NEW TWIST IN ANTI-RETROVIRAL DRUGS DEBATE
By Anthony Stoppard and Farah Khan
Inter Press Service 20 Feb. 2002
Johannesburg -- Efforts by the South African government
to engineer a politically acceptable climb-down from its opposition to
the provision of anti-retrovirals to people living with HIV and AIDS
(news - web sites), have collapsed in the face of objections by the
national Minister for Health, Manto Tshabalala-Msimang.
The South African government has been refusing to make anti-
retrovirals - drugs known to reduce the transmission of HIV from
pregnant mothers to their children - widely available in the public
health system on the ground that they are toxic.
South African President, Thabo Mbeki, has repeatedly insisted that the
drugs are dangerous, and has - controversially - questioned the link
between HIV and AIDS.
But former president Nelson Mandela is fronting efforts by those in
the ruling party who believe the moral policy is to give the drugs to
HIV-positive pregnant mothers and their babies.
Mandela has made it clear that there is no direct conflict between
himself and Mbeki. In a thinly veiled criticism of government's
policy, Mandela has been insisting that debates around the link
between HIV and AIDS and the provision of anti- retrovirals in the
public health system, is distracting government from its efforts to
tackle the disease.
However, after a meeting between Mandela and senior ANC officials,
including Mbeki and Tshabalala-Msimang, a statement was issued,
saying: "The meeting re-affirmed the correctness of the positions
taken by the ANC (the ruling African National Congress and the
government. However, the meeting identified a weakness with regards to
communication on the AIDS issue."
Mandela is reportedly reluctant to comment beyond the ANC statement.
National government policy at present is to only provide anti-
retrovirals at a small number of pilot programs where the
effectiveness of the drugs is being tested.
While most South African and international experts acknowledge that
anti-retrovirals are toxic, they accept that the use of the drugs are
essential to preventing the spread of the virus and improving the
quality of life of people living with HIV and AIDS.
In the face of outright rebellion against national policy in the
medical community, among its allies in civil society and the labor
movement, government appeared to be trying to engineer a climb-down
from its opposition to the use of the drugs.
With one or two exceptions, it has not taken action against doctors in
the public health system, who are supplying the drug to pregnant
mothers or rape survivors.
Neither has it moved against members of the Treatment Action Campaign
(TAC) -- an anti-HIV and AIDS lobby group -- who have been bringing in
anti-retrovirals for use in clinics being run by non-governmental
organizations. TAC has been working with the Congress of South African
Trade Unions (COSATU) the 1.8 million strong labor ally of the
government, to bring in the drugs.
And, it has allowed two provincial governments to expand pilot
programs, which are making anti-retrovirals available through the
public health system. In the Western Cape and KwaZulu/Natal, the
ruling African National Congress is part of provincial coalition
governments that are planning to make the drugs widely available in
their clinics and hospitals.
After a meeting of provincial and national health ministers, it seemed
as if a political compromise had been reached between national
government and the provinces, who are coming under increasing pressure
to make the drugs freely available - even if it was not officially
On Feb 18, the premier of Gauteng, Mbazima Shilowa, announced that
over the next few months, all clinics and hospitals in his province
would make anti-retrovirals available to pregnant mothers and rape
survivors. He put R30 million aside to get the program up and running.
Gauteng is the first completely ANC controlled province to announce
that it would make anti-retrovirals freely available to pregnant
mothers, and more significantly, Shilowa is known to have been a close
political ally of Mbeki.
However, this did not stop Tshabalala-Msimang, from slamming the
province's decision. The ministry "disassociates" itself from
Gauteng's announcement, she said in a statement on Feb 19.
But, to add to the confusion, her statement came after the
director-general of the national Department of Health, Ayanda
Ntsaluba, had expressed his confidence in the provinces ability to
expand its program to make anti-retrovirals available to all pregnant
Even the spokesperson for the South African president, Bheki Khumalo,
expressed surprise at the health minister's statement.
But, for now, it looks like the health minister is on a hiding to
At least two other ANC controlled provinces have indicated they plan
to make anti-retrovirals widely available through their public health
system, while others are most probably quietly expanding their
programs without informing the national department.