Global Policy Forum

By John Mkhize

South Africa says it will comply with a ruling by the country's top court that it must offer pregnant women immediate access to an anti-AIDS drug the government considers costly and dangerous.

The ruling on Thursday was the latest in a string of court defeats for the Health Department and a blow for President Thabo Mbeki, who has been widely criticised at home and abroad for disputing broadly accepted research on HIV, including whether it causes AIDS. The Constitutional Court dismissed the state appeal against last month's lower court order to dispense the drug nevirapine beyond the 18 pilot sites where its efficacy is being researched.

"Our intention is to ensure that facility managers and health professionals in ante-natal clinics are in a position to respond appropriately to this latest development," Health Minister Manto Tshabalala-Msimang said in a statement. The minister said the ruling did not force the government to extend the drug programme fully, but only to provide it at health centres with the facilities for effective intervention and in cases where doctors considered it medically advisable.

The lower court's order is binding only until the Constitutional Court has ruled finally on whether the state has a constitutional obligation to offer the drug. That hearing is scheduled for May 2-3.

MANDELA SPEAKS OUT

The decision came minutes after former President Nelson Mandela renewed his call for a reversal of the policy that denies most pregnant women access to the drug used to block transmission of the virus that causes AIDS during childbirth. "When people are dying -- babies, young people -- I can never be quiet," Mandela said in a radio interview. He said patients should be allowed to decide for themselves whether to risk using nevirapine and other anti-retroviral drugs.

South Africa has more people living with HIV/AIDS than any other country in the world -- 4.7 million people or one in nine of the population. AIDS activists estimate that up to 70,000 babies are infected during and immediately after childbirth every year and say the rate could probably be halved by a single nevirapine dose for mother and baby within hours of delivery.

"It's a relief and the beginning of mothers getting what they deserve," said Pholokgolo Ramothwala, a coordinator for pressure group Treatment Action Campaign, which spearheaded the legal battle. "But we feel we should have settled this a long time ago. It's unfortunate that it had to go to the Constitutional Court for the government to get the message."

CUTS AIDS TRANSMISSION RISK

Nevirapine is recommended by the World Health Organisation and other top international health institutions to cut the risk of mothers passing HIV-AIDS to their babies.

The Health Department has fought claims by activists that it has a constitutional obligation to provide the drug, saying it does not have the funds or the infrastructure and that it doubts the efficacy and safety of the treatment. Mbeki has said anti-retrovirals may do as much harm as the condition they are meant to treat and has appointed so-called "AIDS dissidents" who believe AIDS is caused by recreational drug use, to his advisory panel on the disease.

Germany's Boehringer Ingelheim, which makes the drug, has offered to provide Nevirapine free of charge in South Africa for five years, but the government is still doubtful.

U.S. Health Secretary Tommy Thompson told reporters in Pretoria on Thursday that Washington would give an additional $1 million (627,000 pounds) to South African trade unions to fight AIDS and announced the appointment of a health attache to its embassy. He said the United States did not share the South African government's reservations about nevirapine, but he stopped short of urging Pretoria to extend its use to combat the virus.