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)


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