Hope for the Living Dead

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Every year in South Africa some 80,000 babies are born to die. They contract HIV from infected mothers, and without preventive treatment, they are doomed to a sickly descent into death. Half will die within a year of birth; most of the others will perish before they are five years old.

This death sentence on the unborn has provoked a new activism in the war on AIDS. South Africans are mobilizing against a government they say is not doing enough to fight the pandemic. At issue is the supply of antiretroviral drugs that can reduce the chances of children being born with HIV. Under its national program for the treatment of AIDS, the South African government limits the supply of antiretrovirals to only 18 pilot projects around the country. The drugs are also not readily available to high-risk individuals, not even victims of rape. The government argues that the effectiveness and side-effects of antiretrovirals, specifically nevirapine, have yet to be tested and that the cost and administrative demands of the treatment prevent its use on a national scale.

But last year the government faced, and lost, a major challenge to its policy. The country's leading AIDS activist movement, the Treatment Action Campaign, secured a High Court order compelling the Health Ministry to make nevirapine available at all public hospitals and clinics. The government appealed against the judgement, but last month the TAC renewed its pressure, suing to make the government allow all state doctors to prescribe neviraprine where necessary.

At the same time the AIDS rebels hit on another front. The tac's chairman, Zackie Achmat, went to Brazil to obtain a consignment of cheap, generic antiretroviral drugs for a program of treatment of 85 HIV/AIDS victims, adults and children, in the black township of Khayelitsha, outside of Cape Town. Achmat's shopping trip to Brazil was in open defiance of South Africa's patents law. "Potentially we face a civil action from the drugs companies," said Achmat last week. "We'll just have to wait and see." But public opinion is so firmly behind the activists that drugmakers in South Africa are unlikely to rise to the challenge. Last year the Pharmaceutical Manufacturers Association of South Africa pulled out of a suit against the government on the issues of patents and generic drugs that only threatened to increase sympathy for AIDS organizations.

It's not just activists who are making noise. In defiance of the national government, two of South Africa's nine provinces — Western Cape and KwaZulu-Natal — have declared their intention to provide anti-AIDS drugs to all HIV-positive pregnant women and their children. The Congress of South African Trade Unions, a close political partner of the ruling African National Congress, allied itself with Achmat's drug purchase in Brazil. Many state doctors and health officials, especially in the rural areas, are quietly accepting offers of funding from the private sector and overseas to obtain antiretrovirals. "It's a revolt that's gone underground," said a KwaZulu health worker. But in some provinces officials have been suspended and doctors have lost government contracts for giving nevirapine without authorization.

The South African Medical Association supports the defiant doctors, saying that government policy cannot determine medical ethics that include "post-exposure prophylaxis for sexual assaults and mother-to-child HIV transmission." So too do many leading civic and religious figures. Opening a new HIV research unit at Chris Hani Baragwanath Hospital in Soweto last month, Archbishop Njongonkulu Ndungane, head of the Anglican Church in South Africa, called it "sinful and immoral" to deny drugs that could save the life of a child. Said Nobel laureate Archbishop Desmond Tutu, "We can't afford the luxury of academic debates about the causes of the disease. We are fiddling as our particular Rome burns."

But after meeting with government health officials in the provinces, Health Minister Manto Tshabalala-Msimang last week said more research was needed on the effectiveness of antiretrovirals and promised no change in the national mother-to-child pilot program which, the TAC says, reaches less than 10% of infected pregnant women.

President Thabo Mbeki told the World Economic Forum in New York that South Africa has "the most comprehensive AIDS program in the world." Unfortunately, says Achmat, a veteran A.N.C. supporter and anti-apartheid activist in his youth, in maternity and pediatric wards the death toll says otherwise.