The New York Times - Saturday, December 2, 2000
Rachel L. Swarns

JOHANNESBURG -- After months of official indecision over how to confront the epidemic ravaging South Africa, the government announced today that it would make critical drugs available to people who have H.I.V. or AIDS.

In a deal signed today, World AIDS Day, the government agreed to accept a $50 million donation of the drug fluconazole from the pharmaceutical giant Pfizer. The drug, which treats a deadly brain inflammation and other AIDS-related maladies, will be provided free in public hospitals and clinics for two years.

Earlier this week, South Africa's government gave conditional approval for a drug for pregnant women that reduces the risk of transmission to the fetus of H.I.V., the virus that causes AIDS, according to officials at Boehringer Ingelheim, manufacturer of the drug, nevirapine.

Dr. Nono Simelela, who heads the H.I.V./AIDS unit in the Ministry of Health, confirmed today that nevirapine would be distributed to pregnant women soon.

Details about the drug distribution were sketchy, but they were welcomed by advocates and experts, who have criticized the government's lagging response to the virus, which has infected more people in South Africa than anywhere else.

During the last year, President Thabo Mbeki has confounded scientists by questioning the safety of commonly prescribed anti-AIDS drugs and the widely accepted causal link between H.I.V., the human immunodeficiency virus, and AIDS.

Prominent doctors, researchers and advocates around the world have accused the president of wasting time while people were dying. In October, Mr. Mbeki acknowledged that his public statements were hampering efforts to curb the spread of the virus.

Today, however, the government won praise for its efforts to provide expensive drugs free. In local pharmacies, one tablet of fluconazole costs about $17.

"Until now, it has been accessible only to people who could afford these extremely high prices," said Morna Cornell, director of the AIDS Consortium, which represents dozens of groups fighting the disease here.

This week, the United Nations reported that 25.3 million people in sub- Saharan Africa — the bulk of the world's infected — have H.I.V. or AIDS. This year alone, 2.4 million people in the region died of AIDS.

The good news is that the number of new infections seems to be stabilizing. In 1999, four million people became infected with the virus, the United Nations said. This year, the figure is expected to be 3.8 million.

But there is still a desperate need for affordable drugs. In South Africa, about 20 percent of adults — about 4.2 million people — are believed to have H.I.V. or AIDS.

Today, government officials pledged to continue to pressure pharmaceutical companies to lower prices for the developing world.

The Pfizer drug fluconazole is the only outpatient treatment for cryptococcal meningitis, the brain inflammation that affects 1 in 10 AIDS patients, officials said.

It is also highly effective in treating a fungal infection of the esophagus that afflicts about 20 to 40 percent of AIDS patients. The infection makes it painful to swallow and can result in severe weight loss and death.

Health officials said the drug would be available to all poor patients for two years. And even afterward, they said, Pfizer will continue to provide the drug to patients already taking it.

Sputnik Ratau, a government spokesman, said it was unclear when fluconazole would start appearing in public hospitals. Some advocates for AIDS patients criticized Pfizer and the government for not providing the drug to the minority of poor patients who are treated in private clinics.

Even less is known about how widely nevirapine, the drug that reduces H.I.V. transmission from mother to child, will be distributed.

Officials at Boehringer Ingelheim said the government offered only conditional approval of the drug on Thursday.

Kevin McKenna, the technical director at Boehringer Ingelheim, said he was optimistic that final approval would come quickly. The company has offered to provide the drug free for five years. Mr. McKenna said he hoped that distribution would start by February or March.

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