AIDS case tries S. Africa's resolve to confront disease

Drug sought to stop birth transmission

November 26, 2001|By John Murphy | John Murphy,SUN FOREIGN STAFF

JOHANNESBURG, South Africa - In 1999, Nolutando Makhaba, an unemployed mother living in a black township outside Johannesburg, received two pieces of news that changed her life: One, that she was pregnant. Two, that she had HIV, the virus that causes AIDS.

Doctors warned Makhaba that if she didn't take a vital anti-AIDS drug, she would likely pass on the human immunodeficiency virus to her baby. But the drug was expensive - about $400, a fortune for Makhaba. And the South African government that she depended on for her health care would not help.

So Makhaba did without the drugs and gave birth to a son, Banele, who was HIV-positive.

"He was not healthy at all," Makhaba, 37, recalled. "He had diarrhea, pneumonia. ... I asked God to remove my boy from the pain he was suffering. I asked God to take my son."

On March 22 this year, her son died. And in the months since, Makhaba has wondered how different his life might have been if she had had access to the vital anti-AIDS medicine.

This week, Makhaba's story will be part of a court case to force the South African government to supply HIV-positive pregnant women with medicine that would greatly reduce the risks of passing on the AIDS virus to their babies. Each year in South Africa, more than 70,000 babies are born HIV-positive.

If the government made the anti-AIDS drug widely available, it could save half of those babies, say AIDS activists who are taking the government to court.

But the case is about more than public access to a drug. The trial will force the South African government to defend itself against widespread criticism that it remains unwilling to confront the nation's mounting AIDS crisis.

South Africa has more AIDS cases than any other country in the world. More than 4.7 million South Africans are HIV positive, about 11 percent of the population.

The state-funded Medical Research Council said in a recent report that acquired immune deficiency syndrome will account for a third of all deaths in South Africa this year and will have killed between 5 million and 7 million people by 2010.

Earlier this year, the South African government won a celebrated court case against the world's pharmaceutical giants to force them to lower the cost of desperately needed AIDS drugs by allowing developing nations to produce cheap generic copies of the medicines.

But the government has yet to take advantage of that victory. Government leaders dismiss AIDS medications as too expensive and possibly toxic or unsafe, even though they are widely used in other countries. Meanwhile, South Africa's president, Thabo Mbeki, continues to express doubts over the link between HIV and AIDS, aligning himself with dissident scientists who believe that AIDS is not caused by a virus but a host of factors related to poverty.

At the center of the court case is a drug called Nevirapine. The anti-retroviral drug is approved for use in South Africa and available privately. Studies have shown that a single tablet of Nevirapine given to a mother during labor and a dose to her baby can reduce the chance of HIV transmission by up to 50 percent. It costs about $1 per dose, and the drug's German manufacturer, Boehringer Ingelheim, is offering it to South Africa for free for the next five years.

But the government has yet to accept the offer, choosing instead to conduct a two-year pilot study of the drug at 20 sites nationwide. The approach benefits just a handful of pregnant women who are able to participate, leaving thousands of poor women without access to the drug.

Members of the Treatment Action Campaign, known as TAC, a South Africa-based AIDS lobbying group leading the court battle, want the government to make the drug readily available to pregnant women nationwide. The group argues that Nevirapine is a safe, registered drug, and the government is endangering women's lives.

"The facts show that there is a medicine. That medicine is safe. That medicine is effective. That medicine would bring savings for the government if it were widely available. That medicine would protect women's rights," Mark Heywood, TAC's national secretary, said at a news conference last week.

In its defense, the government maintains that it should not be rushed into making Nevirapine widely available without first designing an effective system to ensure the drug is administered properly.

Government health officials also caution that a major drug campaign would be costly and strain its already overworked resources.

"We believe that it is inaccurate to say that government is refusing assistance to HIV-positive women who are concerned to protect their unborn children," said Ayanda Ntsabula, director-general of the South African Ministry of Health. "We have adopted a different approach to that demanded by TAC and other applicants in the court case. It is a more cautious approach, with a strong monitoring component, and one that takes a rigorous view of safety issues and effectiveness."

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