GOVT WRONG ABOUT AZT
Citizen 3 March 2000
Caption to pic of Dr Costa Gazi: Dr Costa Gazi is in the news again criticising the government's decision to
set up a panel to reappraise evidence that HIV causes AIDS. in this interview with Focus* magazine he pulls no
QUESTION: A disciplinary tribunal found you guilty of bringing former Health Minister Dr Nkosama
Zuma into disrepute because you said she should be charged with manslaughter for refusing to
provide AZT to pregnant women with HIV/AIDS. The Human Rights Commission has taken up the
complaint you lodged with them last November that the government's policy on this issue is a
violation of human rights. Why do you feel so strongly about it?
It's stems from my daily experience since I returned to South Africa in 1990 working first in Umtata, where I ran
11 rural clinics and taught at Unitra Medical School and now as the head of public health department at Celia
Makiwane hospital in Mdantsane near East London. Already many of the children's wards in the provinces
hospitals are filling up with AIDS cases.
One paediatrician says he can only admit an infected child once . If the patient returns with a new infection as
they invariably do all he can do is send the child home with some medication for the mother to administer.
There just isn't space for them all. Most will not survive beyond the age of seven and that is the heart of the
In 1998 I saw research results which showed how cost effective AZT would be in reducing mother-child
transmission of HIV. I wrote many letters to the press and made statements as the PAC's health spokesman
advocating its use. But despite the fact that the lives of some 30000 children a year could be saved if their
mothers had been prescribed AZT in the last weeks of pregnancy, Zuma simply said it was too expensive.
Even when Glaxo the manufacturer which had reduced the price by more than 70% of the world average
offered to go even lower she did not take it up.
QUESTION: President Mbeki switched the argument away from cost when he told the National
Council of Provinces that AZT might be toxic and a danger to health. He has sowed doubts.
Shouldn't it be tested further?
The president went against the overwhelming weight of scientific opinion when he said that AZT is not a new
drug. It has been around for about 30 years and was accepted by our Medicines Control Council; more than 10
years ago. It is available in all public hospitals in case any nurse or doctor scratches themselves with a syringe
from an HIV positive patient.
AZT is not a cure but it does slow down the rate at which the virus replicates itself. Like all powerful drugs it can
have unpleasant side effects. But these occur almost entirely among those who are taking the drug for more
than a few months. However, it is not a drug that you should just prescribe and leave the patient to get along
with it. As with chemotherapy for cancer they must be carefully monitored so that if side effects do appear they
can be countered. That is why I want to see the drug administered within a well organised national screening
programme which would test all pregnant women for HIV/AIDS and give them counselling. We could train
thousands of unemployed matriculants to be counsellors. Those who tested positive would be offered AZT
before the birth, and formula feed afterwards if they have access to clean water since breast feeding can also
transmit the virus to some extent. Rural women need special attention in this regard. This would be more than
a treatment programme it would be huge public education exercise in AIDS awareness that could reach 1
million women a year.
The saying "when you educate a women you educate the nation " is true. The total cost of such a project would
be about 90 million a year. The drug itself accounting for about one third of that.
QUESTION: When Dr Manto Tshabalala-Msimang took over as Health Minister in June it looked as
though government policy might changed. Then what happened?
She really gave that impression when she said she wanted to re-visit the whole policy on AZT. She went to
Uganda and come back very enthusiastic about the new anti-retroviral drug Nevirapine which is much cheaper
than AZT, but since then she has just confirmed Zuma's policy. I think the president's remarks to the National
Council of Provinces took her completely by surprise, but of course she has to support him.
She asked the MCC to look again at the risks and benefits of AZT and when it concluded in two further reports
that the benefits outweighed the risks, she rejected the reports as unsatisfactory. Following my complaints the
Human Rights Commission wrote to Tshabalala-Msimang asking her to explain how she was defending the
rights of HIV positive women. After a delay the Health Department said it had not received the HRC's faxes,
though the commission says it has proof they were sent. She eventually sent a 16-page reply in it she now
claims that AZT is a potentially toxic drug. The HRC has asked her to enlarge on her response.
I have suggested that one rationale for refusing women AZT is that the government does not know what to do
with the AIDS orphans. If it refuses anti-retroviral drugs to pregnant women then many of those children will die
before they are seven and the country won't have so many orphans.
Tshabalala-Msimang said that these remarks were insulting and defamatory. In fact I think that as Zuma always
said cost is the real reason behind the refusal. It does not fit in with the GEAR policy which demands an
immediate reduction in social expenditure. The government is frightened that if it starts to provide
anti-retroviral drugs to pregnant women it wont be long before women who have been raped will demand them
- and then the 4 million or so who are HIV+ but who cannot afford the drugs. There's no way the government's
economic policy can accommodate such expenditure.
QUESTION: Could Nevirapine provide the government with a way out of its dilemma?
Nevirapine is one tenth the price of AZT and pregnant women would have to take only one dose. Compliance
is therefore much easier than for AZT which has to be taken about twice a day for four weeks. However, a
large comparative trial in Uganda has shown that its toxicity is similar to that of AZT. So logically the president
should apply the same danger to health arguments to Nevirapine. The world AIDS congress is taking place in
Durban in July and I predict that before it starts, the government will announce that it is making Nevirapine
available. But strictly limited to pregnant women who are HIV positive. If they don't they are in serious danger of
being attacked and embarrassed at that conference.
One thing is clear, the epidemic is still in the making and none of the government's measures so far has done
anything to curb it. It calls it a fight but its a war. The minister herself has admitted that 6 out of every 10
admissions to hospital are AIDS related, but so far she too has failed to declare war on the disease. I
remember how whites used not to bother about diseases such as TB which affected the black poor until they
finally realised they could affect them as well. Sometimes I think the ANC elite fells just the same about AIDS
and it is all part of massive sell out of the black poor.
QUESTION: What about the new National AIDS Council?
It's a completely useless body. none of the important aids researchers or specialists is represented on it. but it
has 13 government ministers and almost no budget except an expense account. There will be committees at
provincial level and task teams. But is only an advisory body and not a war council with the resources and
power to act. The day after it was launched I set up the Shadow National AIDS Councils (SNAC) I shall be
sending out regular email bulletins to academics, research workers and activists in the field about SNAC's
progress. I'm also planning a website.
* Focus is published by the Helen Suzman Foundation. Website: www.hsf.org.za