Lancet Editorial Examines the Politics of HIV/AIDS in South Africa

While decisions about how to treat people with HIV/AIDS have "never been a simple clinical matter alone," two court cases currently underway in South Africa "illustrate the extremes of opinion" and can "tell us something interesting about the politics" of the disease, a Lancet editorial says. The first case involves a "coalition of groups," including the Treatment Action Campaign, that is suing South African Health Minister Manto Tshabalala-Msimang and the nine provincial health ministers for failing to provide nevirapine to HIV-positive pregnant women in the public sector and for not planning or implementing a "nationwide comprehensive program" to prevent vertical HIV transmission. Although private sector doctors are able to prescribe nevirapine, the government has continually stated that more studies on the drug are needed before it will endorse widescale use in the public sector, citing concerns over the development of nevirapine-resistant HIV strains and the toxicity of the drug. Also, the government says transmission can occur during breastfeeding despite taking nevirapine. The editorial says that "[n]one of these reasons justifies the government's position." Further, the editorial argues that by refusing to allow public sector doctors to prescribe drugs that prevent mother-to-child transmission, the South African government is "discriminating against African men, women and children who rely on public care." Another case, in which Annet Hayman is suing Glaxo Wellcome SA and alleging that her husband died in 1998 because of the "cellular toxicity" of zidovudine, "echoes the concerns of the government" about drug toxicity. In court papers, Hayman also argues that AZT "has no proven anti-HIV effects" to counter "its proven profound cellular toxicity." The editorial says that while HIV/AIDS "is a tragedy for every family it affects," there is "no time to indulge in the luxury of wondering about the side effects of antiretrovirals." The editorial concludes, "AIDS is already wiping out one generation of South Africans; if the government does not act quickly, another generation will be lost" (Lancet, 9/1).