Belinda Beresford
As President Thabo Mbeki waded back into the controversy surrounding HIV/Aids, the government was preparing to defend itself in court against its former allies, the Treatment Action Campaign (TAC).
The TAC lawsuit accuses the national and provincial health departments of breaching the Constitution by failing to provide anti-retroviral drugs to HIV-positive pregnant women.
But strains between different levels of the government are appearing, with one province refusing to join the defence led by the national Department of Health and another appearing to be subverting the national department’s postion while still joining in the state defence.
The last time the TAC and the government were in court together they were effectively on the same side against the Pharmaceutical Manufacturers’ Association in the pursuit of cheaper drugs. This time the national Department of Health and eight of the nine provincial MECs will be in the dock facing the TAC.
The lawsuit says that denying HIV-positive mothers access to nevirapine or AZT drugs that can cut transmission of the virus to their unborn children by up to 50% breaches the constitutional right to life, and access to basic healthcare.
They also say the state is discriminating against black women because they are the vast majority of women using public antenatal facilities. The lawsuit also cites numerous other international conventions, including the Universal Decalaration of Human Rights.
The lawsuit has two parts. The one is to force the Ministry of Health to provide nevirapine within the public health service, while the second is to force the creation of a national treatment plan for HIV-positive pregnant women. Such a plan could include the provision of baby formula and counselling to prevent children contacting the virus through breastfeeding.
The Western Cape sent a letter to the TAC detailing its plans to roll out a comprehensive programme to combat mother to child transmission of HIV. It has separated itself from the other defendants, engaging separate lawyers .
Similarly the Gauteng director of public health, Dr Mmipe Modise, sent a letter listing plans to combat mother to child transmission to TAC.
Gauteng province has a number of sites either already in the process of, or preparing to provide such treatment, including the Perinatal HIV Research Unit at Chris Hani Baragwanath hospital. According to Modise, this unit alone will roll out to all maternal outpatient units in Soweto.
However, the Gauteng MEC will be joining the other provinces and the national Department of Health in defending itself .
The Department of Health has come under intense criticism for the lack of speed at which it has been acting to cut transmission of HIV from pregnant women to their children. It is estimated that up to 70000 children are born HIV-positive each year, and that half could be saved if their mothers were given nevirapine during pregnancy.
The manufacturer of nevirapine, Boehringer Ingelheim, has offered the drug free for this purpose. Studies worldwide have shown the efficacy of nevirapine and to date provided minimal risks in the form of side effects to mother or child, and the development of drug resistant virus.
A doctor who treats Aids patients said: “The treatment is safe, effective and cheap. There is no reason not to use it It is ridiculous that we give these children a cocktail of expensive vaccines and do not treat them with nevirapine. It makes no sense.”
Aids doctors and activists have criticised the government’s response to the HIV/Aids epidemic. Some have charged that Mbeki’s public questioning of the links between HIV and Aids, and the controversial public statements by some government figures, have handicapped attempts to at least slow down, if not curb, the impact of the virus.
This debate was fuelled this week with the leak of a letter written by Mbeki to the Minister of Health Manto Tshabalala-Msimang, in which he asked her to examine whether state health resources were being directed correctly to combat the leading causes of death. He used figures from the World Health Organisation (WHO) for 1995, which show HIV as the 12th-ranked cause of death.
In his letter Mbeki said: “Needless to say, these figures will provoke a howl of displeasure and a concerted propoganda campaign among those who have convinced themselves that HIV/Aids is the single biggest cause of death in our country.”
The WHO figures for 1995 are the latest the international organisation has from the South African government. The WHO’s own estimates are that 250000 people died of HIV in 1999.
A taskteam of different research and government organs is working on a strategy to create unified death statistics, due to be released in December.