South Africa
AIDS drug rebellion in South African province

afrol News, 14 February - Lionel Mtshali, Premier of the South African province KwaZulu-Natal, has ordered that the drug Nevirapine, preventing HIV transmission from mother to unborn child, be given to all prospective mothers in the Province. As 40% of women giving birth in his province are now HIV positive, there was no time for testing all of them before distributing the drug.

Lionel Mtshali's provincial government is dominated by the majority Inkatha Freedom Party (IFP), which looks back on decades of tradition of black opposition to the ANC, South Africa's ruling party. Inkatha founder and leader, Mangosuthu Buthelezi, however rules in coalition with the ANC and now holds the office of South Africa's Minister of Home Affairs.

Minister Buthelezi announced KwaZulu-Natal's drastic change in AIDS policies in the South African parliamentary State of the Nation Debate on Tuesday. Buthelezi was especially disappointed by the continued refuse by President Mbeki to ensure the free distribution of HIV/AIDS drugs such as Nevirapine - essential in preventing the transmission of HIV to unborn children. 

The national government maintains its scepticism in these drugs and is having them tested nationally in a time-consuming process. On Tuesday, Health Minister Manto Tshabalala-Msimang reaffirmed this controversial policy. President Mbeki has also been noted for his reluctance in believing what he calls the "thesis" that the HIV virus causes AIDS. "You cannot attribute immune deficiency solely and exclusively to a virus," Mbeki holds.

Buthelezi told Parliament there were issues "omitted" in Mbeki's State of the Nation Address, which had "forced my party and me into soul-searching."

- I come from communities where people are dying from HIV/AIDS, Buthelezi told Parliament, and "in God's name, let us recognise our mistakes and correct them as soon as we can before our people pay too dire a price for them." 

For this reason, his party now had given its national chairman, Premier Mtshali of KwaZulu-Natal, "the firm instruction to order the immediate distribution of Nevirapine to all HIV-positive pregnant women in KwaZulu-Natal, so as to avoid their babies being born with a death sentence." 

KwaZulu-Natal is the South African province with the greatest percentage of HIV infection. Last year alone 80,000 people died of AIDS-related diseases and 40,000 babies were born HIV positive. "All those children could easily have been saved," a moved Buthelezi told Parliament. 

- For this reason, my party had to do what it did, Buthelezi defended his instructions counteracting national policies. "The Premier of KwaZulu-Natal has now instructed that henceforth health facilities in KwaZulu-Natal shall ensure that children are not born with a death sentence. He went to the full measure of what can in fact be done, and instructed that even in those areas where testing and counselling cannot take place at this juncture, Nevirapine be made available to all mothers whether or not they are HIV positive."

KwaZulu-Natal was therefore to distribute Nevirapine to all prospective mothers in the province, unless a mother chose to opt out of the programme by producing an HIV negative test. "We cannot wait for months, if not years, to have an infrastructure, which can determine the HIV status of women and provide them with the required counselling, as 40% of women giving birth in his province are now HIV positive," Buthelezi said.

Inkatha's national spokesperson, Reverend Musa Zondi, confirms his party is loosing patience with ANC's AIDS policies. "The reality on the ground is that people are being turned away from state hospitals and there is lack of access to essential medication," Zondi lamented last week. 

The South African government has not commented its dissident minister's announcement yet. Health Minister Tshabalala-Msimang however reaffirmed her government's restrictive AIDS drug policy on the same day Buthelezi made his speech. She defied the massive pressure from civil society urging the free distribution of Nevirapine in state hospitals by referring to the ongoing studies carried out in 18 pilot sites. "When you do research, the findings of that research must inform policy," she said.

The Treatment Action Campaign (TAC), which is leading the campaigns in South Africa to ensure access to HIV and AIDS treatment, has brought the government's Nevirapine policy to court. A December 2001 judgement instructing the state to implement a drug treatment programme for HIV-infected pregnant women and new-born babies was appealed by the government. 

TAC last week however filed a new application at the Pretoria High Court, seeking the court to order the immediate execution the part of its original judgement, stating the state had to "make Nevirapine available ... in public health facilities." 

Commenting on the importation of renowned generic AIDS drugs from Brazil by TAC and the trade union COSATU last month, ANC head of Presidency Smuts Ngonyama further clarified his party's stands on AIDS drugs. Bringing "untested drugs" into the country was "irresponsible," Ngonyama maintained. "Many people may die using untested drugs." TAC and COSATU however have announced they would continue to import cheap drugs "in defiance of the government, which has been reluctant to give them to AIDS sufferers," according to TAC.

Also other dissident voices are currently heard in South Africa. Western Cape Province, lead by Premier Peter Marais of the Democratic Alliance (DA), recently cut an international deal, enabling it to provide Nevirapine freely among HIV infected pregnant women.

Western Cape, possessing a significantly better infrastructure than KwaZulu-Natal, however will follow a much more restrictive policy distributing the drug. Nevirapine will not be immediately available to all, Hélène Rossouw from the provincial government told afrol News. Rossouw said the drug will be made available according to the Province's roll out programme prioritising areas of high prevalence. Testing, counselling and infant feeding programmes would follow the highly monitored distribution of Nevirapine.

While the ANC viewpoint on HIV/AIDS medication is increasingly attacked and isolated, the party whip still assures its policy is implemented in the most of South Africa, where the ANC has a comfortable majority. 

In the ANC-ruled Northern Province, for example, the AIDS epidemic is still treated in "conventional" ways, by a South African scale. Premier Ngoako Ramatlhodi this week informed the provincial legislature the AIDS campaigns were going well. "In the coming year, we will continue to spread the key messages of abstinence, faithfulness to partners and condomising," Ramatlhodi said.

On the medical treatment of HIV positive pregnant women, Ramatlhodi only said his government was "examining the possibility of expanding the trials to other institutions, particularly to our 6 major district hospitals." No immediate actions were mentioned.

Sources: South African govt., Inkatha, TAC, AEGIS and afrol archives 

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