S. Africa Put on Spot Over AIDS Policy

The history of this country is rife with human rights abuses. The secret horrors of the apartheid security apparatus continue to unfold in court hearings. Even hushed-up atrocities from the Boer War, fought a century ago, are now coming to light.

Three years ago, the new black-majority government enacted a revamped constitution that guarantees far-reaching human rights protections. The intention was to declare: “Never again.”

Now a public hospital administrator from rural Eastern Cape province is invoking the constitution in a challenge to a government policy on acquired immune deficiency syndrome. In the new South Africa, according to Dr. Costa Gazi, the victims of human rights abuses have new faces: children dying of AIDS because the government refuses to provide lifesaving drugs.

“I was jailed and tortured in the 1960s as an opponent of apartheid, so I know the abuses of the apartheid regime were abominable,” Gazi said. “But we have a new measuring stick now, a democratic government that says it serves the people. We are losing 35,000 children each year to AIDS that could be saved.”

Gazi wants to compel the government to provide the anti-AIDS drug zidovudine, or AZT, without charge to pregnant women infected with HIV. To do otherwise, he insists, violates the human rights of newborns, who under the constitution are entitled to “health care services, including reproductive health care.”

The South African Human Rights Commission has agreed to investigate, though the official watchdog group has authority only to advise the government.

“The commission is not concerned with whether or not AZT is the proper drug in the circumstances, but rather with the broader socioeconomic question of what the state is doing to deliver in terms of its obligations under . . . the constitution,” said spokesman Siseko Njobeni.

Studies have shown that AZT reduces mother-to-child transmission of HIV, or human immunodeficiency virus, by about 50%. Gazi’s calculation of 35,000 lives is based on estimates that 70,000 to 80,000 newborns in South Africa are infected with HIV each year. The virus can lead to AIDS.

AZT has been widely used in the United States, and an oral dose during delivery has been strongly endorsed by the Atlanta-based Centers for Disease Control and Prevention as a less costly alternative for developing countries.

AZT has been available in South Africa for 10 years, according to its London-based manufacturer, Glaxo Wellcome. With few exceptions, however, the drug has been distributed at private clinics where government subsidies--on which the vast majority of people depend--do not apply.

The South African government has been inconsistent about its objections to providing AZT. Early this year, then-Health Minister Nkosazana Zuma said it was too expensive. Last month, President Thabo Mbeki said it was too toxic. This week, Health Minister Manto Tshabalala-Msimang said the matter needed to be reviewed by independent scientists.

“We simply do not have enough information, either on the affordability or on the appropriateness of the drugs, to make any decisions that might have long-term health effects on the lives of children born to HIV-positive mothers,” she said.

Gazi says the government is waffling, but his critics contend that he has an ax to grind. He comes from the Pan-Africanist Congress, a small party at odds with the ruling African National Congress. And he faces a misconduct hearing for allegedly bringing Zuma into disrepute by publicly criticizing her stance on AZT.

But Gazi is not alone. His cause is supported by many AIDS activists, who complain that health officials are doing too little about one of the fastest-growing epidemics in Africa.

“There are a lot of human rights questions around AIDS, and providing AZT is one of them,” said Mark Heywood of the AIDS Law Project at University of Witwatersrand here. “The government is nervous about providing access to treatment because they know once they start, they will set off a tidal wave of demand.”