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Some researchers are considering boycotting the World AIDS Congress in Durban in 18 months' time, in protest at the decision by South Africa's health minister to abandon a planned pilot programme to administer the antiviral agent AZT to HIV-positive pregnant women.

Nkosazana Zuma's decision was announced in October after a meeting with the health ministers of the country's nine provinces, which are responsible for providing health services in South Africa's federal system. The reason given was that funds to support the programme were not available at provincial level.

The move sparked an outcry, and the volume of complaints increased last month when the government announced plans to spend R30 billion (US$5 billion) upgrading the country's defence force. Now, several US AIDS researchers say they may not attend the congress unless the policy is changed.

“This is something some of us are actively discussing — we would prefer it didn't come to that, but it might be necessary to get a boycott organized,” said one US-based researcher.

Clinical trials in Thailand earlier this year indicated that administering AZT over the last four weeks of pregnancy and during labour (a ‘short-course’ regimen) more than halves the mother-to-child transmission of HIV.

Zuma's decision to axe the programme appears not to have been based on the costs of the pilot programme — the French-based International Solidarity Fund has since offered to pay for this — but on fears that it could lead all HIV-positive pregnant women to believe they have a right to the drug.

“There is not much point in running a pilot study unless you can implement its findings,” says physician Ian Roberts, special adviser to Zuma. But Roberts indicates that the minister's decision is not necessarily irreversible. “Next year the provinces might have a budget for the programme, depending on the cost at which Glaxo is prepared to supply the drug,” he adds.

In neighbouring Botswana, the government has already decided to make the drug available to all such women. The cost of implementing the scheme in South Africa, assuming the pilot programme is successful, is estimated at R80 million (US$14 million). The country is believed to have an adult infection rate of 15 per cent, with the percentage of infected pregnant women varying from 16 to 27 between regions.

But Glenda Gray, co-director of the perinatal HIV research unit at the University of the Witwatersrand's Chris Hani Baragwanath Hospital, says that a study has shown that the short-course regimen is ultimately more cost-effective than treating children who could have escaped infection.

“The pilot study would have teased out difficulties concerned with implementation, such as securing drug supplies, ensuring safe distribution and dispensation, supplying milk in lieu of breast-feeding, and problems related to responses to intervention, teaching and counselling,” says Gray. “Its implementation makes good sense — the only reason Zuma could have made this decision is that she was ill-informed.”

Gutaaf Wolvaardt of the Medical Association of South Africa, who is chairman of the organizing committee for the World AIDS Congress in 2000, says he is unaware of any moves by researchers to respond to Zuma's decision by boycotting the congress. “I would question the logic of this, as the congress is not organized by the Minister of Health,” he says.