South Africa faces suit over cheap AIDS drug

Twice a month, Nora Motshelanoka travels across the sprawling metropolis of Johannesburg. Her destination: a tiny concrete wing of Soweto's Chris Hani Baragwanath Hospital. She is 4-1/2 months pregnant, diagnosed as HIV-positive, and very much alone. No one in her community knows about her HIV-status, and she lives in fear that she may pass the deadly virus to her unborn child.

Mrs. Motshelanoka's one source of support is her bimonthly visit to the hospital, where she receives counseling and routine prenatal care. When she nears her delivery date, she will be given a single dose of Nevirapine, an antiretroviral drug that tests have shown can halve the likelihood of AIDS being transmitted to her child.

"When I first found out, I cried every night. I asked God why this had to happen to me," Motshelanoka says. "Now I think maybe my baby will be healthy."

Baragwanath Hospital is one of only a handful of hospitals in South Africa that treats HIV-positive pregnant women, such as Motshelanoka. AIDS groups say the government has been slow to make the drug widely available to the estimated 25 percent of pregnant women in South Africa who are HIV-positive.

In the wake of the highly publicized lawsuit by international drug companies earlier this year to block generic drugs, the German pharmaceutical Boehringer Ingelheim, the producers of Nevirapine, offered to provide the drug free for the next five years. But the South African government hasn't accepted the offer.

One AIDS group is now threatening to sue the government if Nevirapine is not made more widely available, but the government says that concerns about the drug's safety still need to be addressed.

An estimated 2.5 million South African women of child-bearing age have been diagnosed as HIV-positive. Without treatment, the South African government calculates that more than 100,000 HIV-positive babies will be born in the country this year.

At Baragwanath Hospital, the world's second-largest maternity hospital, nearly 30 percent of the 16,000 women who give birth here are diagnosed as HIV-positive.

The Department of Health has pledged to implement Nevirapine pilot programs in two sites in each of the country's nine provinces, which they say would reach an estimated 90,000 pregnant women each year. But only two provinces now have pilot programs up and running.

At Baragwanath, the inexpensive Nevirapine therapy is privately funded and run through an independent unit of the University of the Witwatersrand. Another province, controlled by the opposition Democratic Alliance Party, is running its own program - using a different, more expensive drug.

The government says the pilot programs are needed to answer questions of drug resistance and toxicity.

"We believe the drug has proved effective in preventing intrapartum transmission at the time of birth, but it's the practices thereafter and sustainability that require looking at," says Jo-Anne Collinge, a spokeswoman for the Department of Health.

She says Nevirapine is only a small part of a successful mother-and-child program, and that other essential components - HIV-counseling, prenatal health care, and the provision of formula to newborns - are complicated and expensive to implement, especially in rural areas.

But Boris Jivkov, an obstetrician in the Perinatal HIV Research Unit, says, "We have shown them a model of how mother-to-child transmission can be reduced." He argues that providing HIV-positive women with Nevirapine, at an estimated cost of $3 per woman, is far more cost effective than treating HIV-positive children.

He says that 95 percent of the pregnant women at Baragwanath now choose to take a voluntary HIV test. Money from international donors is paying for all women who test positive to have access to Nevirapine.

"Basically, what the they're [the health department] doing is repeating what research we've already done," says Dr. Jivkov.

In an attempt to force the government to move more quickly, an AIDS activist group, the Treatment Action Campaign (TAC), has threatened to file a lawsuit against the government this week. If the government doesn't promise in writing to provide Nevirapine to all HIV-positive pregnant women, the group will file suit, claiming that the constitutional right to reproductive freedom has been violated.

"If a mother wants to have a child, and there is Nevirapine available that can prevent the transmission from the mother to the baby, the government has the obligation to provide that to the mother," says Mandla Majola, Western Cape coordinator for TAC.