Inter Press Service - November 30, 2001
Anthony Stoppard

Anti-retrovirals are generally accepted to reduce the impact of Aids on people with HIV and there is a 50 percent chance that pregnant mothers taking the drug will not pass the disease onto their children.

"The immediate and hasty provision of nevirapine to all pregnant women with HIV in public health facilities, could negate the potential benefits of the drug. It could even set back efforts to develop sustainable ways to prevent the transmission of HIV from mother to child," he says in a letter to his to the membership of the governing African National Congress, ANC, released Friday.

This week, the Treatment Action Campaign, TAC, took the government to court in a bid to force it to provide the anti- retroviral drug nevirapine in all public hospitals to prevent mother-to-child transmission, MTCT, of the Aids virus.

The Pretoria High court has promised to make its judgment before Christmas 2001. Ironically, the TAC was part of the court case in which government won the right to import or manufacture generic anti-retroviral drugs, which are cheaper than those produced by the international pharmaceutical companies that hold the patents for the medicine.

And, Europe's biggest pharmaceutical company, GlaxoSmithKline, is to slash 20 percent off the price of two key antiretroviral AIDS drugs in South Africa from next year, the company announced on Friday. Under its latest prices, a month's treatment of the drug Combivir will fall to 800 Rand from 1000 Rand. Treatment with the drug 3TC will drop to 640 Rand from 800 Rand. (1U.S. dollar equals R10)

The Chief Executive Officer of the company in South Africa, John Kearney, says they sincerely believe their HIV-AIDS medicines will now be more accessible to a greater number of people.

Nevirapine is currently available in South Africa's public health system as part of a MTCT pilot programme in 18 sites across the country.

Government says the programme aims to determine the operational needs for wider distribution of the drug, as well as its effectiveness, and long-term impact on patients. In its argument before the court the TAC said government's current policy was "irrational and irresponsible", that government had no plan for the expansion of the MTCT programme and that the refusal to currently provide nevirapine in all state facilities was a violation of the rights of such mothers and their babies.

Mbeki counters that: "While there is an inalienable right to access to health care, there is no inalienable right to a specific drug. Government has indicated that its aim is to have wide-scale implementation of the MTCT programme, which will be informed by the outcome of the research and the lessons learned at the 18 research sites."

He warns that government is not presently in a position to implement the MTCT programme on a wide-scale. The first few months of the pilot programme have shown a critical element of the success of the MTCT programme is the quality of HIV counselling and testing provided, which requires sufficiently trained counsellors and other resources in each site. Another lesson is that the gains of using a drug like nevirapine can be reversed by mothers breastfeeding their child, explains Mbeki.

"If the TAC case were to succeed in its application, and government is compelled to make nevirapine available to pregnant women with HIV who give birth in the public sector, women would not receive the proper counselling nor the six month supply of feeding formula, as this capacity does not exist throughout the country," he adds.

Despite the reasoned tone of his arguments, Mbeki is increasingly isolated in his stance on making anti-retrovirals available to pregnant mothers and those who need them. In addition to widespread criticism of his approach by opposition parties and community-based organisations, the parliamentary committee on the status of women in South Africa - which is dominated by ANC representatives - called for the public health service to make anti-retrovirals available to pregnant women. While recognising some risks, the committee found the benefits of making the drugs available to mothers, far outweighed any negative side-effects.

And, the ANC's political ally, the 1,8 million strong Congress of South African Trade Unions, Cosatu, has also taken up the call for anti-retrovirals to be made freely available.

It is estimated that over four million people in South Africa are living with HIV and Aids. This year, World Aids Day has been taken up with extra-ordinary enthusiasm by the media, business, labour and community based organisations. Government has taken up the slogan: "I care enough to act...do you?"

So far, many South Africans are not happy with Mbeki's answer. (ENDS/IPS/AF/HE/AS/SM)
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