South Africa: activists, physicians sue government to prevent maternal transmission, ask international support.

On November 26 South Africa's Treatment Action Campaign (TAC), supported by about 200 doctors, sued the South African government, asking for wider use of nevirapine to prevent mother-to-infant transmission of HIV. About 70,000 infants every year are born with HIV in South Africa, and about half of these infections at birth could be prevented by a single tablet of nevirapine given to the mother, and a single dose to the infant. This lawsuit follows five years of lobbying by civil-society organizations.

The government is currently running a pilot program that offers testing, counseling, and nevirapine if needed to about 10% of pregnant women. It argues that it needs time to evaluate this program before expanding it; TAC says that the current program will not allow any expansion beyond the 18 current sites until at least April 2003. The government also says that it cannot afford antiretrovirals, because it has only $207 million a year to spend on public-sector medicines for the country of over 40 million people.

How you can support TAC in this case? At this time TAC is asking for letters to be sent to South Africa, and also for individuals and organizations to sign the Bredell Consensus Statement -- a statement on HIV treatment in South Africa, endorsed by participants of the Bredell Conference, which took place October 18 and 19. Since the situation will change over time, check their Web site, http://www.tac.org.za. This site also includes court papers and other background on the case.

Comment

It is widely believed that the real issue for the government is not the cost of the nevirapine for preventing maternal-infant transmission (which the drug's manufacturer Boehringer Ingelheim has offered free, although the cost of so little nevirapine would not be a baffler in any case), but that once the government provides the drug routinely to HIV-positive pregnant women, there will certainly be more pressure to also treat the mothers, fathers, and others. Antiretrovirals are heavily patented and expensive in South Africa. While generic nevirapine is available from India, which has different patent laws, the South African government is afraid to use compulsory licensing or other means to override patents and obtain drugs it can afford, due to fear of economic retaliation. While South Africa is considered a middle-income country, so much of its population is infected that it could not pay for widespread access at the high prices set by the manufacturers.

A related problem is that South Africa's President Mbeki personally has a hard time backing down from a position once he has taken it. In this case, he picked up conspiracy theories over a year ago from AIDS denialists who argued that antiretrovirals are inappropriate because HIV does not cause AIDS -- or because AIDS in Africa does not exist, and the deaths are due to other illnesses and to poverty instead. So officials under him are constrained in what they can do.

The result is that South Africa is not successfully making the plans, building the infrastructure, and getting the experience to deal with one of the highest rates of HIV infection in the world.