|Feb 20, 2002
SOUTH AFRICA: New Twist in anti-retroviral drugs debate
Efforts by the South African
government to engineer a politically acceptable climb-down from its opposition
to the provision of anti-retrovirals to people living with HIV and AIDS, have
collapsed in the face of objections by the national Minister for Health, Manto
Tshabalala-Msimang. The South African government has been refusing to make
anti-retrovirals - drugs known to reduce the transmission of HIV from pregnant
mothers to their children - widely available in the public health system on the
ground that they are toxic. South African President, Thabo Mbeki, has
repeatedly insisted that the drugs are dangerous, and has - controversially -
questioned the link between HIV and AIDS.
But former president Nelson
Mandela is fronting efforts by those in the ruling party who believe the moral
policy is to give the drugs to HIV-positive pregnant mothers and their babies.
Mandela has made it clear that there is no direct conflict between himself and
Mbeki. In a thinly veiled criticism of government's policy, Mandela has been
insisting that debates around the link between HIV and AIDS and the provision
of anti-retrovirals in the public health system, is distracting government from
its efforts to tackle the disease.
However, after a meeting between
Mandela and senior ANC officials, including Mbeki and Tshabalala-Msimang, a
statement was issued, saying: ''The meeting re-affirmed the correctness of the
positions taken by the ANC (the ruling African National Congress) and the
government. However, the meeting identified a weakness with regards to
communication on the AIDS issue.'' National government policy at present is to
only provide anti-retrovirals at a small number of pilot programmes where the
effectiveness of the drugs is being tested.
While most South African
and international experts acknowledge that anti-retrovirals are toxic, they
accept that the use of the drugs are essential to preventing the spread of the
virus and improving the quality of life of people living with HIV and AIDS.
In the face of outright rebellion against national policy in the
medical community, among its allies in civil society and the labour movement,
government appeared to be trying to engineer a climb-down from its opposition
to the use of the drugs.
With one or two exceptions, it has not taken
action against doctors in the public health system, who are supplying the drug
to pregnant mothers or rape survivors. Neither has it moved against members of
the Treatment Action Campaign (TAC) -- an anti-HIV and AIDS lobby group -- who
have been bringing in anti-retrovirals for use in clinics being run by
non-governmental organisations. TAC has been working with the Congress of South
African Trade Unions (COSATU) the 1.8 million strong labour ally of the
government, to bring in the drugs.
And, it has allowed two provincial
governments to expand pilot programmes, which are making anti-retrovirals
available through the public health system. In the Western Cape and
KwaZulu/Natal, the ruling African National Congress is part of provincial
coalition governments that are planning to make the drugs widely available in
their clinics and hospitals.
After a meeting of provincial and
national health ministers, it seemed as if a political compromise had been
reached between national government and the provinces, who are coming under
increasing pressure to make the drugs freely available - even if it was not
officially national policy.
On Feb 18, the premier of Gauteng, Mbazima
Shilowa, announced that over the next few months, all clinics and hospitals in
his province would make anti-retrovirals available to pregnant mothers and rape
survivors. He put R30 million aside to get the programme up and running.
Gauteng is the first completely ANC controlled province to announce that it
would make anti-retrovirals freely available to pregnant mothers, and more
significantly, Shilowa is known to have been a close political ally of Mbeki.
However, this did not stop Tshabalala-Msimang, from slamming the
province's decision. The ministry ''disassociates'' itself from Gauteng's
announcement, she said in a statement on Feb 19. But, to add to the confusion,
her statement came after the director-general of the national Department of
Health, Ayanda Ntsaluba, had expressed his confidence in the provinces ability
to expand its programme to make anti-retrovirals available to all pregnant
mothers. Even the spokesperson for the South African president, Bheki Khumalo,
expressed surprise at the health minister's statement.
At least two
other ANC controlled provinces have indicated they plan to make
anti-retrovirals widely available through their public health system, while
others are most probably quietly expanding their programmes without informing
the national department. (IPS)