Problem Pregnancy

Doctors regard AZT as an AIDS vaccine for babies. But South Africa says it's too expensive.

These questions could have been answered by South Africa's pilot studies, say local researchers. But the government has put those studies on hold.

The AZT decision will only intensify the conflict between AIDS activists and health minister Zuma, a complicated figure known for being intelligent and committed—but also headstrong. "We've had an enormously difficult relationship with the minister," says AIDS Consortium director Cornell. "It's been one pitched battle with her after another."

Zuma crafted a well-regarded AIDS plan early in her tenure, but she has since made two high-profile blunders. The first was a lavish, multimillion-dollar musical, Sarafina II, that was supposed to impart HIV prevention information. However, it was roundly condemned for sending mixed messages, and it was astronomically expensive, consuming one-fifth of the governmnent's AIDS budget. Zuma tried to avoid responsibility by claiming the musical had been funded by the European Union, but that was not true. Later, Zuma championed a drug called Virodene as a treatment for AIDS, even though it had not been rigorously tested and despite the fact that most of South Africa’s medical establishment decried it as worthless.

Zuma also possesses a famous stubborn streak, and according to several people who have worked with her, she digs in her heels hardest when challenged. But UNAIDS and Glaxo insist the door is still open, and the very people who will bear the brunt of Zuma's decision—black South African women, especially those who are poor—are the people she has spent her life fighting for. A staunch ANC member who has Nelson Mandela's absolute loyalty, she made her name working to improve community health.

So it's people like Florence Ngobeni who just might change her mind. A Soweto woman who lost a daughter to AIDS last year and now works as an HIV counselor, Ngobeni is organizing other women to rally against the ministry of health’s decision. "I'm very angry and very ashamed of my government," she says. She worries about women who will have to suffer what she did—the loss of a child—even though that can now be prevented. And she worries for herself, too. "If the government says no to something like this that's affordable, what about me when I get sick? Will I get treatment? I’m not even talking about antiretrovirals," she says. "What about simple things like diarrhea. Will they treat me?"

Other women apparently feel the same way. Almost 60 showed up to a meeting organized by Ngobeni, twice as many as she had expected. Pregnant, HIV-infected women have not been vocal activists, like gay men. Often poor and worried about the reaction of their husbands and family, they face a myriad of difficulties. But this decision may have galvanized some of them. "For the first time in my life," says Ngobeni, "I see HIV-positive women standing up to these problems."

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