South Africa is the leading country in the AIDS epidemic, with more than five million of its people afflicted with the HIV virus [1]. As these increasing infection rates seem shocking when coupled with the fact that South Africa has more resources and funds than other neighboring countries, the answers to people’s questions become even more convoluted, and one might ask, “Why isn’t the government doing anything in South Africa?”

The solution to the problem cannot be packaged in a neat antiretroviral-like nevirapine and handed out to rape victims, infected pregnant mothers, or health workers using needles, although it seems to make the most sense to dampen this wildfire of disease running rampant all throughout the country. Great controversy lies within the whole issue, causing delayed approvals from the government, sometimes leading to temporary approvals for drug use to alleviate the not-so-passive voices of AIDS activists. But why was the health minister, Manto Tshabalala-Msimang, so hesitant about the power of nevirapine, a new, cost-effective, single-dose pill that promises to reduce transmission from mother to child about 50%, as opposed to a 28-day treatment along with another anti-retroviral drug? Concerns were with the level of resistance to antiretroviral drugs that might occur as a result of the treatment [1].

A study at the Johns Hopkins Medical Institutions helped elucidate the possible implications of drug resistance that might develop in a mother or child. The study compared nevirapine resistance (NVPR) in Ugandan women in 7 days versus 28 days. NVPR mutations were found in 70 of 279 (25%) of the maternal plasma of the women. Genotyping was used to analyze when the resistance would occur. Studies showed that the resistance can be detected as early as 7 days. Generally, 30-50% of the women can build resistance, but the resistance can possibly start to fade after 6 months [2]. However, this issue of resistance poses as a major roadblock to approving the use of nevirapine. It may be cost-effective, but is it worth the health risk?

The nevirapine seems like a promising one-shot deal, but it’s actually wrapped with more sticky issues than its resistance that prevents South Africa’s quick decision to mobilize treatment. The problem does not lie solely in resistance; rather there are also the concerns of the level of toxicity that nevirapine contains. Transaminase elevations, a common effect of nevirapine treatment, were indicators for liver toxicity. However, more attention is turned to those who have hepatitis C that are undergoing treatments with nevirapine concentrations greater than 6 m g/mL; these patients developed a 92% chance of liver toxicity [3].

Results from various studies give Thabo Mbeki, South Africa’s president, more reason to be convinced that nevirapine is as dangerous as the disease, thus delaying the governmental response to fighting the disease. Consequently, most doctors in state hospitals have been barred from prescribing certain antiretrovirals such as nevirapine, with the exception of selectively enabling private sales to patients, which was made available only in eighteen state hospitals. However, some doctors risked losing their jobs to supply the antiretrovirals anyway. Charities and unions joined in the effort by smuggling generic copies of drugs from Brazil into hospitals and clinics [1].

The health minister questions the plausibility of fighting the virus with a drug that can lead to increased resistance and damage to other organs of the body. But the government is also under pressure to face the reality of the cost of developing infrastructure that embraces prevention, education, and treatment. Simply doling out nevirapine isn’t necessarily going to clear up the thick fog of problems that the disease is creating, but it still merits as a step to saving lives. No one else seems to doubt the benefits of nevirapine. Besides, what are we waiting for? If we don’t take risks compared to the cost, we might as well take our health policy home.