Health minister Manto Tshabalala-Msimang needs to clarify as a matter of urgency whether government will agree to give drugs to HIV positive mothers to prevent them from transmitting the virus to their babies.

On Friday, Nelson Mandela joined the powerful chorus of voices appealing to government to approve “large-scale actions to prevent mother-to-child transmission” at the close of the international AIDS conference in Durban.

This week, the Treatment Action Campaign (TAC) will start preparing court papers to be served on government as part of its campaign to demand that the drug, Nevirapine, is given to all HIV positive pregnant mothers.

For the past 18 months, the government has failed to act to prevent mother-to-child transmission, blaming drug costs and possible drug toxicity.

However, one of the most significant findings presented at AIDS conference, the SA Intrapartum Nevirapine Trial (SAINT) found that three tablets of the drug Nevirapine two for the mother and one for the baby — could cut the transmission rate from about 24% to about 7%.

The drug costs about R21 per dose, far less than the cost of treating a baby with AIDS something government is compelled to do as it offers free healthcare for children under the age of six.

In addition, drug company Boehringer Ingelheim, which manufactures Nevirapine, has offered to supply the drug free of charge to South Africa for the next five years.

According to Professor Jerry Coovadia, head of paediatrics at Durban’s King Edward Hospital and co-organiser of the AIDS conference, about 60 000 HIV positive babies will be born in our country this year. Nevirapine could reduce this rate by two-thirds, thus saving about 40 000 babies.

So far, the health department’s response has been non-committal. Director-General Ayanda Nstsaluba said last week that his department still had to meet the SAINT researchers to discuss their findings. “We can’t just wake up in the morning and give Nevirapine,” said Ntsaluba.

Tshabalala-Msimang says government has yet to receive a formal offer from Boehringer Ingelheim and has demanded that the offer be extended to all SADC countries.

Dr Glenda Gray, co-director of the perinatal HIV unit at the Chris Hani-Baragwanath Hospital, described the SAINT study as “compelling”. According to Gray, the main barrier to the state issue of Nevirapine was the “lack of [HIV] testing and counselling services” at state clinics.

Another major challenge facing the health ministry is how to get cheaper drugs both antiretrovirals to stop the progression of HIV to AIDS and drugs to treat opportunistic infections.

Health officials initially claimed that they were not able to go ahead with the parallel importation of cheaper generic drugs because of the Pharmaceutical Manufacturers’ Association (PMA) threatened court action to block this. They later admitted they were investigating using the Patents Act to do so.

However, real progress needs to be made. The TAC has threatened to bring generics into the country itself and unless drug distribution is centrally controlled, there is a real danger of the development of drug-resistant HIV.

At the same time, the challenge for cheaper drugs has been taken up by the United Nations AIDS Agency (UNAIDS), which is in negotiations with the world’s top five drug companies.

While the Durban conference was brilliantly organised by South Africans Coovadia, Professor Salim Abdool Karim and others, it exposed the government’s inability to communicate its policies clearly and to pose demands to the developed world.

Without Mandela’s intervention, President Thabo Mbeki’s defensive opening speech by and the finger-wagging approach of Tshabalala-Msimang to the press created the impression that our government is not combating the HIV/AIDS pandemic as it should.

The increased budget allocation to fight the epidemic indicates the opposite. But, as Mandela said, “the challenge is to move from rhetoric to action, and action at an unprecedented intensity and scale”. -Health-e News