South Africa
ANC might bow to pressure on AIDS drugs

afrol News, 21 February - Gauteng is the third South African province to counter national policy on Nevirapine, the anti-retroviral drug preventing HIV transmission from mother to unborn child. However, Gauteng is the first province governed by the ANC party to do so, causing massive reactions from the party central.

Although South Africa's smallest province in land surface, Gauteng is not just any other province. Gauteng is the urban heart of South Africa, housing the cities of Johannesburg, Soweto and Pretoria, the national capital. "Gauteng", meaning "Place of Gold" in Sesotho language, is where the country's thriving gold industry was sparked off by the discovery of gold in 1886. Gauteng now accommodates 22 percent of South Africa's population and accounts for about 40 percent of its GDP. And it is a stronghold of the ANC, the national ruling party of President Thabo Mbeki.

The provincial government of Gauteng this week followed the opposition led provinces Western Cape and KwaZulu-Natal in opposing national policies on HIV/AIDS drugs. "During the next financial year, we will ensure that all public hospitals and our large community health centres provide Nevirapine for the prevention of mother to child transmission," Gauteng Premier Mbhazima Shilowa said, opening the Gauteng Provincial Legislature on Monday.

- Our long-term objective is, to make it possible for pregnant women throughout Gauteng to access the full package of care within a reasonable distance from their homes, Shilowa announced. "An amount of R30 million will be made available to back our words with action." 

Shilowa was however careful not to criticise the national government - on the contrary - he legitimised his decision with President Mbeki's recent State of the Nation address. Mbeki thus had opened for those provinces having an adequate health infrastructure to expand their Nevirapine programmes. 

The national government's viewpoint however remains that these programmes only are for doing research on the effects of Nevirapine. A general distribution to all HIV infected prospective mothers was still out of the question, as the drug still is perceived as "toxic" by the government. Mbeki still insists that anti-retroviral drugs are dangerous and even questions the link between HIV and AIDS.

The national Minister for Health, Manto Tshabalala-Msimang, keeps holding tight on the ANC's controversial AIDS drugs policy. In a statement issued on Tuesday, she said her Ministry "disassociates itself from Gauteng Nevirapine roll-out programme." In the Minister's view, the programme was "in breach of" earlier resolutions and agreements of "setting out the envisaged roll out programme based on the experiences and lessons learnt from the agreed upon research sites."

Tshabalala-Msimang reacted at a time when it was perceived that the rigid national policy on anti-retrovirals was bound to crumble. Massive attacks had been launched by civil society, provincial governments, trade unions, the church, health personnel, government ministers and from within ANC itself. A slowly progressing undermining of the policy was noted throughout the country.

Last month, the ANC allied trade union COSATU had participated in the importation of generic AIDS drugs from Brazil by TAC. The Ministry of Health remained silent and did not move against the distribution of the drugs. Only ANC head of Presidency Smuts Ngonyama protested over the "irresponsible" act of bringing "untested drugs" into the country. 

In the last week of January, the opposition-dominated province Western Cape signed a contract with the German company Boehringer-Ingelheim, providing 5 years of free Nevirapine distribution for the province. Western Cape Premier Peter Marais announced Nevirapine would be made available to the 38 maternity facilities and would be distributed at all 101 provincial baby clinics. The Ministry of Health did not protest.

On 12 February, South African Minister of Home Affairs Mangosuthu Buthelezi, also leader of the Inkatha Freedom Party, held an emotional speech in Parliament. He had instructed Lionel Mtshali, Premier of the Inkatha ruled province KwaZulu-Natal, to distribute Nevirapine to all pregnant women of the province, "unless a mother ... produces an HIV negative test." 

- 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, Buthelezi told Parliament, explaining his dramatic answer to the "emergency" in KwaZulu-Natal, where over 40 percent of women giving birth are now HIV positive. Still, there was no reaction from Minister Tshabalala-Msimang. 

With one or two exceptions, the Ministry of Health has not taken action against doctors in the public health system, who are supplying anti-retrovirals to pregnant mothers or rape survivors. 

Opposition within the ANC was a different thing, though. When the popular ex-President Nelson Mandela, South Africa's moral godfather, entered the debate to try to change the ANC's AIDS drug policy, quick action was taken. A meeting was arranged between Mandela, Mbeki, Tshabalala-Msimang and other senior ANC officials, resulting in a statement saying it had "re-affirmed the correctness of the positions taken by the ANC and the government. However, the meeting identified a weakness with regards to communication on the AIDS issue."

Gauteng's decision to break with ANC AIDS policies was thus too much for Minister Tshabalala-Msimang, slowly loosing her face. The announcement however clearly demonstrated the split within the ANC, thus far denied by Mbeki and Mandela. 

Gauteng Premier Shilowa is known to have been a close political ally of Mbeki, and yesterday he announced he would meet the Health Minister and "was confident that the concerns raised would be effectively addressed." The Gauteng Social Services Ministry yesterday further made it clear that the fight against HIV/AIDS was "a battle we are not ready to abandon."

As the internal discussion within the ANC gets louder, new arguments are being presented. Finance Minister Trevor Manuel today warned about the cost of providing anti-retrovirals nationally, speaking on SABC radio. Manuel said that "given the cost of it on a sustainable basis, we would have to devote virtually all of the health budget to just dealing with it."

The South African government was involved in a range of programmes on AIDS, Manuel maintained. "For whatever reason, the debate on anti-retrovirals seems to be the only thing that people think deals with Aids. We don't at this stage have a cure for it - all that you can do is ameliorate, and that's what anti-retrovirals do. They don't cure."

These arguments by Manuel have been disputed for a long time by the Treatment Action Campaign (TAC) and leading South African scholars, claiming a nationwide antiretroviral programme is good economy. A University of Cape Town study has shown that preventing babies from getting HIV is cheaper than the hospital and medical costs that would be incurred if Nevirapine is not distributed. TAC claims a nationwide Nevirapine programme would cost the state approximately R80 million a year, about one percent of the total health budget.

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

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