South Africa’s ANC-Controlled Gauteng Province to Provide Nevirapine to HIV-Positive Pregnant Women in Defiance of National Policy, Other Provinces Al
Mbhazima Shilowa, premier of South Africa's Gauteng province, yesterday announced that his government will make the antiretroviral drug nevirapine available to all HIV-positive pregnant women at public hospitals in an effort to reduce vertical HIV transmission, a move that defies national policy set forth by Shilowa's own party, the African National Congress, AP/Newsday reports. "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 told the opening session of the province's Legislature (Kraft, AP/Newsday, 2/18). The project will be launched on Friday at the Ga-Rankuwa-Soshanguve Complex in Pretoria and will open at eight other hospitals within the next 100 days. Shilowa noted that the province last year outfitted 40% of its hospitals with the technology and equipment necessary to distribute the drug, saying that the "progress and experience of the past nine months" made the expansion of the project possible (South African Press Association, 2/18). He also said that the provincial government has earmarked $2.6 million for the project. The announcement makes Gauteng -- the nation's wealthiest province, which includes Johannesburg and Pretoria -- one of four districts that plan to provide the drug (AP/Newsday, 2/18). Peter Marais, the premier of the Western Cape province, on Friday said that his administration will continue with its plans to distribute antiretroviral drugs to HIV-positive pregnant women and rape survivors. Thirty test sites have already been established in the province, and Marais said he has secured a free, five-year supply of nevirapine (Associated Press, 2/15). Officials in opposition-controlled KwaZulu-Natal, which has the nation's highest prevalence of HIV/AIDS, and ANC-led Eastern Cape have also gone public with their intentions to distribute nevirapine. The national government provides the drug at 18 test sites throughout the country but has refused to expand the program -- despite a court order to do so -- saying that it lacks the proper health infrastructure (AP/Newsday, 2/18).
Defying National Policy
Bheki Khumalo, a spokesperson for President Thabo Mbeki, who is continually criticized for questioning the causal link between HIV and AIDS and for calling the safety and efficacy of AIDS drugs into question, said yesterday that Mbeki "would not comment" on Shilowa's announcement, adding, "It's something that the Health Department should comment on, not the presidency" (South African Press Association, 2/18). The health ministry yesterday initially said that Gauteng was "in a position to advance the [nevirapine] program within the parameters set" forth at a meeting of provincial and national health officials last month (South African Press Association, 2/19). However, the health ministry today criticized Shilowa's decision, saying it ran "contrary to the resolution" adopted at that meeting, Agence France-Presse reports. Health Ministry spokesperson Sibani Mngadi said in a statement that the resolution had called for "further study and consultation in order to formulate an appropriate response in line with national protocols on the management of mother-to-child transmission of HIV," and Shilowa's announcement was therefore "in breach of that resolution, as well as earlier decisions setting out the envisaged roll-out program based on the experience and lesson learnt from" the 18 government test sites. Mngadi added that the health ministry "therefore disassociates itself from Gauteng's pronouncement ... based on these reasons" (Agence France-Presse, 2/19). National Health Minister Manto Tshabalala-Msimang warned AIDS activists not to "put the cart before the horse," noting that the first children to receive nevirapine as part of South Africa's pilot project were only eight months old. She "impl[ied]" that four more months of monitoring are needed, saying, "Research must inform policy" (Agence France-Presse, 2/18). But Thabo Masebe, a spokesperson for Shilowa, said Gauteng is "not acting in defiance of national policy," adding, "The president has said when a province is ready to expand the sites, the policy will not stop them" (Agence France-Presse, 2/19). Gauteng ANC Provincial Secretary David Makhura added that the province's "comprehensive strategy is in [the party's] view within the framework of the national government" (South African Press Association, 2/18). However, national ANC spokesperson Smuts Ngonyama said the party could not yet comment on the plan and its relation to national policy because it had not received a copy of the plan (South African Press Association, 2/18).
AIDS activists and opposition leaders welcomed Gauteng's announcement Monday. Mark Heywood, secretary of the Treatment Action Campaign, which launched the lawsuit resulting in the court order that the national government expand its nevirapine program to include all public hospitals, said Gauteng's move was "inevitable." He added, "This disease is more and more around us and to continue to hold a policy that bases itself on limiting medical intervention was nonsensical" (AP/Newsday, 2/18). Jack Bloom, health spokesperson for the opposition Democratic Alliance party, said the decision was "long overdue," adding, "I commend Premier Shilowa for providing this clear undertaking as opposed to the mixed signals from the national health department" (South African Press Association, 2/18). The Congress of South African Trade Unions also "welcomed" the announcement, saying that because Gauteng is the "country's most densely populated province and the center of [South Africa's] economic life," it is "very significant that this important province should recognize the seriousness of the HIV/AIDS crisis, appreciate the future cost of doing nothing about it and decide to make antiretroviral medicines (available) to those who need them" (South African Press Association, 2/18).
Mandela Breaks Rank With the ANC, Criticizes Mbeki Again
In related South Africa news, former President and ANC leader Nelson Mandela on Sunday spoke out against the government's "lackluster" response to HIV/AIDS, the AP/Dallas Morning News reports. "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," Mandela told the Sunday Times of Johannesburg. Mandela "has pointedly resisted" criticizing Mbeki, his successor, but Sunday's interview marked the second time this month Mandela has criticized the government's response to the HIV/AIDS epidemic. In a Feb. 7 speech, he called for the prevention of vertical HIV transmission to be "central to any government prevention program" (AP/Dallas Morning News, 2/18). Mandela said Sunday that there was no South African leader "who can boast of having done better than ... Mbeki," but said it "is necessary to say that there are problems which I am finding difficult to answer and I will spell them out inside the channels of the ANC" (Agence France-Presse, 2/17). He added that he was concerned that the ANC has "stifled" criticism of Mbeki and created a climate of "hero worship" around the leader (McGreal, Guardian, 2/18). However, Mandela said that he has "no doubt that we have a reasonable and intelligent government, and that if we intensify this debate inside, they will be able to resolve it." Mandela was set to meet with senior ANC officials yesterday to discuss the issue further (South African Press Association, 2/17).