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Bulletin of the World Health Organization

Print version ISSN 0042-9686

Bull World Health Organ vol.80 n.4 Genebra Jan. 2002 

Court orders South Africa to treat pregnant HIV-positive women with nevirapine

The South African government has received a court order to make the antiretroviral drug, nevirapine, available to all pregnant, HIV-positive women giving birth with public sector support. The government can, however, appeal against this order.

Nevirapine (and zidovudine) were included in the WHO Model List of Essential Drugs in 1999, for the prevention of mother-to-child transmission of HIV. Clinical trials have shown that short-course antiretroviral regimens using nevirapine alone, zidovudine alone, or a combination of zidovudine and lamivudine, substantially decrease the risk of HIV transmission to the child.

The order from the Pretoria High Court was the result of legal action launched by the Treatment Action Campaign (TAC), an AIDS activist organization. TAC's aim was to force the government to extend its prevention of mother-to-child HIV transmission (PMTCT) programme from its current 18 pilot sites.

TAC's two claims — that doctors in public service have the right to prescribe nevirapine to all their patients, and that the government has a duty to provide nevirapine to all public health facilities where the medicine is needed and can be properly used — were both upheld by the court last December.

The government is appealing against the decision on the grounds that the use of nevirapine is a policy matter and should be decided on by government, not the courts. In addition, the government argues that it needs more time to research the effectiveness of its PMTCT pilots, and that some of its health institutions lack the capacity to roll out the programme.

The court case has been a public relations nightmare for the South African government. Even its former liberation allies — most notably powerful religious organizations and the Congress of South African Trade Unions — took to the streets in support of TAC's court action. There is also widespread dissatisfaction within the ruling African National Congress (ANC) with government's AIDS policies.

Former president Nelson Mandela, a national executive committee member of the ANC, has been outspoken in his support for nevirapine to be made available to all pregnant HIV-positive women.

"If the government says `Don't make any move until we have completed our research', young people and babies are going to die in scores every day," Mandela said shortly after the government had been granted leave to appeal. "The government must allow people, while it conducts its research, to go anywhere they want (to get nevirapine). If we do that, we will remove the perception that we don't care about our people who are dying."

A few days earlier Mandela had commented: "We can't afford to be conducting debates while people are dying. We have to ensure that our people are given the drugs which are going to help them. This is a war." He called for anti-retroviral drugs to be made available free for all AIDS sufferers, not just pregnant mothers, in public health facilities.

As this report went to press, the government had still not delivered nevirapine to all its clinics and hospitals. However, the country's top HIV/AIDS official, Dr Nono Simelela, said that it was time to "move away from pilots and go to scale" with initiatives to fight the disease.

Kerry Cullinan, Durban



Note: Experience in the field suggests that an oral tablet of nevirapine for the mother can be taken at home at the onset of labour. However, it is essential that the child should be brought to a health facility within 72 hours of birth for an oral dose of nevirapine in suspension.