KwaZulu-Natal Breaks Rank With South African Government, Joins TAC in Battling Appeal of Nevirapine Mandate
South Africa's KwaZulu-Natal province, in a "dramatic turnaround," has broken rank with the central government, withdrawing from its appeal of a December High Court ruling that requires the government to provide the antiretroviral drug nevirapine to all HIV-positive pregnant women to prevent vertical HIV transmission. The province is now publicly siding with the Treatment Action Campaign, the AIDS advocacy group that brought the lawsuit, Health-e News reports. The government has appealed the ruling, and TAC is seeking a court order requiring the government to distribute the drug while it carries out its appeal. KwaZulu-Natal Premier Lionel Mtshali said on Friday that his government wants all pregnant women to have "universal access" to nevirapine, calling its distribution a "moral imperative of government," and lent the province's support to TAC's request to enforce the court order. Mtshali acknowledged that the infrastructure needed to offer HIV testing and counseling and to distribute the drug may not be in place in all provincial health facilities but suggested that the province may offer the drug to all pregnant women "as a prophylactic measure." He added, "Intervention should be based upon the universal administration of nevirapine to pregnant women during childbirth and to their children, save only where there is a decision by the women in question to decline the administration of nevirapine." He said that offering the drug as a prophylactic without testing was "in line" with protocols for fighting other infectious diseases such as polio. Professor Jerry Coovadia, an HIV/AIDS expert, said he "understood and supported" Mtshali's desire to offer the drug to pregnant women, but said it was "essential" that, "as a minimum," HIV counseling be offered. "Counseling reduces the spread of HIV by encouraging behavior change. It also encourages people to deal with their HIV status rather than driving it underground," Coovadia added. TAC welcomed Mtshali's announcement and said it will monitor the province's nevirapine efforts. Both TAC's petition and the government's request for an appeal were to be heard by Pretoria High Court Judge Chris Botha on Friday (Thom/Cullinan, Health-e News, 3/1).
Mandela Voices Support for Access to AIDS Drugs
Former South African President Nelson Mandela on Sunday said that AIDS drugs should be made available to all South Africans who desire them, but stressed that his position was not in conflict with the government's policy on the drugs, the Associated Press reports. "People who want to consult doctors or any other person whom they think can give them a drug which is going to be useful ... must be free to do so because otherwise the impression is going to continue that we don't care for people who are dying," Mandela told a press conference, adding, "We can't afford to be conducting a debate while our people are dying. We have to concentrate on ensuring that our people are given the drugs which are going to help them. This is a war." However, he did not say which drugs should be made available and emphasized that the government needed to ensure "that these drugs are safe for distribution." He noted, "Overseas research is not enough. Social conditions here are different." The government has refused to provide antiretroviral drugs through the public health system and has questioned their safety and efficacy. Last month, Mandela caused a stir when he seemingly criticized the government's AIDS efforts, saying that prevention of vertical HIV transmission should be "central" to the government's HIV/AIDS policy. Although Mandela said he "strongly support[s]" the government's HIV/AIDS policies, political scientist Tom Lodge of the University of Witwatersrand said the fact that Mandela spoke out when President Thabo Mbeki was out of the country "might signify a rift" within the ruling African National Congress (Kraft, Associated Press, 3/4).