South Africa breaks through to realism on antiretrovirals for AIDS


The South African government has tripled its HIV/AIDS Budget to 1 billion rand (about US$ 90 million) in a single year. In doing this it hopes to keep the promise it made in April to provide free antiretroviral drugs to rape survivors. The government also promises to make nevirapine universally available to all pregnant HIV-positive women by December. Official sources say that the government has been trying to move away from the controversies that have dogged its position on HIV/AIDS for a considerable time.

Meanwhile a range of South African women's organizations, including People Opposing Women's Abuse and Rape Crisis, have launched a campaign to put pressure on pharmaceutical companies to reduce their drug prices so that the government can keep its promise.

South Africa has one of the highest rates of rape in the world, and the largest HIV-positive population in the world.

Antiretrovirals (ARVs) are expected to be available to rape survivors by late this year, once the Department of Health has finalized its national protocol on the treatment of victims of sexual assault, according to the Health Minister, Manto Tshabalala-Msimang.

The Cabinet's decision to make antiretroviral drugs available to rape survivors took many AIDS activists by surprise. A month prior to this, the ruling ANC's National Executive Committee had announced the opposite: that antiretroviral drugs to prevent HIV transmission following sexual assault or needle-stick injury "could not be provided in public health institutions" as their efficacy was "unproven".

The new decision represents a victory for a number of key government officials who have been working for months behind the scenes to improve the government's stance on HIV/AIDS. These officials include Ayanda Ntsaluba and Nono Simelela in the health department, Joel Netshitenzhe who is in charge of government communication, and three Cabinet Ministers: Tshabalala-Msimang, Essop Pahad, and Ben Ngubane.

At the Cabinet's annual retreat in January, ministers and top officials had voiced dissatisfaction with the government's handling of HIV/AIDS. Several ministers were given the task of preparing a document that could revitalize the national HIV/AIDS campaign. In February, President Thabo Mbeki told Parliament in his state of the nation address that his government was committed to "intensifying its comprehensive programme against AIDS", and was in discussions with some of the pharmaceutical companies to find new ways of making drugs more affordable.

While Simelela and Ntsaluba were drawn into preparing the new document on HIV/AIDS control, a court case instituted by the Treatment Action Campaign put the government under intense pressure to provide nevirapine to all pregnant HIV-positive women. Condemnation of the government's refusal to expand access to nevirapine came from several sources, including former President Nelson Mandela, old anti-apartheid ally Danny Glover, heads of South African missions abroad, members of parliament, trade unions, and ordinary citizens.

The new HIV/AIDS proposals gave the Cabinet a golden opportunity to send a message of hope to the nation. Some of its more important points are the following:

• Acceptance that ARVs can "help improve the conditions of people living with AIDS if administered at certain stages in the progression of AIDS".

• Commitment to continue efforts to reduce the cost of ARVs including discussions with drug companies, applying to the Global Fund to Fight HIV/AIDS, TB and Malaria for help, and investigating the production of generics. (According to the health department, the treatment of one million people would cost the government in the region of 7000 million rand - about US$ 630 million. The Actuarial Society of South Africa estimates that the country will have 6.5 million HIV-positive people by the end of 2002).

• The establishment of a Presidential HIV/AIDS Task Team consisting of Deputy President Jacob Zuma and Ministers Tshabalala-Msimang, Pahad and Ngubane.

• Revamping the South African National AIDS Council (SANAC), the multisectoral body charged with leading the national HIV/ AIDS campaign. The Treatment Action Campaign's Nathan Geffen said his organization would give "serious consideration" to becoming part of a genuinely representative SANAC.

• A call to people living with HIV/ AIDS to "partner with government" in monitoring the availability of drugs at health institutions to treat opportunistic infections.

Kerry Cullinan, Durban

World Health Organization Genebra - Genebra - Switzerland