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Baby sanctuary
Listen to Caroline Dempster's report from South Africa's first hospice for Aids babies
Greg Barrow
"The government has refused to listen"
Dr Peter Piot, Head of UNAIDS
"There is no problem in modern times so associated with stigma and discrimination as Aids"
Case Study: South Africa
Case Study: South Africa
By Greg Barrow

Many African children will have short lives

Every day, around 1500 people are newly infected with HIV in South Africa. Four million people are already HIV-positive, and there is no sign that the rate of infection is slowing down.

But at a time when Aids and HIV infection pose a grave threat to the country's future economic development, the government has blocked the provision of anti-Aids, or anti-retroviral drugs in the public health service, and has opened up a debate over whether HIV actually causes Aids.

This mind-boggling policy has been condemned by many scientists in the international community, but the voice of protest has been disturbingly quiet inside South Africa.

Dr Costa Gazi, the health spokesman for the tiny opposition party, the Pan Africanist Congress of Azania, is one exception.

The son of Greek immigrants to South Africa, Dr Gazi was jailed for his opposition to the apartheid regime in the 1960s, and then spent 20 years in exile in Britain. With his flowing grey hair, and Chicago Bulls baseball cap pulled low over his brow, he cuts an eccentric figure - but on the subject of Aids and HIV infection Dr Gazi has become a voice of clarity.

His call is simple: provide anti-Aids, or anti-retroviral drugs to pregnant mothers and tens of thousands of unborn babies can be protected from HIV infection. It's a call that the government has chosen to ignore.

"All we've had is a series of excuses," he says.

"They started by saying that anti-retroviral drugs are too expensive, then they were toxic, then they said we must examine the whole science of Aids. There's no seriousness on the side of the government, except that they don't want to spend more money on public health."

The HIV virus can be transmitted in breast milk

The voices of black patients from the township of Mdantsane, echo down the bare corridors of the Cecilia Makiwane hospital in the city of East London where Dr Gazi works. Named after South Africa's first black nurse, under apartheid it used to be the blacks-only hospital. In the new South Africa it has remained that way - a decrepit building of crumbling walls and leaking roofs, where open drains carry dirty water past overcrowded wards.

The metal gates that bar entry to the wards in the Cecilia Makiwane hospital are there to stop criminals stealing blankets and medicine. Poverty is so widespread in East London, that even the dying are not safe from the hands of thieves.

The hospital is desperately under-resourced, and now it is becoming increasingly overburdened by patients suffering from opportunistic illnesses associated with their HIV status. Dr Gazi believes there is a strong argument for the provision of anti-retroviral drugs because of the impact they would have in cutting the transmission of HIV from pregnant mothers to their unborn babies.

He has gone so far as to buy his own supplies of the anti-retroviral, Nevirapine, and intends to use it in the hospital. It's a move that is getting him into trouble with the local health authorities.

"They are threatening to punish me again," he says.

"But I'm going ahead anyway. The dispensary here is keeping its own supply of Nevirapine. I'm bringing it in to give it to them. We have to have good security because this is going to be popular stuff. You give the Nevirapine to women in labour, and then three drops are given to the baby after birth, and that's it! One tablet for the mother, three drops for the baby, end of story! You can save half the babies that would have been born with HIV."

It seems to be a simple argument in favour of the anti-retroviral drugs, but the ruling African National Congress says it cannot afford to pay for them and blames the international pharmaceutical companies for seeking to profit from Africa's Aids crisis.

There are, however, legal mechanisms the government could employ to secure a right to produce its own cheap anti-retrovirals.

South African President Thabo Mbeki has expressed doubt that HIV causes Aids

If it can demonstrate that the drugs are required to contain a medical emergency, under the laws governing international trade, the government could seek what is known as a compulsory licence. Dr Gazi believes those conditions do exist.

"We have four million people who are HIV-positive," he says.

"At this moment, the number of deaths per day is going up very rapidly. This is a dire emergency, so anything that can be done to stem the progress of the epidemic, must be done.

"The anti-retroviral drugs will slow it down considerably, so I believe that this government can and should be issuing compulsory licences as of now. Also, we should be importing drugs… from countries that are making these drugs as a generic drug - countries like India and the Philippines.

"If not, we should be paying the price these companies are selling at today because even at today's prices, this is a cost-effective therapy."

Dr Gazi points out that the alternative to drug treatment is caring for sick children in homes - for as long as they remain alive - which according to some estimates would cost 10 or 20 times as much.

One possible explanation for the government's lack of enthusiasm for making anti-retroviral drugs available in the public health service is that it does not want to upset its economic ally, the United States.

If the government was to begin the process of issuing compulsory licences, it would send the wrong signal to potential foreign investors. The licences undermine the principle of free trade, and they would set an uncomfortable precedent in a developing country.

But while these principles are pondered, the deadly impact of HIV in South Africa is rapidly increasing.

Greg Barrow reports from South Africa for the BBC

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