Independent Evaluation of South African Nevirapine Test Sites Finds ‘No Good Reason’ Against Expanding Program
An independent evaluation of the South African government's test project to reduce the risk of mother-to-child HIV transmission through the use of the antiretroviral drug nevirapine, released yesterday, endorses nationwide expansion of the project but acknowledges that the government has "valid concerns" about how the drug is administered, the Associated Press reports. The report, commissioned by the South African Department of Health and conducted by Health Systems Trust, surveyed operations at the country's 18 nevirapine pilot project sites and found that research data "varied widely" between sites. In some areas, only 17% of pregnant women agreed to be tested for HIV, while up to 96% of pregnant women were voluntarily tested in other areas. The HIV infection rate of women who agreed to be tested varied from 5% in some areas to 47% in others. David McCoy, a researcher who worked on the report, said that access to HIV counseling was a "major determinant" of whether women agreed to be tested and, if they tested positive for HIV, to take nevirapine, which can reduce the risk of HIV transmission to infants by 50%.
The report acknowledged that the government's concern that infected women could still transmit the virus to their infants through breastmilk was valid. Formula is expensive and resources are often not available to cover the cost. "Although the long-term aim should be to enable all HIV-positive women to provide safe and affordable formula feeding, under the current circumstances the policy may lead to higher rates of mortality and morbidity due to other diseases," the report stated. The report recommended that the government undertake a study of whether giving infected women a "short course" of AIDS drugs could reduce the odds of the virus being transmitted through their breastmilk (Cohen, Associated Press, 2/27). Despite the concern over breastmilk transmission, the report stated that there are "no good reasons for delaying the gradual phased expansion of prevention of mother-to-child transmission services," adding, "With coherent and committed political and senior management leadership at the national and provincial levels, it should be possible for all provinces to begin implementing prevention of mother-to-child transmission services in some new sites by the middle of 2002" (South African Press Association, 2/27). Nono Simelela, chief director of the health department's AIDS program, said the report would be evaluated and noted that the government has not "picked up any side effects in mother and baby" from nevirapine. The government had previously questioned the efficacy and safety of the drug (Associated Press, 2/27).
A Little Understanding
Health Minister Manto Tshabalala-Msimang on Tuesday "pleaded for greater understanding from the media" of the government's efforts against HIV/AIDS, the South African Press Association reports. "We are in the driving seat but of course we need to bring everybody else on board to understand which direction we are moving (in). ... I'm just hoping that the media can begin to interact with us from that perspective to say the department of health plus the provinces are not letting down this country in terms of our response," she said while on a visit to Cape Town, where she was meeting with Western Cape provincial Health Minister Piet Meyer. Western Cape province recently announced plans to expand access to nevirapine through its public hospitals in defiance of national policy. Tshabalala-Msimang said that she and Meyer did not discuss HIV/AIDS during their meeting and added that she has requested a "special session" on the matter with Western Cape authorities some time in the near future (South African Press Association, 2/26). Nick Koornhof, health spokesperson for the opposition Democratic Alliance, said Tshabalala-Msimang's proposed visit presents "a very real danger here that the national African National Congress government wants to take control and force [Western Cape officials] to fall in line with their disastrous policies on HIV/AIDS" (South African Press Association, 2/27). AIDS advocates worry that Western Cape, which also offers antiretroviral drugs to rape survivors, could be pressured to conform with ANC policies since the ruling DA and New National Party ended their alliance last October (Kaiser Daily HIV/AIDS Report, 11/8/01).
Newsweek Examines Mbeki's HIV/AIDS Policies
The March 4 issue of Newsweek, in a feature titled "South Africa's Lonely Rebel," profiles South African President Thabo Mbeki and his controversial HIV/AIDS policies. The magazine asks why Mbeki appears "willing to wreck his presidency over AIDS?" According to Mbeki biographer Mark Gevisser, to understand Mbeki, who has publicly questioned the link between HIV and AIDS and asserted that AIDS drugs are "poison," one "needs to understand that he still bears scars" from years in exile and the struggle for power within the ANC and "that he has developed, as a result, a carapace of caution, even ... of paranoia." Mbeki, the son of an ANC organizer who has been a member of the party for 50 years, went into exile at the age of 20. After going to school at Sussex University in England, a "bastion of British welfare socialism," Mbeki spent time in Moscow, Swaziland, Botswana, Nigeria and Zambia before becoming a "protege" of ANC leader-in-exile Oliver Tambo. Immediately prior to the ANC's "unbanning" in 1990, Mbeki adopted the "maverick view" that the party had to "learn to do business with Western capitalists." Sticking to that unpopular view "served him well" when the Soviet Union fell shortly thereafter, Newsweek reports, noting that his diligence in maintaining his position then might be influencing his reluctance to change his policies on HIV/AIDS now. Other observers maintain that Mbeki continues to deny the scope of South Africa's AIDS problem "for the sake of his economic policy," which seeks to elevate the country by attracting investors. His reluctance to alter his views and provide greater government assistance for those affected by the disease has created a "mood of defiance" in the country, and that mood is "spreading," according to Newsweek, which cites a recent rebuke by former President Nelson Mandela and Home Affairs Minister Mangosuthu Buthelezi's call for an "about-face" on HIV/AIDS treatment. The magazine said that Mandela and Mbeki have "papered over" the incident, but noted that the president's office stopped returning Mandela's calls after the comment. Newsweek also reports that Buthelezi spoke out only after Mbeki "shut down" his attempt to expand the panel that addresses the president on AIDS issues (Masland, Newsweek, 3/4). Mbeki spokesperson Bheki Khumalo said that the Newsweek article was "not worth responding to," adding, "It appears to be part of a well-orchestrated personal campaign against the president. We do not quite understand its origins and ultimate objective" (South African Press Association, 2/27). The full Newsweek article is available online. Newsweek also features a profile of Thandeka Mantshi, an HIV-positive South African woman who is active in protesting the government's policies (Masland, Newsweek, 3/4). That article is also available online.