Owing to regional and international clamor
for a more vigorous attack against the AIDS epidemic, the South African
government yesterday changed its stand on providing drugs to combat the
virus, saying it would develop a plan to offer them to infected people
through its public health system by October 1.
"Government shares the impatience of many
South Africans on the need to strengthen the nation's armory in the
fight against AIDS," the South African cabinet said in a statement
after a special meeting to assess the financial costs of a national
anti-H.I.V. drug plan and to explore options for treating those with
the infection.
South Africa has the largest number of
H.I.V.-infected people in the world, about 5 million, or over 11
percent of its population of 43.8 million, according to the United
Nations AIDS program. The figures are more staggering for the 23.7
million people aged 15 to 49; about 20 percent of them are infected.
The epidemic poses a major threat to the
future of South Africa's economy and security by primarily affecting
young sexually active adults and incapacitating the traditional
extended family system that cares for sick and orphaned relatives. So
far, the epidemic has left 660,000 South African children as orphans.
Yet, for years, as the AIDS virus has
spread, President Thabo Mbeki and his top aides have resisted national
programs to provide anti-H.I.V. drugs, known as antiretrovirals, making
him the target of intense criticism at home and abroad.
The South African government said that
because not every infected person needed anti-H.I.V. drugs, its program
would provide them initially to people with more advanced cases of
AIDS. The drugs can extend life for many people but are not a cure. The
government program is also expected to provide prevention programs
aimed at the tens of millions of people who are not infected.
The change in policy comes in the same week
that South Africa held its first AIDS conference, and just a month
after President Bush pressed Mr. Mbeki during his visit to Africa to
come up with a plan that included both a drug regimen and prevention
efforts. Mr. Bush has pledged to provide $15 billion over five years in
fighting global AIDS, although it remains uncertain whether Congress
will appropriate that much. "The White House welcomes any effort to
address the AIDS pandemic," said Claire Buchan, a White House
spokeswoman who was with the president in Texas yesterday.
In the past, Mr. Mbeki and his aides have
questioned the safety, effectiveness and costs of the drugs, as well as
questioned the very connection between H.I.V. and AIDS. Mr. Mbeki has
also emphasized the difficulties that many Africans experience in
taking the complicated regimens of multiple drugs every day. He has
stressed the importance of reducing poverty, calling it a major factor
in producing the AIDS epidemic, and urging improvement in the diets of
poor people.
The AIDS epidemic began to mushroom when Mr.
Mbeki was vice president in the administration of Nelson Mandela. That
administration did little to control the epidemic. But in recent years,
Mr. Mandela has spoken out on AIDS and exerted considerable pressure on
the government, and foreign countries, to do more to improve the
quality of life for infected South Africans.
The costs of treating those infected are
difficult to calculate, but are expected to run into billions of
dollars. The government said it would follow guidelines that the World
Health Organization issued in April describing the combinations of
anti-H.I.V. drugs that work best and the simplest acceptable laboratory
tests to monitor their use. The guidelines were intended to show
doctors in poor areas how to prescribe such drugs safely.
Of the 42 million people living with AIDS in
the world, an estimated 30 million, or 70 percent, are in sub-Saharan
Africa, which has a population of 640 million. Women make up about 58
percent of them, the United Nations says. Dr. Peter Piot, the director
of the United Nations AIDS program, said AIDS had an even greater
impact on the continent because about 60 million people throughout
Africa were living with the disease, had died of it, or had been made
orphans by it.
The South African government's change of
policy came after a four-day national conference on AIDS earlier this
week in Durban where demonstrators jeered the government's health
minister, Manto Tshabalala-Msimang. It was the first major AIDS meeting
in South Africa since an international AIDS conference was held in
Durban in 2000.
Zachie Achmat, the chairman of one advocacy
group, the Treatment Action Campaign, had led a growing grass-roots
campaign to force the government to make the drugs widely and cheaply
available and had become internationally known for refusing to take the
drug cocktails himself until the government changed its policies.
Although he welcomed the government's decision yesterday, Mr. Achmat
said his group "will wait to see the actual operational plan before
celebration." In an interview with the BBC, he also said, "For all of
us living with H.I.V. in South Africa, and our families, this is the
first sign of hope."
Dr. Piot told participants at the AIDS
meeting in Durban this week: "Throughout the world, the debate is not
on whether to offer antiretroviral treatment in the public sector, but
how to do it given the numerous real constraints. For Heaven's sake,
let us not wait to act until we have the perfect solution because the
era of perfect solutions is still far away."
A major concern is how to use anti-H.I.V.
drugs safely in developing countries because they cannot be taken like
aspirin and experts have warned that injudicious use of the drugs could
be seeds of a disaster, possibly in spreading drug-resistant strains of
the AIDS virus. But a number of AIDS experts from the United States and
elsewhere have been teaching doctors in Africa in the proper use of
such drugs.
The South African cabinet took note of such
concerns and said AIDS experts in the country and specialists from the
William J. Clinton Presidential Foundation would assist the government
in developing an operational plan. The foundation said it had worked
with the government in reviewing drafts of its plan.
The availability of generic or cheaper
anti-AIDS drugs has been a long-fought battle in developing countries.
In April 2001, the pharmaceutical industry dropped its legal fight
against South Africa, which the industry contended had been violating
international trade agreements and patent restrictions through the
government's efforts to buy brand-name drugs at the lowest rates
available in the world. On a visit to South Africa in June, Mr. Bush
promised that it would be among the first nations to receive new
American financial assistance to fight the disease.