South Africa takes first steps to provide antiretrovirals

For the first time, the South African Cabinet has acknowledged that antiretroviral treatments for HIV/AIDS - which stop the HIV virus multiplying in the body - may be a good idea for the one million people needing them in the country, and hinted that if it they are affordable it may provide them. According to the Cabinet statement, "antiretroviral treatments can help improve the condition of people living with AIDS if administered at certain stages in the progression of the condition, and in accordance with international standards".

In the past, key government officials, particularly President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang, have questioned the safety of antiretroviral drugs. In 2000, Mbeki told parliament that AZT was toxic, while this year Tshabalala-Msimang questioned the safety of nevirapine. Most AIDS activists have, understandably, been cautious in their welcome of the government's new position on the subject.

The Cabinet now says that it intends to tackle a number of challenges aimed at "creating the conditions that would make it feasible and effective to use antiretrovirals in the public sector". The challenges included the high cost of the drugs and the health infrastructure necessary to supervise and monitor the taking of these drugs. A task team made up of health and treasury department officials has been set up to investigate how much it would cost to introduce the drugs, the announcement, made on 10 October, adds.

Regulations allowing the importation and manufacture of cheap and generic drugs are to be introduced, and South Africa may work with a number of other African countries and pharmaceutical companies to manufacture affordable drugs on the continent. According to the Cabinet statement, the government plans to engage the private health care sector in discussion on the "costs, the impact, issues of resistance, compliance with drug prescriptions and so on" as a matter of urgency.

Treatment Action Campaign secretary Mark Heywood described the announcement as "significant", as it was the first time that government had made "concrete commitments" to extending access to antiretroviral drugs. The country's biggest trade union federation, the Congress of South African Trade Unions also welcomed the announcement as a step in the right direction but it recommended a wait-and-see approach: other government-appointed task teams have rejected various developmental initiatives on the basis of cost. Des Martins, chairman of the HIV Clinicians' Society, also said he wanted to see the commitment translated into action.

In April this year, the Cabinet announced that it would make antiretroviral drugs available as post-exposure prophylaxis to rape survivors. In addition, a court ruling ordered the government to extend its mother-to-child transmission prevention programme to all health facilities that have the capacity to give pregnant HIV-positive women nevirapine. However, delays in implementing these measures have resulted in widespread scepticism.

Meanwhile, HIV specialist François Venter estimates that universal provision of antiretroviral drugs will consume about 20% of South Africa's total health budget "which I don't think is excessive given that AIDS is the major cause of death in this country".

The government has submitted applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria for support for care programmes, including antiretrovirals, in three of the country's provinces (KwaZulu-Natal, Gauteng and the Western Cape).

Kerry Cullinan, Durban

World Health Organization Genebra - Genebra - Switzerland