of access to healthcare.

And the issue will surface again next month in a court case against Dr Costa Gazi, head of public health at a major Eastern Cape hospital, who faces charges laid against him by the health department for his outspoken public opposition to the AZT policy.

Gazi charges that the policy amounts to a failure to serve the country's poorest.

A recent report from the US Investor Responsibility Research Centre on the economic impact of South Africa's Aids epidemic maintains the government is unlikely to divert from its commitment to fiscal discipline to borrow or introduce new taxes as the cost of providing healthcare for Aids infected people rises.

Instead there is likely to be a shift in the standard of state healthcare. "The overwhelming financial burden of treating Aids infected people could see minimum ethical standards of healthcare replacing present standards," Whiteside says. "We may have to move from trying to prolong life at any cost to ensuring that people's lives are free of pain or discomfort".

The government has no long-term system yet in place, but a form of homecare for people with Aids would be in line with its present thinking, health ministry spokeswoman Nothemba Dlali says.

A final decision on AZT and Nevirapine will be made early next year after tests end.

About 1.7 million young people are infected with Aids every year in Africa; a majority of these new infections occur in southern Africa, according to the UNAIDS.(END/IPS/ss/mn/99)
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