Anti-Retroviral drugs in South Africa

Introduction

The history of HIV and AIDS in South Africa is perhaps the most controversial of any country. It is littered with examples of government inaction and harmful interference, pseudoscience, and conflict between politicians, AIDS organizations and scientists. The after-effects of some two decades of counterproductive policies are still being felt today in a country that has the world's largest HIV epidemic. A number of high-profile initiatives in the mid 1990s, far from signifying the move toward an effective response, actually marked the beginning of an era characterized by the South African government's unhelpful reaction to the epidemic. AIDS organizations believed the money could have been better spent on local projects, and saw the fact they were not consulted on the play as a sign they were being marginalized.

Mbeki views: Fight for Antiretroviral Drugs

The first major battle over the provision of an established, effective antiretroviral drug (ARV) was for AZT (also known as Zidovudine). In this instance its potential was in the prevention of mother-to-child transmission (PMTCT). In 1998, it was announced that a trial using a short course of AZT in Thailand had cut the mother-to-child transmission (MTCT) rate in half. This led South African advocates and researchers to call for the drug to be provided to pregnant mothers (Venter et al, pp. 30-37).

However, its use was rejected in all ANC-run provinces on cost grounds despite the manufacturer cutting the price and economists believing the use of AZT would result in cost savings. The health minister Dlamini-Zuma also justified her opposition to the use of AZT by saying the government would prefer to focus on prevention rather than treatment, despite the drug being put forward as a preventive measure. The Western Cape, not under the control of the ANC, went ahead with providing AZT in 1999 (Van Roey et al, 601-605).

Treatment Action Campaign

An organisation led by Zackie Achmat, who would later become a Nobel Peace Prize nominee for his campaigning - was launched in 1998 as a result of the battle for the PMTCT drug, AZT. The group grew into one of South Africa's leading voices for the rights of people living with HIV and AIDS directing its energy towards the government and pharmaceutical companies whose policies stood in the way of people receiving treatment. Achmat, himself HIV positive, publicised the situation by refusing to take antiretroviral drugs until they were available to all South Africans (Rotty, 235-241).

The departure of health minister Dlamini-Zuma, following the controversy over AZT provision and her conflicts with AIDS organizations, led to her being replaced by Dr Manto Tshabalala-Msimang, often referred to simply as 'Manto'. She was greeted with optimism when she first became health minister, meeting with NACOSA, drug manufacturers, doctors and those involved in projects on the ground. However, optimism faded as she, and newly-elected President Thabo Mbeki, who had appointed her, once again brought arguments doubting the effectiveness of MTCT drugs to the fore. Mbeki claimed AZT was toxic, with Manto saying the drug weakened the ...