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 punches.

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 matter.

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: