Aids drug policy 'insane'

2001-11-26 13:56

Pretoria - The government's policy on the distribution of Nevirapine to reduce mother-to-child HIV transmission was described in the Pretoria High Court as "not only a manifestation of irrationality, but nothing short of insanity".

The government has maintained that the drug is toxic and that outside of pilot projects testing the use of the drug, there is no capacity to implement a mother-to-child transmission prevention programme.

Gilbert Marcus SC, appearing for the Treatment Action Campaign (TAC), argued that the government's present policy was irrational, unreasonable and arbitrary, because the programme would only reach about ten percent of babies.

This meant that in the next two years, 90 000 babies would simply not be covered by the pilot sites set up by the government in the various provinces.

The policy also meant that doctors in the public sector, however well qualified, were precluded from prescribing and dispensing a potentially life saving drug. The policy forced doctors at non-designated sites to behave unethically, Marcus argued.

The TAC is seeking a court order to force the Minister of Health and Health MEC's to distribute Nevirapine to all HIV-positive pregnant women.

Marcus argued that it could not be gainsaid that poverty, race and chance played a role as to which children would live and which would die.

"Seventy-five to 80 percent of patients in South Africa are forced by poverty to use the public health system.

'Most vulnerable sector of society'

"This case is about victims who constitute the most vulnerable sector of our society. The impact on them is nothing short of a tragedy.

"We are seeking to confront a state sanctioned programme which amounts to a conscious choice - which the respondents [the State] vigorously defend - that results in thousands of predictable, yet avoidable deaths of children.

"It flows from the failure by the State to adopt a reasonable programme to reduce the risk of HIV infection to children," he said.

Marcus referred to the enormity of the Aids epidemic, quoting a government strategic planning document, which described the pandemic as "an incomprehensible calamity".

He pointed out that most children born with HIV were likely to die before the age of five and that the estimated death toll would be four times the death toll resulting from the attack on the World Trade Centre. Those statistics would repeat itself every year, unless the government did something.

'Real hope' in form of Nevirapine

He said there was "very real hope" in this gloomy scenario, in the form of Nevirapine, which has been offered to the government free of charge for five years - an offer that has yet to be accepted.

The efficacy of Nevirapine, which was registered in South Africa in April this year, was not in real dispute. It was recognised by the Medicines Control Council, the World Health Organisation and the Department of Health itself, although it made "a constant attempt" to talk about the side effects and toxicity of the drug, he argued.

Marcus stressed that it was not the TAC's case that there should be "wholesale dispensing" of the drug without the necessary support systems, even though it was a once-off application. It should go along with counselling, he said.

Implementation would result in financial saving

As for the costs of a nationwide implementation programme, Marcus said it would result in a financial saving for the government. One of the government's own studies in fact told them that.

Marcus described the government's attitude to the Johannesburg Hospital, where doctors prescribed Nevirapine after receiving a donation of the drug, but who were afterwards accused of "flouting the rules" and "acting irresponsibly" as "amazing".

Marcus quoted the case of an HIV positive patient, who was aware of her rights and wanted to use Nevirapine, yet was refused such treatment because she went into premature labour and was taken to a hospital that was not one of the government's designated sites.

He said the response by the Director General of Health, Dr Ayanda Ntsaluba, who accused the woman of neglecting her own health, was "astonishing and callous".

Marcus described the government's present programme as "at best haphazard and at worse incoherent".

Referring to the Western Cape's deadline for full treatment by March 2003, he said the TAC was advocating a similar deadline for other provinces.

He said the reasons advanced by the Health Department for the policy were "incoherent and palpably bad".

The application continues before Judge Chris Botha.

- SAPA