Wall Street Journal - August 11, 2003
Mark Schoofs, Staff Reporter of The Wall Street Journal

While activists and doctors publicly applauded the move, they privately expressed skepticism, saying they would wait to see if the government actually delivers on its latest promise.

South Africa has more people infected with HIV than any other country -- an estimated 4.8 million at the end of 2001, or about 10% of the total population, according to a major study funded by Nelson Mandela's foundations. Yet President Mbeki has publicly questioned whether the drugs are too toxic, and even whether HIV causes AIDS.

As a result of that, and daunted by the high cost of treatment, the South African government has dragged its heels on providing the life-prolonging antiretrovirals.

Fifteen months ago, the South African cabinet issued a statement saying the drugs could prolong life if used correctly. But no action was taken, and a $41 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria that in part would have provided antiretroviral treatment was delayed several times. A cost study prepared in April, which showed the government could afford the drugs, wasn't addressed by the cabinet for months.

Last week was a watershed. The government signed the Global Fund deal, and a South African company, Aspen Pharmacare, announced it was producing the first generic AIDS drug in the country. Friday, the cabinet met in a special session to debate the long-delayed cost study. After the meeting, the government released a statement ordering the health department to finalize an operational plan to provide the drugs by the end of September.

The cabinet said former U.S. President Clinton's charitable foundation is giving it advice on the AIDS treatment plan. Through frequent phone calls, Mr. Clinton has urged President Mbeki to embrace AIDS treatment, say people close to Mr. Clinton and to South African AIDS policy making.

Still, the cabinet statement doesn't explicitly promise the government would provide the drugs, and Health Minister Manto Tshabalal-Msimang told local media that after the operational plan was finalized, the government still would have to look at the expense in order to make a decision, raising questions on whether such a plan would be carried out.

The fight to provide the drugs has been led by an activist group called the Treatment Action Campaign. The group's founder, Zackie Achmat, said in an interview that there was "a month of nail-biting" ahead to find out if the government actually would deliver the drugs.

Write to Mark Schoofs at mark.schoofs@wsj.com
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