Around 75,000 South African children were born with HIV-1 infection in 2000; half these infections could have been prevented, the authors state, if short-course antiretroviral treatment had been available. The South African government has cited cost, toxicity, drug resistance, breastfeeding, and pressures on the South African Health Service as reasons why antiretroviral drugs, such as nevirapine and zidovudine, have not been made available-even though the manufacturers of nevirapine have offered the drug for free to African countries over the next five years.

Lead author Salim Abdool Karim, from the University of Natal, comments: In a developing country such as South Africa the few opportunities for controlling HIV spread need to be maximised. Over 5 million of the 42 million people living in South Africa are HIV-infected, and with more than half these infections occurring in women, vertical transmission will continue to increase. There is a moral and public-health imperative to provide cost-effective interventions of known efficacy. The South African Government has an exemplary record by providing free immunisations against major childhood infections to children under the age of 6 years. The lack of a similar policy to prevent the single most common perinatally transmitted cause of mortality in children is of concern.

He concludes: As scientists and clinicians, we share a deep commitment to our patients and the public health of our nation. We have conducted and/or supported research aimed at decreasing vertical transmission. We remain fully committed to the implementation, within the broader government programme for AIDS prevention and care, of a national programme
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Contact: Richard Lane
richard.lane@lancet.com
44-20-7424-4949
Lancet
21-Mar-2002