A South African perspective on 2001.

Abstract

For South Africa and HIV/AIDS, 2001 was the year of the two court cases. In the first, 39 members of the Pharmaceutical Manufacturers Association (PMA) challenged the South African government over its Medicines and Related Substances Act of 1997. The claim was that sections of the Act breached the Trade-Related Aspects of Intellectual Property agreement. But faced with unprecedented national and international opposition, the PMA withdrew their case on 19 April 2001. It seemed that patients would be placed before patents. When the PMA's case collapsed, however, so did the united front of government, labor, nongovernmental organizations, and the Treatment Action Campaign (TAC). Health Minister Manto Tshabalala Msimang indicated that South Africa was not planning to implement antiretroviral treatment, citing the very argument used by the PMA: inadequate infrastructure. Defending the government's practice, Msimang said, “it is erroneous to believe that South Africa does not give treatment to people with AIDS” ([1][1]). This intransigence over antiretroviral treatments led directly to the second case, filed on 26 November 2001, in which the TAC took the government to court over the delay in implementing mother-to-child transmission prophylaxis. The TAC called for the government to make nevirapine available throughout the public health sector and not only at 18 pilot sites. TAC also demanded that the government produce a national treatment plan. The government opposed the action, but on 14 December, Judge Chris Botha of the Pretoria High Court found in favor of the TAC. He ruled that state health departments are “obliged to make nevirapine available to pregnant women with HIV…and to their babies,” and he also ordered that the state “forthwith plan an effective comprehensive national program to prevent or reduce mother to child transmission…including the provision of voluntary testing and counseling…and formula feed” ([2][2]). Within days the government appealed. Msimang said that the courts were meddling in executive affairs and that this would “throw executive policy making into disarray and create confusion about the separation of powers, which is a cornerstone of our democracy” ([3][3]). The government has tried to justify their opposition to treatment programs by arguing that resources are scarce, costs are prohibitive, and further research is needed—this last being the motivation behind the testing of nevirapine at 18 pilot sites. The day after World AIDS Day 2001, the African National Congress (ANC) National Executive Committee “endorsed government's wide-ranging strategy to combat HIV/AIDS” and insisted that “so little is currently known about the longer term effects of [nevirapine]” ([4][4]). As with the Presidential AIDS Panel of May 2000, where the issue of whether HIV causes AIDS was reopened, politics is again meddling in science. Jerry Coovadia, a leading pediatrician, has said that “nothing could be simpler” than the nevirapine regimen in mother-to-child transmission prevention ([5][5]), yet Msimang calls advocates of treatment “irresponsible” ([6][6]). Presidential spokesperson Smuts Ngonyama has accused the TAC of being “in the pockets of the pharmaceutical industry.” Such statements evidence the “crisis of truth-telling” ([7][7]) that Justice Edwin Cameron has identified as a major impediment to progress against HIV/AIDS in South Africa. It is chimerical for government spokesperson Jo-Anne Collinge to say that South Africa's policies are “in line with [United Nations] practise” ([8][8]). Now, to our shame, the government is to challenge a ruling based on Section 27 of the constitution, which guarantees the “right of access to health care services, including reproductive healthcare services.” Msimang has said it is a “crime against humanity” for the poor to die because they lack medicines ([9][9]); yet, is it not scandalous that her own people are being denied freely donated nevirapine? South Africa is party to the Commitment of Intent that came out of the United Nations special session in June 2001; but in December the ANC posed the question, “Does an infective agent exist? If it does, is it a virus?” ([10][10]). The real question is how South Africa and the concerned international community can rid the country of nonsense that is killing thousands of our people. 1. [↵][11]“Government AIDS drugs still a way off,” Business Day, 20 April 2001, p. 1. 2. [↵][12]Case no. 21182, Transvaal Provincial Division, Judge C. Botha, High Court of South Africa, ruling 14 December 2001. Full text of the judgement is available on the TAC Web site, at . 3. [↵][13]TAC news release, “TAC responds to governmnet appeal,” 19 December 2001. 4. [↵][14]Statement of the ANC National Executive Committee, 2 December 2001. Available at [www.anc.org.za/ancdocs/pr/2001/pr1202.html][15]. 5. [↵][16]“ANC still cautious on drugs to safeguard newborns,” The Star, 3 December 2001, p. 5. 6. [↵][17]“Rigorous facts will prove the best antidote to HIV-related hysteria,” Sunday Times, 14 October 2001, p. 22. 7. [↵][18]“‘Crisis of truth’ undermines campaign,” Business Day, 25 October 2001, p. 11. 8. [↵][19]1. Z. Nkuta , Sowetan 1 (30 November 2001). 9. [↵][20]“Cheaper AIDS drugs must be on trade talks agenda, says minister,” Business Report, 30 October 2001, p. 1. 10. [↵][21]ANC, “HIV/AIDS in South Africa: challenges, obstacles, responses,” briefing document, 30 November. 2001, Available at [www.anc.org.za/ancdocs/anctoday/docs/aidsbrief.htm][22]. [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5 [6]: #ref-6 [7]: #ref-7 [8]: #ref-8 [9]: #ref-9 [10]: #ref-10 [11]: #xref-ref-1-1 View reference 1 in text [12]: #xref-ref-2-1 View reference 2 in text [13]: #xref-ref-3-1 View reference 3 in text [14]: #xref-ref-4-1 View reference 4 in text [15]: http://www.anc.org.za/ancdocs/pr/2001/pr1202.html [16]: #xref-ref-5-1 View reference 5 in text [17]: #xref-ref-6-1 View reference 6 in text [18]: #xref-ref-7-1 View reference 7 in text [19]: #xref-ref-8-1 View reference 8 in text [20]: #xref-ref-9-1 View reference 9 in text [21]: #xref-ref-10-1 View reference 10 in text [22]: http://www.anc.org.za/ancdocs/anctoday/docs/aidsbrief.htm