SA CAN'T AFFORD AZT
SAf News Agency 16 Nov. 1999
South Africa simply could not afford to give the anti-AIDS drug AZT to
people with HIV and AIDS, Health Minister Manto Tshabalala-Msimang said on
Further advice and study were needed regarding the appropriateness of the
drug, she said in a statement to the National Assembly.
At current market prices, the cost of administering AZT to the estimated
four-million South Africans who are HIV-positive would be 10 times the
country's total health-care budget, and 140 times what was spent on
pharmaceuticals in the public sector.
She said AZT was initially developed for use in chemotherapy for cancer
"It was, however, never used in cancer patients because it was regarded as
too toxic to use.
"Tests have shown that rats that were exposed to high levels of AZT for
prolonged periods of time developed vaginal cancer; this is a very serious
finding," she said.
As health minister, she was responsible for ensuring that South Africans
got appropriate and affordable health care.
"This responsibility extends to ensuring that no health care intervention
has a long-term negative effect on people.
"With the evidence before me, I believe that the proper thing to do is to
invite both the South African Medicines Control Council and a group of
independent scientists, approved by Southern African Development Community
health ministers, to review the use of AZT, and to inform me and other SADC
health ministers of their position."
Tshabalala-Msimang referred to various trials on the efficacy of AZT in
preventing the transmission of HIV from pregnant mothers to their babies,
as well as one jointly done by the United States and Uganda involving a
new drug, Nivirapine.
The latter proved to be markedly more effective than AZT. It was also
safer, less expensive and more practical than AZT, or any other drugs
tested so far. However, resistance to Nivirapine seemed to develop faster
than to AZT. Studies were being done in South Africa to compare Nivirapine
to a short course of AZT, and to a course of AZT plus another retroviral
drug, 3TC. The findings, expected in March next year, would provide
critical information on mother-to-child transmission of HIV in South
"Until then, we simply do not have enough information, either on the
affordability... or the appropriateness of the drugs to make any decisions
that might have long-term health effects on the lives of children born to
HIV positive mothers."
One problems was that the virus could be transmitted through breastfeeding.
In South Africa, substitutes for breast milk were not affordable to many
women, and many also had no reliable source of clean water to use for the
mixture, or to sterilise bottles.
Also, the toxic effects of the drugs in babies were doubled because they
got their own dose of the drug and a dose from their mothers during labour
and delivery. Only a quarter of HIV-positive mothers passed the virus on
to their babies.
Tshabalala-Msimang said South Africa was the only country where AZT was
registered to treat health care workers following needle-stick injuries.
However, as far as she knew, AZT was not registered in South Africa or
anywhere else in the world for use by women who were raped by men with HIV
"We have absolutely no idea of what the effects are, either short-term or
long-term, of using AZT, a known carcinogen, on healthy people. The use of
AZT is, at the present time, illegal, aside from it being dangerous."
Tshabalala-Msimang said South Africa's plans to investigate the development
of a vaccine for HIV and AIDS were well advanced. The Medical Research
Council would undertake this process.
She said she had also instructed her department to develop guidelines for
the prevention and treatment of opportunistic infections, such as
diarrhoea, pneumonia and other HIV-related diseases.
In an effort to make sure the government got medicines for at appropriate
market prices, she had instructed her department to compare the prices of
local medicines with those in other countries, and to report back urgently.
"In addition... the World Health Organisation's regional office for Africa
has initiated a pilot scheme for dealing with the treatment of
opportunistic infections in a home-based care situation, and South Africa
is one of the 15 Southern African countries that is benefiting from the
scheme," Tshabalala-Msimang said.