IAPAC Monthly - Vol. 8, No. 3, March 2002
José M. Zuniga

One of the more lamentable paradoxes of our modern world is that while the marvels of technology and medicine yield potential to significantly enhance both the quality and duration of life, those in positions of political import often fail to harness the will and conscience necessary to make the most of these advances. Most of us remain incessantly bewildered by and horrified at the suffering and death that, sadly, is often caused not by want of either knowledge or means, but rather as a direct and indirect consequence of political complacency and bureaucratic rigidity.

The global AIDS community recently has watched as complacency and rigidity has foamed forth in South Africa, evidenced in the rhetoric employed by the country’s sitting government as it responds to demands that nevirapine be supplied for administration to HIV-positive pregnant women. Nevirapine—a single dose of which halves the likelihood of an HIV-positive woman transmitting the virus to her child at birth—has thus far been unavailable through national public health services.

In response to the government’s failure to supply nevirapine, a group of approximately 200 South African physicians—many of whom have been paying for and supplying the drug to women out of their own pockets—has cooperated with South Africa’s Treatment Action Campaign (TAC) to pressure the government to open up access to the drug. The debate over nevirapine seems to have brought them to an impasse with the government.

Since assuming leadership of the country in 1999, President Thabo Mbeki and his government have experienced numerous AIDS related political challenges. From the brouhaha following his questioning of AIDS’ causal agent, to a government-mounted defense to defeat an eventually retracted lawsuit meant to limit its ability to import generic drugs, the national political response has been spotty, at best. The government’s political response to this new dilemma has been far worse.

A December 2001 high court ruling that the government begin dispensing nevirapine to all suitable HIV-positive women in the country has only produced further controversy. And, despite national and international pressure, Mbeki’s government appears to be seeking reprieve from its duty by resorting to the politics of rhetoric.

The government had previously committed itself to putting in place mechanisms and regulations necessary to facilitate the import of generic AIDS drugs, and has now been further compelled by the high court to design a comprehensive strategy for reducing mother-to-child transmission of HIV. Yet, nothing to date has been forthcoming.

Petitioning the high court to reconsider its recent ruling on nevirapine access, the government stated both that numerous provinces can simply not afford to supply nevirapine, and that to give attention to HIV/AIDS concerns over and above other competing public health concerns would be unjust. These defenses only underscore an inexcusable resort to rhetoric instead of forthrightness.

In South Africa, a country in which an estimated 4.7 million people are currently infected with HIV—the highest national incidence rate in the world—HIV/AIDS constitutes a public health emergency, the gravity of which cannot be overstated. Thousands of South African children, women, and men are infected with HIV each day, and thousands die each week from AIDS-related illnesses. The arguments put forth by the government, therefore, constitute no less than an implicit death sentence for those living with AIDS.

My words here are not meant to reflect a concentrated and exclusive attack on South Africa’s government. In the dilemma it faces, as well as in its equivocal response to this critical public health emergency, Mbeki’s government has many partners on the global stage, both within and outside of the African continent. Rather, directing my gaze upon the epidemic of unparalleled national proportions that South Africa is faced with, this serves both as a call to conscience and a plea for action.

That the South African government may not have at its immediate disposal the funds to fully open up access to nevirapine and other antiretroviral drugs is a legitimate argument. So, too, is the point that the country faces other pressing public health issues.

These, however, are not acceptable excuses for inaction. Indeed, there is no acceptable excuse for inaction.

South Africa’s government must seek creative funding schemes and establish ethical and strategic alliances to expand and sustain drug access. And, where lacking in the capacity to fulfill its public health functions, the government must reach out to organizations that have at their disposal the energy, knowledge, and networks to provide critical technical assistance and capacity building.

Ultimately, the decision about whether to commit to such action is one that will record, for posterity, the true character of President Thabo Mbeki and his government—and, by natural extension, that of the citizens they govern.

José M. Zuniga is President of the International Association of Physicians in AIDS Care and Editor-in-Chief of IAPAC Monthly.

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