South African Medical Groups Show Support for Use of Nevirapine to Prevent Vertical HIV Transmission, Call Denial of Drug ‘Unethical’

The Colleges of Medicine of South Africa, the country's "leading body" for specialist physicians, today issued a statement saying it supports the use of nevirapine to prevent vertical HIV transmission and that failure to provide such treatment is "unethical," Agence France-Presse reports. "We believe it is unethical and against medical principles to withhold preventive treatment for mother-to-child transmission of HIV," CMSA President-elect Ralph Kirsch said, adding that the group's stance was based on "indisputable evidence" that a single dose of the drug can "dramatically" reduce the odds of passing the virus on to an infant. AIDS activists estimate that use of the drug could prevent 70,000 new infections in infants each year. CMSA also criticized the government's statements that the drug may be toxic, saying it is unethical to "create in the minds of the public the belief that proven effective treatment is useless or even harmful" (Agence France-Presse, 2/5). The national government is fighting a court order to provide the drug to all pregnant women served by the national health service and has restricted use of the drug to "a few pilot sites," saying that the drug's "safety remains unproven" and that "inadequate structures are in place to administer it" (Kaiser Daily HIV/AIDS Report, 1/24). CMSA said that toxic side effects are "rare" with nevirapine and added that the cost of treatment would be "less than the increasing burden of treating AIDS complications." The group also came out against the government policy of penalizing doctors in the national health system who administer the drug to their patients "in the proper manner" (Agence France-Presse, 2/5). The South African Department of Health in 1999 issued national guidelines for post-exposure antiretroviral treatment that barred doctors from giving the drugs in government hospital to patients who had HIV exposures, including victims of rape. According to the guidelines, post-exposure treatment should only be given to health care workers who may have been exposed to HIV-contaminated blood on the job (Kaiser Daily HIV/AIDS Report, 1/14).

Black Armbands
Meanwhile, the South African Junior Doctors Association (Judasa) at its annual meeting in Durban on Saturday launched a "Black Armband Campaign," endorsed by the Treatment Action Campaign, to call attention to the "urgent need" to fight HIV/AIDS, the South African Press Association reports. The campaign's armband, which features the red AIDS ribbon, represents the "mourning of patients" who have died from AIDS-related causes and solidarity with HIV-positive people, Dr. Karl le Roux, chair of Judasa, said, adding that one of the program's goals is to encourage doctors to gather information about HIV/AIDS and share it with the government (South African Press Association, 2/2). "We felt it was time for doctors to speak out," le Roux said, adding that "all doctors" were encouraged to wear the armband, which is already being worn by several doctors in the KwaZulu-Natal province. Le Roux has also called for a "massive AIDS awareness campaign" and for the government to begin distributing nevirapine to HIV-positive pregnant women to reduce the risk of vertical HIV transmission. "No honest human being can argue that (the drugs) are not effective in saving lives," le Roux said (Associated Press, 2/2).

KwaZulu-Natal Premier Profiled
The New York Times today profiles Lionel Mtshali, premier of South Africa's KwaZulu-Natal province, who has ordered his government to initiate a program to dispense nevirapine to pregnant women with HIV in defiance of national policy. KwaZulu-Natal has the nation's highest HIV prevalence with 36% of adults infected with the virus. The full article is available online (Swarns, New York Times, 2/5).