The first major aids policy battle in South Africa was over mother-to-child transmission prevention (mtctp). Between 1998, when the government first pronounced that it would not introduce mtctp, and 2001, when it was ordered to do so by the constitutional court, the government's position remained implacable: South Africa could not afford it. When questioned by journalists, the minister of health would explain (often with an evident degree of irritation) that South Africa simply did not have the resources. Her implication was clear: people who were demanding such an intervention did not understand economics and were, unlike government officials like herself, not in a position to appreciate the ranking of social priorities.

Chapter 2 touched on a range of factors (including the president's views on antiretrovirals and aids) which may have contributed to this inflexible position. This chapter takes the government's argument about affordability at face value, and shows that there is little (if any) basis for it once the costs of not introducing mtctp are considered. The chapter shows that it almost certainly costs the government more to treat the opportunistic infections suffered by hiv-positive children over their short lives than it would to save many of them through mtctp.

Introduction

By the late 1990s, there was a wealth of evidence from developed and developing countries that treating pregnant women with a short course of antiretrovirals could dramatically reduce the transmission of hiv from mother to child.