The South African government must provide free treatment to HIV-positive pregnant women to reduce the risk of transmission of the virus to their babies, the country’s high court has ruled.
A single dose of the drug nevirapine given to the mother during labour and to the baby within 72 hours of birth can slash the rate of HIV transmission by half. According to an official survey, one quarter of pregnant women in South Africa are HIV-positive.
German manufacturer Boehringer Ingelheim has offered to provide nevirapine free to South Africa for five years. But the government has long argued that the cost of distributing the drug is prohibitive. Contrary to the findings of widely accepted research, it has also questioned nevirapine’s efficacy and maintained that the risk of serious side effects is unclear.
“We have made history,” said Mark Heywood, a spokesman for the Johannesburg-based Treatment Action Campaign, which brought the court case. “Now we have the potential to save the lives of 50,000 babies next year.” The government would make no immediate comment on the judgement.
Advertisement
Mother’s milk
The government now has until 31 March 2002 to draw up a plan for a national nevirapine programme. But even critics of the government’s HIV stance say implementation of an effective programme will be problematic.
HIV can be transmitted in breast milk, so mothers treated with nevirapine will also have to give their infants formula feed. “In a poor country, there are difficulties in using formula feed – there are issues of cost and access to clean water, and there are other health benefits to using breast milk,” says Saul Walker of the UK’s National AIDS Trust.
The government will also have to employ more medical workers to ensure the safe administering of nevirapine to women around the country.
However, reducing transmission rates would cut the number of people needing medical treatment for AIDS-related illnesses. “In terms of overall cost-effectiveness, there is no doubt that if you can prevent transmission, that’s the thing to do,” Walker says.
“Irrational” rejection
The TAC has condemned the government’s official reasons for its rejection of nevirapine treatment as “irrational”. But the true reasons may be very different, Walker suggests.
“I guess they think that providing nevirapine would be the thin end of the wedge in terms of making antiretrovirals more widely available,” he says.
In April, the government won a landmark court case against pharmaceutical companies, allowing it to import and produce cheap generic AIDS drugs. But it says it cannot afford to provide even cheap drugs to the 4.7 million HIV-infected people in South Africa.
South Africa’s President Thabo Mbeki has also repeatedly questioned whether HIV causes AIDS. “These views have backed the government into a corner somewhat,” says Walker. “No government particularly likes to have been shown to be wrong over something.”
