South Africa: A Party Man Bucks the African National Congress on Drugs

Mbhazima Shilowa is a party man, a member of the ruling African National Congress (ANC), and President Thabo Mbeki's handpicked choice to run South Africa's most urban and prosperous province. But this week he is publicly bucking the ANC party line. He has announced that Gauteng province -- which includes Johannesburg and the capital city of Pretoria -- will provide the drug nevirapine to all pregnant women infected with HIV. When Shilowa announced his plan, he said that the province had the infrastructure and resources necessary to administer the medicine at all hospitals and clinics, and portrayed his decision as consistent with governmental policy.

This is a thunderclap and the surest sign that South Africa is no longer the euphoric country that toppled white-minority rule eight years ago. "This is huge," said Abbey Makoe, a newspaper columnist in Johannesburg. "No one has ever seen such a well-regarded, high-ranking ANC member go against the ANC in such a public way. . . . The ground has shifted."

In a country that has more people -- an estimated 4.7 million -- infected with HIV than any other, the government's handling of the pandemic baffles and angers increasing numbers of South Africans. As the number of AIDS deaths mounts, while the government's conservative economic policies fail to create jobs for millions of poor blacks, the gap between reality and once-soaring expectations has transformed politics and public discourse.

When the government announced last year that nevirapine would be given only to poor women in a pilot project in a handful of public hospitals, a group of AIDS activist challenged the restrictions in court -- and won. But the restrictions are still in place and doctors and nurses have begun to smuggle nevirapine into state-run hospitals. Last month, Lionel Mtshali, premier of South Africa's most populous province, KwaZulu-Natal, announced that his administration would no longer abide by the national government's policy on antiretroviral drugs.

Today, South Africa's health minister made clear that the government disagreed with Shilowa's plan. "In the minister's view, the Gauteng premier's announcement is . . . in breach" of national policy, said a statement released by the office of the minister Manto Tshabablala-Msimang.

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