Dissent Grows Over AIDS Policies

The government’s AIDS policy is facing a serious challenge as key South African politicians, medical specialists and church leaders rebel against state restrictions on the distribution of drugs that could curb the spread of the disease.

In recent months, five of the country’s nine provinces have either ordered their doctors to administer the anti-retroviral drug nevirapine to pregnant women infected with the human immunodeficiency virus, or HIV, or have announced their intentions to make the treatment widely available.

Mandela Among Those Voicing Concern

Citing the Hippocratic oath that obliges them to do their utmost to assist patients, doctors have also defied the drug restrictions, while church leaders have thrown their support behind the dissent and implored the government to rethink its policy. Prominent politicians, including former President Nelson Mandela, have also joined the chorus, lambasting what they view as a lackluster national response to tackling the AIDS crisis.

South African President Thabo Mbeki has drawn criticism for questioning the link between HIV and AIDS and for downplaying figures that show AIDS to be the country’s leading cause of death.

Citing costs, drug toxicity and inadequate infrastructure, the government has declined to provide the medications--in particular nevirapine--at public clinics. It has authorized experimental trials of nevirapine at 18 treatment centers.

The uprising against the government’s AIDS policy was an inevitable response to the growing severity of the problem, medical experts said. They warned of a snowball effect as the pandemic continues to rage out of control.

“As the disease starts to affect more people, the rebellion will grow and people will begin to demand treatment,” said Debbie Mathew, executive director of the Durban-based AIDS Foundation of South Africa, which helps support community organizations with funding and technical support.

At least 4.7 million South Africans, or more than 10% of the population, are infected with HIV. A study last year by the state-funded Medical Research Council found that as many as 7 million people could die here by 2010 if efforts to combat AIDS aren’t intensified.

During his State of the Nation address earlier this month, Mbeki said that monitoring the effectiveness of anti-retroviral drugs will continue at the 18 pilot sites. On Wednesday, the Finance Ministry allocated an additional $357 million toward fighting AIDS over the next three years.

But the government has made it clear that it will not make the anti-retroviral treatment available at state hospitals until the research has been completed.

Widely accepted medical studies indicate that nevirapine--which costs as little as $1 per dose--can significantly reduce the chances of a woman transmitting HIV to her baby at birth.

Opposition to the government’s policy gained momentum this week when Gauteng province, the first to be fully governed by the ruling African National Congress, announced that nevirapine would be made available to HIV-positive women at all public hospitals and community health centers during the next fiscal year.

The provinces of KwaZulu-Natal and Western Cape have begun issuing anti-retroviral drugs, while last week Northern province said it was examining the possibility of expanding its nevirapine treatment program beyond its pilot sites. Eastern Cape has also indicated that it will train nurses in anticipation of extending its project.

Local Officials See Disease’s Impact

Mark Heywood, secretary of the Treatment Action Campaign, a group lobbying for the widespread distribution of anti-AIDS drugs, said that provincial officials were much more aware of the impact of the disease at the grass-roots level and that this had contributed to the groundswell of opposition.

“The AIDS epidemic is real,” Heywood said. “It builds its own pressures in terms of what people witness, in terms of the suffering caused by HIV and people dying.”

Health Minister Manto Tshabalala-Msimang accused Mbhazima Shilowa, the premier of Gauteng province, in which Johannesburg and Pretoria are located, of contradicting national policy.

The South African Communist Party, an ANC partner, called Tshabalala-Msimang’s criticism of Shilowa “regrettable and disappointing,” and the Congress of South African Trade Unions, or COSATU, condemned the health minister’s stance Tuesday.

Popular opposition to the government policy escalated in December after activists won a court case forcing the government to expand its distribution of nevirapine. The state has appealed the ruling.

The aid organization Doctors Without Borders has begun importing anti-AIDS drugs from Brazil for distribution in township clinics, and earlier this month, the Colleges of Medicine of South Africa, which represents thousands of the country’s doctors, declared the government’s delay in providing nevirapine unethical.

Some doctors are known to be using funds from private donors in South Africa and abroad to buy anti-AIDS drugs. Others have delved into their own bank accounts to buy the medication.

Prominent politicians have added their voices to the mounting public fury.

In a Feb. 7 speech, Mandela called for greater action on tackling the AIDS issue. He said that preventing mother-to-child transmission of HIV must be central to any government AIDS intervention program.

Then, last weekend, the Sunday Times of Johannesburg quoted Mandela as saying: “This is a war. It has killed more people than has been the case in all previous wars and in all previous natural disasters. We must not continue to be debating, to be arguing, when people are dying.”

Home Affairs Minister Mangosuthu Buthelezi, who heads the Zulu-dominated Inkatha Freedom Party, has also thrown his weight behind the uprising.

“Our nation is dying of AIDS,” Buthelezi said in a speech to Parliament this month. His home province, KwaZulu-Natal, is South Africa’s most AIDS-stricken. “We can no longer hesitate or falter. This is the time to act in the full measure of our capacity.”

But despite the national outcry, activist Heywood cautioned that securing widespread distribution of anti-AIDS medication is likely to continue to be an uphill struggle.

“We are not over the hill yet,” he said. “We need a comprehensive national treatment plan, and that is not yet something that is being seriously entertained.”