The spot light will be turned today on the South African government's response to HIV when the Treatment Action Campaign (TAC) relaunches its law suit demanding that nevirapine is made available to pregnant women in all state hospitals and clinics.
TAC is accusing the South African national government and eight of the nine provincial governments of breaching the constitution by "violating [Aids] sufferers ...right to life and health care" by failing to provide nevirapine to HIV-positive pregnant women. The case first came to court in the summer. TAC is not proceeding against the authorities in the Western Cape, which decided when the case was first lodged that it would provide nevirapine to all HIV-positive pregnant women.
The South African health department has resisted providing the drug to pregnant women claiming it was "too expensive and toxic." Nevirapine is only available from the state to pregnant women enrolled in a clinical trial. Currently only two clinics in each state are participating in the trial. It is estimated that 70,000 infants are infected with HIV every year by their mother, either during birth or by breast feeding in South Africa.
There are two aims to the TAC action: to make nevirapine available in all state hospitals and clinics and to ensure that the government plans and implements a national programme for HIV education, prevention and care for pregnant women. TAC will argue in court that use of nevirapine can cut the risks of vertical transmission by 50 per cent.
Evidence from health economists will be presented by TAC showing that the use of nevirapine will, in the long run, save the government money and the World Health Organisation (WHO) will be providing expert evidence to support the effectiveness and safety of nevirapine. In written testimony the WTO said "the benefit of these drugs in reducing mother to baby transmission greatly outweighs any potential adverse effects...The prevention of mother-to-child transmission should be part of the minimum package of care for women who are known to be infected and their infants."
Manufacturers of nevirapine, Boehringer Ingelheim, have offered the drug free of charge to the governments of developing countries hit hardest by HIV, South Africa included.
In its defence the South African national and regional authorities are arguing that they lack the money and resources to administer nevirapine across the country. Furthermore they are maintaining that it would be pointless to provide nevirapine to all HIV-positive expectant mothers as many babies born virus free would subsequently become infected through breast-feeding. Additional cash and personnel would therefore be needed to offer counselling and HIV-testing to all expectant mothers, and to provide information to those testing positive on the risks of breast-feeding and safer alternatives.
Testimony from health care providers in rural areas that they have the infrastructure to do this looks set to weaken this aspect of the government¹s defence.
With World Aids Day just around the corner a series of domestic and international protests has been planned to focus media attention on the South African authorities' response to Aids. Major demonstrations are planned in Cape Town and Durban over the next few days and the New York based Human Rights Watch has accused South Africa¹s President, Thabo Mbeki of "acts of injustice" against the South African people for his failure to acknowledge that HIV causes AIDS, and for his resistance to the provision of nevirapine to expectant women.