Sunday Times, South Africa - August 20, 2000
Laurice Taitz

So it was not surprising that the statement last week by the Minister of Health, Dr Manto Tshabalala-Msimang, calling for the expansion to all provinces of research sites for Nevirapine - the drug used to prevent mother-tochild transmission of HIV - received barely a mention in news reports.

What should have been cause for small celebration was drowned out by the rest of the department's usual noise.

Tshabalala-Msimang was speaking after a two-day summit between government officials and HIV-AIDS researchers held to "reflect" on the 13th International AIDS Conference, which took place in Durban last month.

The prospect of the summit had raised expectations among researchers and activists as it had offered the first formal opportunity for the findings of studies on using Nevirapine to be discussed and, possibly, endorsed by top health officials.

While this was not the forum where decisions on moving ahead with such a programme would be made - this would fall to Cabinet - many hoped the meeting would break the policy deadlock in place since the former Minister of Health, Dr Nkosazana Zuma, on the instructions of Cabinet, announced that the government would not be implementing a programme to prevent vertical transmission of HIV.

But instead of firmly taking the reins and validating the work done by local researchers - which would have been a first - and acknowledging the need for action, Tshabalala-Msimang used the opportunity to reel off a long list of rehearsed statements that included recognising that poverty plays a role in fuelling the HIV/AIDS epidemic, that the government supports efforts to find an effective vaccine and that the Durban conference was a success.

Interestingly, she also noted that the Durban conference had affirmed the general approach of South Africa's national AIDS strategy.

One could be forgiven for thinking that the minister was talking about a different conference.

At the conference which the other 13 000 delegates attended, a number of key issues emerged. In session after session, activists, researchers and international experts repeated the same phrase: "We know what works." They were referring to, among other things, the use of anti-retroviral drugs to prolong the lives of those infected with HIV and prevention-of-vertical-transmission programmes which have reduced the rate of transmission to around 2% in developed countries.

It was a theme picked up by former President Nelson Mandela, who received a standing ovation when he said in his closing address: "There is a need for us to focus on what we know works. We need to break the silence, banish stigma, and discrimination, and ensure total inclusiveness within the struggle against AIDS.

"We need bold initiatives to prevent new infections among young people, and large-scale actions, to prevent mother-tochild transmission."

In saying this, he cleared the way - previously barred by its mismanagement and its defiant and unapologetic stance - for the government to take bold steps that would restore public confidence in its ability to handle the epidemic.

But no such action has been forthcoming.

Whether there is a need for mother-to-child-transmission prevention programmes was not debated at the conference. What was debated was the best way to pursue these and to achieve results.

What was clearly highlighted was that the developing world needs its own solutions. Drugs need to be affordable and easy to administer. Nevirapine first hit the headlines precisely for these reasons.

In the US and the UK, the standard of care in preventing HIV infections to newborn babies is a long, costly regimen of AZT.

In these countries, unlike in South Africa, there is no need to seek cheaper alternatives.

The World Health Organisation recommends that all countries should have a programme to prevent motherto-child transmission of HIV as part of a health package.

It is left to individual countries to decide which drug regimen should be followed.

The government clearly has reservations about Nevirapine, despite assurances by researchers that it is safe, easy to administer and does the job at an affordable price. But despite its reservations, it has made little movement on any other fronts to change the status quo.

While a lot of noise has been made about high drug prices, there has been little or no action on the part of the government to negotiate with drug companies to bring down prices or to pursue other measures that would force the hand of the pharmaceutical giants.

At the opening of the Durban conference, President Thabo Mbeki said there was "a desperate and pressing need to wage a war on all fronts to guarantee the rights of all our people to good health".

As any good general knows, waging a war involves strategy and tactics, fostering high morale among the troops and fighting to win.

Instead, the government has fumbled and backtracked, missed precious opportunities and failed to promote a vision of success.

Amid all of this, there has also been a lack of compassion or grounds for hope among the millions infected with HIV.

In war, leaving his wounded to the enemy would blight the career of even the bravest general.

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