South African Government May Implement Policy for Universal Nevirapine Access in December
There is a "possibility" that the South African government in December will launch a program to provide universal access to the antiretroviral drug nevirapine for HIV-positive pregnant women to prevent vertical HIV transmission, Reuters reports. Joel Netshitenzhe, head spokesperson for the government, said yesterday at a news conference that "universal access to [nevirapine] ... was on the cards for 2003" (Boyle, Reuters, 4/18). The government's final decision to implement a national plan will depend on the results of current research being conducted at 18 pilot sites in the country to examine the effects of nevirapine on mother-to-child HIV transmission rates. The results of the research should be available by December, Netshitenzhe stated, and the government has "[m]easures ... in place to prevent delays should [the] ongoing research justify universal distribution" of the drug (South African Press Association, 4/18). Dr. Ayanda Ntsaluba, director general of the South African Health Department, said that the early results from 5,000 women involved in the pilot program were "positive," adding, "It seems the evidence that is emanating would suggest there is a real possibility that come December we may be in a position to roll out a national program" (Reuters, 4/18). Until a national program is developed, hospitals "with the necessary facilities" to distribute nevirapine will dispense the drug to HIV-positive pregnant women on a "case-by-case basis" (Singer, Boston Globe, 4/19). However, Netshitenzhe said that the government still plans to appeal a decision by the Pretoria High Court that ordered the provision of universal access to nevirapine. This appeal will be based on "broader constitutional issues," Netshitenzhe said, adding that there are still concerns about the cost of the drug, although the government plans to "pressure" pharmaceutical firms to lower their prices. The government may also use generic copies of patented AIDS drugs, he said (Nessman, Associated Press, 4/18).
The announcements follow the government's declaration on Wednesday that sexual assault survivors would be able to obtain post-exposure antiretroviral treatment from public health facilities (South African Press Association, 4/18). Reuters reports that these recent actions represent the government's "most far-reaching policy shift yet on HIV and AIDS" (Reuters, 4/18). However, Netshitenzhe stated that there has been "no significant shift in government policy" regarding antiretroviral drugs and that the government still maintains that the drugs "could be dangerous if wrongly used" (South African Press Association, 4/18). Nonetheless, in a statement issued Wednesday, the government did acknowledge that antiretrovirals "could help improve the conditions of people living with AIDS," and Netshitenzhe said yesterday that the "starting point of government is based on the premise that HIV causes AIDS." South African President Thabo Mbeki has faced public criticism for his questioning of the causal link between HIV and AIDS (Reuters, 4/18). Dr. Saadiq Kariem, the second-ranking health official within the ruling African National Congress, said that the government's announcements this week were spurred by the recent "negative publicity" surrounding ANC leaders who were "denying the existence of the disease" (Associated Press, 4/18).
The Treatment Action Campaign, which filed the court challenge requiring the government to expand access to nevirapine, praised the news of possible nationwide nevirapine program. TAC said in a statement that the government "has given us hope after months of despair." The Congress of South African Trade Unions called the recent changes a "victory for logic," and UNAIDS Executive Director Peter Piot said that the announcements symbolized a "new sense of urgency" on the part of the government toward fighting HIV/AIDS (Associated Press, 4/18). "This is a sign that government is ready to make a big change. South Africa's health professionals are celebrating," Dr. Haroon Saloogee, a pediatrician and AIDS activist in South Africa, said (Boston Globe, 4/19). The Inkatha Freedom Party stated that the changes were "long overdue" (South African Press Association, 4/18). Democratic Alliance leader Tony Leon "congratulate[d]" the government for its announcements but "demanded an apology" from Mbeki regarding statements Mbeki previously made about Leon's position on antiretroviral drugs. Leon said that when he mentioned the possibility of providing antiretroviral drugs to sexual assault survivors in June 2000, he "was subjected to a sustained campaign of vilification" by Mbeki. "President Mbeki owes an apology, not just to me, but to the people of South Africa and particularly to all those whom he demonized for the past 22 months for holding a position which has now been endorsed by his cabinet," Leon said (South African Press Association, 4/18).