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Battle over AIDS drug in S. Africa

PRETORIA, South Africa -- An anti-AIDS drug that can stop HIV transmission from pregnant women to their newborns is at the center of a battle between AIDS activists and the South African government.

The government is taking a cautious approach to the drug nevirapine, making it available at 18 research sites scattered throughout the country.

It plans to run the pilot program for two years to see if can overcome what it calls operational and infrastructure problems.

"From a public policy point of view, we need to approach this issue very rationally," says Ayanda Ntsalube of the government Health Ministry.

"We can, of course, opt for the easy way out of just dispensing the drugs and not care about it. But I think this is where the South African state would be abrogating its responsibility to its citizens."

However, the Treatment Action Campaign (TAC) is demanding that the drug be made available sooner in all state hospitals and clinics and that doctors be allowed to prescribe it.

AIDS activists -- who once backed the government in its efforts to reduce the high costs of AIDS drugs -- have now sued the government over nevirapine. A ruling is expected in 2002.

Plaintiffs in the lawsuit say that by not making the drug widely available, the government is discriminating against people who rely on public hospitals and clinics -- 85 percent of the population.

The plaintiffs call it a "conscious choice" resulting in potentially thousands of deaths of children.

"The government's own figures suggest that 70,000 children are born with HIV every year. If you take a medicine like nevirapine, you could cut that number of new births with HIV by 10,000 or 20,000," says Mark Haywood of TAC.

Plaintiffs point to studies showing that one nevirapine tablet given a woman during labor and a half-spoonful given to the infant within 72 hours of birth have successfully reduced mother-to-child infections by as much as half.

Moreover, they say, such treatment costs the equivalent of a little over $1.

Hundreds of the country's paediatricians and AIDS campaigners want the drug to be made available through the public health system, and a German-based pharmaceutical company, Boehringer Ingelheim, has offered to distribute the drug for free.

Nevirapine has been used effectively to stop mother-to-child transmission of HIV in a number of countries and is recommended by the World Health Organization.

A lawyer for the Treatment Action Campaign said estimates of some 20,000 children dying from AIDS every year amount to approximately four times the death toll in the World Trade Center, to be repeated every year unless the government acts.

Gilbert Marcus, an advocate for AIDS activists, has described the state's position as arbitrary, unreasonable and irrational and says it amounts to a decision that could cause "potentially thousands of predictable but avoidable deaths of children."

He says government figures show that almost 23 percent of pregnant women are HIV positive in South Africa, yet only 10 percent of these have access to nevirapine. Some 4.7 million people in the country are infected with HIV.

Marcus says nevirapine had been registered and approved as safe in South Africa. Adding that he saw the government's refusal to dispense as affecting the most vulnerable sector of society, he said: "The impact of the policy is nothing short of tragic."

But the government says the drug's safety has yet to be proven.

State advocate Marumo Moerane said the government had to adopt a cautious approach to issuing the drug to ensure recipients were adequately educated.

Despite being administered nevirapine, women were still transmitting HIV to their children through their breast milk, Moerane said.

Meanwhile, at least two provinces are not waiting for either the government or the courts. One is already providing antiretorvirals on a widespread scale and another announced it would follow suit soon.

-- CNN Johannesburg Bureau Chief Charlayne Hunter-Gault contributed to this report.


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