South African Government Sued for ‘Refusing’ to Provide HIV-Positive Pregnant Women With Access to Nevirapine
The South African AIDS advocacy group Treatment Action Campaign and two other parties filed a lawsuit Tuesday against South African Health Minister Dr. Manto Tshabalala-Msimang and nine provincial health ministers in an effort to require the South African government to provide nevirapine to HIV-positive pregnant women cared for in the public health sector, Reuters/South African Broadcasting Corporation reports. TAC, the Children's Rights Centre and a pediatrician at the Chris Hani Baragwanath Hospital say that the government needs to ensure that more HIV-positive pregnant women are receiving nevirapine to prevent vertical transmission of HIV (Reuters/South African Broadcasting Corporation, 8/21). Mark Heywood, national secretary for TAC, said that the lawsuit has two aims: to "force" the South African government to make nevirapine available "throughout the public health system" and to require the government to develop a "clear national policy" on the prevention of vertical transmission, "including all components, such as counseling" (Agence France-Presse, 8/21). The suit also contends that by "refusing" to make nevirapine "widely available" to HIV-positive pregnant women, the South African government is "denying women and children their constitutional right to health care" (AP/Washington Post, 8/22). TAC said that by not providing greater access to nevirapine within the public health system, the government is "creat[ing] a two-tier health care system in violation of the country's constitution," which "guarantee[s] equal access to health care for all South Africans." Tshabalala-Msimang has expressed doubts about nevirapine, stating that it "may not be appropriate because it could be toxic and might create a new drug-resistant strain" of HIV (Block, Wall Street Journal, 8/22). The government is expected to receive the suit today, and the health ministers listed as defendants will have until Sept. 12 to respond (South African Press Association, 8/22).
Creating a National Program
A spokesperson for the South African health ministry yesterday stressed that officials have not yet seen the suit, but noted that the health department has launched 18 pilot programs to evaluate "certain operational challenges" linked to the use of nevirapine (Wall Street Journal, 8/22). However, TAC spokesperson Anneke Meerkotter said that these programs are "inadequate" (Reuters/South African Broadcasting Corporation, 8/21). TAC estimates that the programs include only 10% of the country's HIV-positive pregnant women (Kaiser Daily HIV/AIDS Report, 8/21). Boehringer Ingelheim, which produces nevirapine, offered more than one year ago to make the drug available for free to developing nations, but South Africa had not accepted the offer "until recently," when it decided to use the drug in the pilot programs (South African Business Day, 8/21). Joanne Collinge, spokesperson for the South African health ministry, said that the health department has "been talking to the company about being part of the program, but that some aspects remained to be settled" (South African Broadcasting Corporation, 8/21). TAC has stated that the pilot programs "are no substitute" for a national nevirapine program, adding that the government could treat pregnant women with nevirapine for approximately $30 per pregnancy. A national program "could save more than 20,000 children a year" and would cost less than 1% of the country's health care budget, the group said (Swindells, Reuters, 8/21).
Support Among Medical Community
Several of South Africa's "most prominent doctors and AIDS researchers" have lent their support to the lawsuit, the Guardian reports. Dr. Haroon Saloojee, the pediatrician named as one of the plaintiffs in the suit, said, "Health professionals have almost been sidelined from these issues, issues we deal with on a daily basis. It is us in the health profession and not the politicians and policy makers who have to deal with the consequences of this policy. ... Every day we have to inform parents that their children have HIV when it could have been prevented at minimal cost" (McGreal, Guardian, 8/22). Heywood said that the suit may have a significant impact on AIDS policy in South Africa. "If we are successful in this case regarding children it begins to beg the question about the parents. This may take us closer to the rational view of medicine proven effective and safe for people with HIV," he said (Wall Street Journal, 8/22). A South African Broadcasting Corporation audio clip of Heywood discussing the suit is available online. Note: You must have RealAudio to hear this clip.