Pretoria High Court Rules That South Africa Must Provide Nevirapine to All HIV-Positive Pregnant Women

Pretoria High Court Judge Chris Botha today ruled that the South African government must supply the antiretroviral drug nevirapine to all HIV-positive pregnant women in the public health system in order to reduce transmission of the virus from mother to child, the South African Press Association reports (South African Press Association, 12/14). When administered to the woman at the onset of labor and again to the infant 72 hours after delivery, nevirapine can reduce the risk of transmitting HIV by 50%. In South Africa, about 200 infants a day are born with HIV (BBC News, 12/14). The Treatment Action Campaign, the Children's Rights Center and Haroon Saloojee, a physician in charge of community pediatrics at the University of the Witwatersrand, this summer filed suit against the South African Department of Health and eight of nine provincial health departments in an effort to force the government to provide the drug to all HIV-positive pregnant women through public hospitals and health clinics. Last spring, the government launched two pilot programs in each of the country's nine provinces to examine the effects of nevirapine treatment on pregnant women with HIV, but according to TAC, the programs reached only 10% of the country's HIV-positive pregnant women. In addition, the lawsuit asked the government to plan and implement a national program to prevent vertical transmission (Kaiser Daily HIV/AIDS Report, 8/21). In a 70-page ruling, Botha said the government was "obliged" to provide the drug under the constitutional right to health treatment and gave the government until March 31 to draw up a comprehensive plan for dispensing the drug and reducing vertical transmission overall in the country (Swindells, Reuters, 12/14). The government had argued that nevirapine's safety "remained unproven" and that officials lacked the resources needed to implement a national scheme. Lawyers for the government also noted that even if the drug were provided, women would still transmit the virus to their infants through breastmilk and argued that the courts had "no right to rule on policy decisions" (BBC News, 12/14). Boehringer Ingelheim, the German manufacturer of the drug, had previously offered to supply it free-of-charge for five years to the South African government, but officials had rejected that offer. According to Kevin McKenna, Boehringer's managing director in South Africa, the offer still stands. "If the government decides to move forward we would be happy to supply the product," he said.

Paving the Way
AIDS advocates hailed the ruling, saying it could halve vertical transmission rates and pave the way for expanded HIV/AIDS treatment. "This is a very important victory, a great step forward. The judge granted everything that the TAC sought," Mark Heywood, TAC national secretary, said (Reuters, 12/14). He added that the ruling will bring "hope to tens of thousands of pregnant women" and could eventually lead to expanded HIV/AIDS drug availability to others in the country. "We don't want to save the lives of children only to have a generation of orphans," he explained (Kraft, Associated Press, 12/14). The government won a "landmark" court case against 39 drug companies earlier this year that would allow it to import generic AIDS drugs, but officials have not taken action to do so. The government is expected to appeal Botha's ruling to the country's Supreme Court (Reuters, 12/14).