http://www.newsday.com/news/printedition/ny-hsside82777316jul08.story

Rage Over 'Poison' As AIDS Treatment

South African's fears disputed by others

By Laurie Garrett
STAFF CORRESPONDENT

July 8, 2002

Barcelona, Spain - The minister of health for South Africa yesterday called drugs used to prevent transmission of HIV from mother to child poison.

Her nation's top court ruled last week that the government is required to permit use of such drugs. The South African government of President Thabo Mbeki has consistently opposed widespread use of anti-HIV drugs, citing their toxicity, costs and health-care infrastructure issues.

When free drugs have been offered by humanitarian organizations, the government has argued that HIV simply may not exist.

Yesterday, Health Minister Manto Tshabalala-Msimang told Newsday of her unhappiness with the ruling, and her characterization of the drug nevirapine as "poison" may signal an intention to continue to thwart use of the drug. In comments later she said, with obvious rage, "We will implement because we are forced to implement."

"The High Court has decided the Constitution says I must give my people a drug that isn't approved by the FDA . I must poison my people," she said.

Though the FDA was never asked to approve single-dose nevirapine for use by pregnant Americans, its use as one of the drugs in the anti-HIV drug cocktail been approved, Dr. Allan Rosenfield, dean of the Mailman School of Public Health at Columbia University, said.

"I'm speechless," said Dr. James McIntyre, director of the Perinatal HIV Research Unit at the University of Witwatersrand in Soweto, when told of Tshabalala-Msimang's comments. " ... All we hoped was that the drug would be used the way the World Health Organization, international agencies say it should."

McIntyre estimates 250,000 HIV-infected women give birth annually in South Africa. In contrast, the U.S. Centers for Disease Control and Prevention announced today that only 370 babies were born HIV-positive in the United States in 2000, largely because of the efficacy of such medication.

The WHO-approved protocol for prevention of transmission from mother to child calls for use of a single dose of nevirapine during delivery.

Last month, U.S. Secretary of Health and Human Services Tommy Thompson visited South Africa, and in a televised news conference said that nevirapine is considered safe, and is used in the United States.

Rosenfield, who is heading up an international effort to bring such drugs to pregnant women worldwide, said it is U.S. policy to treat women with a full cocktail of anti-HIV drugs. That cocktail has far more potential toxicity than nevirapine alone.