S. Africa Clarifies AIDS Drug Policy

The government here launched a full-court press Friday to clarify its position on the use of anti-AIDS drugs and quiet a storm of criticism.

At a regular Cabinet meeting earlier in the week, authorities resolved to step up efforts to eliminate inconsistencies in what activists, health officials and opposition politicians say has been a controversial and confusing policy toward South Africa’s AIDS epidemic.

The campaign kicked off with a high-profile advertisement in national newspapers Friday headlined “A Message From The Government.” It sought to explain the state’s program aimed at reducing the spread to infants of the human immunodeficiency virus, which causes AIDS, and to underscore official resolve to deal with the crisis.

“The primary aim is to clarify the government’s position and ensure there are no ambiguities,” said Joel Netshitenzhe, head of government communications. He added that, if necessary, additional public announcements will be used to communicate the government’s stance.

But critics said the communication campaign is just another way of delaying decisive action on allowing the widespread use of anti-AIDS drugs in a country where about 4.7 million people--more than 10% of the population--are HIV-positive and an estimated 70,000 babies are born with the virus every year.

“It’s just part of the procrastination,” said Clive Evian, a doctor and director of AIDS Management and Support, a public health consulting group. “They should stop talking and leave the decisions to the clinicians. They should leave the care to the doctors, nurses and hospital authorities and what they can do with what’s available in their budgets.”

The government’s advertisement said that South Africa will expand research into the use of the anti-AIDS drug nevirapine, which international studies show can limit mother-to-child transmission of HIV, but that the treatment will not be universally available.

The government has cited cost, inadequate infrastructure, and the lack of knowledge about possible negative side effects of nevirapine in declining to provide the drug at public clinics. It has authorized experimental trials of the drug at 18 treatment centers around the country.

“Universal access will be decided upon when important questions have been answered by the research,” Friday’s ad read.

Anti-AIDS activists said the state is wasting time making poor excuses instead of exploring concrete ways to make antiretroviral medication immediately available.

“They are beating around the bush,” Evian said. “For some reason, they are reluctant to put their full force behind this issue. They are looking at how they can’t do it rather than how they can do it.”

On Friday, the government also reaffirmed its decision to continue appealing a court order won by activists in December that grants access to nevirapine at all state hospitals. The ad said, however, that the appeal is not motivated by government reluctance to expand efforts to curtail mother-to-child transmission of the disease.

“It is because we need to gain clarity on whether the courts or the elected government decides on the detail of providing health services. This is a critical question about the division of powers in our democracy,” the ad said.

Analysts said the fact that the government felt compelled to launch an advertising campaign had more to do with the substance of its rhetoric than with an inability to convey its message.

“I don’t think the issue is failure to communicate,” said Steven Friedman, director of the Center for Policy Studies, a Johannesburg think tank. “I think what the government is communicating is the problem. It’s the kind of messages that are coming out of government that’s the problem.”

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 leading cause of death in this country.

The government’s approach to dealing with the pandemic has faced serious challenges in recent weeks from key politicians, medical specialists and rights activists. In addition, several provincial administrations have defied national policy by either ordering doctors to administer nevirapine or announcing their intention to make the treatment widely available.