Sunday Times (Johannesburg) - August 10, 2003
Lee-Ann Alfreds And Celean Jacobson

The government, lead chiefly by President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang, has spent five years procrastinating over providing the life-saving drugs.

It wavered between declaring drugs like AZT and Nevirapine, used with success to prevent mother-to-child transmission, highly toxic and saying it could not afford to make the medicines widely available.

Now the government says these drugs do help improve the quality of life of those suffering from the Aids and will make them available at public hospitals.

Some of the reasons for this decision are they say that new and cheaper medicines are available and that there are new opportunities to manufacture these drugs in South Africa.

Some of the milestones in the last five years which has lead to the government's decision are:

1997: Mbeki, then deputy president, along with the then-health Minister Nkosazana Zuma endorsed an anti-Aids drug, Virodene, one of the major constituents was dry-cleaning solvent. The Medicine's Control Council refused to sanction trials of the drug, raising concerns over the methodology and ethics of the drug.

1997: the South African government tried to obtain cheaper versions of the AZT drug treatment which is available in most western countries. It was blocked by the world pharmaceutical industry, which took up a law suite against alleged breach of intellectual property rights. But even after the companies agreed to charge lower prices, the government said it was unable to fund the drugs even for HIV-positive mothers and rape victims.

In June 1999, when Tshabalala-Msimang was appointed she vowed to put her weight behind stemming the tide of the pandemic and she was welcomed by the same people who had been marginalised by her predecessor.

Towards the end of the year, the health department released a five-year plan with a strategy for preventing mother-to-child transmission.

But then Mbeki made statements about the toxicity of AZT and the following January a new version of the plan was released and the objective of reducing mother-to-child transmission was no longer much of a priority.

In 2000, Mbeki started questioning whether HIV caused Aids and said discussion was necessary on the causes. In April of that year, he wrote to world leaders contrasting the spread of the disease in Africa through heterosexual contact to that in the West, where it first emerged in gay communities in America. Calling for an "African solution to an African problem", he said his government would not "condemn our own people to death by giving up the search for specific and targeted responses to the specifically African incidence of HIV/Aids".

Mbeki established an advisory committee/panel of Aids dissidents and mainstream scientists in 2000.

In July 2000, he opened the 13th International Aids Conference in Durban, saying that all South Africa's problems could not be blamed "on a single virus".

By the end of 2001, the government announced its decision to appeal against a High Court order that directed state health authorities to make Nevirapine available at all public health facilities.

This was after the Treatment Action Campaign had taken the Government to court in August 2001 for its refusal to provide antiretroviral drugs in state hospitals.

Tshabalala-Msimang said the decision to appeal against the court order was not because "we are against protecting babies from HIV" but because they felt it was wrong that the judiciary was dictating policy.

In July 2002, the Constitutional Court ordered that Nevirapine had to be provided in State hospitals to reduce the risk of mother-to-child transmission of HIV/Aids.

The government had asked the court to rule on the matter after the Pretoria High Court ruled three times that government must allow for national use of Nevirapine for pregnant mothers.

In April 2002, under huge pressure the government announced widely applauded plans to extend its provision of the drug beyond 18 existing pilot sites. But it said it would continue with its legal fight.

In January, Finance Minister Trevor Manual told the World Economic forum that South Africa would not be seeking money from the Global Aids Fund because the problem was not cash, but the lack of infrastructure to deliver treatment.

In January, Anglican archbishop of Cape Town, Njongonkulu Ndungane, slammed the government for "sinning" by withholding truth and maintaining the silence of denial" over Aids.

In February, former president Nelson Mandela waded into the dispute over the government's Aids policies by meeting the ruling ANC leadership to press for an end to the delay.

He told the Sunday Times: "This is a war. It has killed more people than has been the case in all the previous wars and in all the previous natural disasters. We must not continue to be debating, to be arguing, when people are dying."

On Thursday this week, the government finally put an end to its 18-month delay in signing an agreement with the Global Fund to Fight Aids, TB and Malaria - giving South Africa access to $41-million for the fight against the pandemic.

On the same day, Tshabalala-Msimang issued a conciliatory statement acknowledging that antiretrovirals "can help improve the condition of people living with Aids". The statement was a major departure from earlier utterances in which she indicated that she doubted the efficacy of the drugs.

On Friday, Cabinet announced it has asked the health department to prepare a plan for the provision of Aids drugs by next month.

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