September 27, 2001

S. Africa to Fight AIDS Lobby on Nevirapine Demand

By Brendan Boyle

CAPE TOWN (Reuters) - The South African government will oppose a court bid by AIDS campaigners to force it to provide drugs that cut mother-to-child HIV transmission at birth, Health Minister Manto Tshabalala-Msimang said on Thursday.

``Yesterday was the deadline for us to respond. We have indicated that we intend to oppose their case,'' she told reporters at a briefing.

The Treatment Action Campaign (TAC) is demanding that the government start a national program to distribute a key antiretroviral drug called nevirapine to help cut the number of children born with the human immunodeficiency virus (HIV) that causes AIDS.

Earlier this year, the TAC fought alongside the government in a successful court battle for the right to manufacture copies of patented drugs in South Africa and to buy branded drugs at the best prices available anywhere in the world.

Now the TAC says the government is dragging its heels on a key intervention to cut the HIV infection rate, which already is estimated at one in nine with close to 5 million people already carrying the virus. Experience in other countries indicates that nevirapine given to an HIV-positive mother during delivery significantly cuts the rate of infection amongst babies.

South Africa has more people living with HIV and AIDS than any other country in the world.

Tshabalala-Msimang said the government would continue a pilot study at 18 clinics around the country, monitoring the success of the single-dose nevirapine intervention at childbirth and its influence on resistance for 2 years before deciding whether to extend the program.

She said cultural and other issues also had to be managed, citing community reaction to women who, in line with the non-transmission strategy, do not breast-feed their babies.

``In our culture, a woman who gives birth and does not breast-feed raises eyebrows,'' she said. ``If you don't have support systems on the ground, this program will just fall flat on its face.''

South Africans rarely admit publicly to being HIV-positive because it usually leads to social isolation and sometimes even to physical attacks or murder. President Thabo Mbeki has stirred international controversy by questioning the link between HIV and AIDS and by saying that violence and not AIDS was the biggest single cause of death.

Tshabalala-Msimang said the government was not considering any other use of antiretroviral drugs in the public health system because their use remained too expensive.

She said drug treatment of adult AIDS cases required expensive drug cocktails and regular clinical monitoring and blood sampling for life to prevent the development of drug-resistant strains.

``We just cannot afford the medicine. If I want to buy antiretrovirals, I would have to forget everything else, even at the reduced costs that are being talked about,'' she said.

Several major pharmaceutical companies have offered South Africa AIDS drugs at cut prices, but the government has not yet accepted, saying the health system cannot afford the monitoring that goes with their use.