PRETORIA, South Africa - South African AIDS activists won a major court battle against their government yesterday, as a judge ruled that public health officials must supply pregnant women with a drug that can protect their babies from becoming infected with the AIDS virus.
Applause and cheers filled the courtroom here when Judge Chris Botha delivered the ruling that will make the drug nevirapine available nationwide in public hospitals and clinics.
For the government, yesterday's ruling was a humiliating defeat. With more AIDS cases than any other country, South Africa has been widely criticized for its reluctance to respond to the mounting health crisis. President Thabo Mbeki has questioned the link between the human immunodeficiency virus and acquired immune deficiency syndrome and rebuffed calls by activists for access to lifesaving anti-AIDS drugs, dismissing them as too costly and possibly toxic.
Yesterday's ruling forces the government for the first time to dispense one of these sought-after drugs to its citizens.
A single tablet of nevirapine given during labor to a pregnant woman who is HIV-positive - and one dose given to the newborn - can reduce the risk of passing on the infection to the child by as much as 50 percent.
Each year, 70,000 babies are born with the AIDS virus in South Africa. More than 4.7 million people in South Africa are infected with the virus, about 11 percent of the population.
The government has allowed only limited use of nevirapine in its hospitals, saying the treatment is too costly and possibly unsafe. Health officials now offer the drug as part of a pilot project in 18 sites around the country. The project, which includes counseling, AIDS testing and other support, reaches about 10 percent of the 1 million mothers who give birth each year in South Africa.
Treatment Action Campaign, known as TAC, a South African AIDS advocacy group, took the government to court last month to make the drug available to all pregnant women who are HIV positive.
During a hearing in November, the group's lawyers denounced the government's position as immoral and unethical, noting that nevirapine is a registered drug and has been offered to the government free of charge by its German manufacturer, Boehringer Ingelheim. The government never accepted the offer.
After the ruling was announced, activists applauded, cheered and hugged each other in the courtroom. "We made history today," said Mark Heywood, TAC's national secretary, as he stepped out of the courthouse. "It's a judgment that will bring hope to tens of thousands of pregnant women with HIV."
Government officials did not appear in court yesterday to hear the decision and could not be reached for comment.
Dr. Haroon Saloojee, one of the pediatricians who filed the lawsuit, praised the ruling as a liberation for the country's doctors, who have been unable to use the life-saving drug. "We have been shackled for too long by our policy-makers. Now we are free to do what we are best trained to do, and that is saving our babies," he said.
In a 72-page decision, Judge Chris Botha rejected the government's concerns over nevirapine's possible side effects. Although some studies found side effects such as skin disease and liver problems associated with long-term use, nevirapine is only taken one time, Botha noted. "In view of all this evidence there is in my view no justification to suggest ... that nevirapine should not be made generally available to the South African public," he wrote. "It can be made available for general use."
How soon distribution of nevirapine to all HIV-positive pregnant women will begin is unclear. The court gave the government until March 31 to present a plan for making the drug available in all public hospitals and clinics. The government has said a large-scale program may be difficult.
During the original hearing, government lawyers argued that the public hospitals lacked the staff to administer the drug. They also argued that mothers would still risk passing HIV to their children through their breast milk. The government provides baby formula to mothers in its pilot project to prevent breast milk transmission.
As part of yesterday's order, the court asked the government to make formula available to all HIV-positive mothers.