From 1 April, government will offer HIV positive pregnant women in Durban and Pietermaritzburg the anti-retroviral drug, nevirapine, for free to prevent them from transmitting the virus to their babies.

Women to benefit will be those attending ante-natal clinics at:

• King Edward VIII hospital (and satellite clinic KwaMashu Polyclinic);  
• Prince Mshiyeni Hospital (including clinics in Umlazi’s Section D and Section K);
•  Pietermaritzburg’s Grey’s, Northdale and Edendale hospitals and Mbalenhle Clinic;
•  Tugela Ferry’s Church of Scotland Hospital.

As breastfeeding can also transmit HIV, mothers will be given the choice of whether to breast or bottle feed, and those who opt for bottle feeding will be offered free milk formula for six months.

However, mothers living in areas where there is no running water or good sanitation and babies run the risk of getting gastroentritis, will be encouraged to breastfeed exclusively.

Dr Dhaya Moodley, provincial co-ordinator of the mother-to-child-transmission programme, said the programme was initially planned to start on 1 March. However, implementation had been delayed by a month to “prepare the community and hospital staff and to ensure that the pharmacies can cope with the supply of nevirapine and milk formula”.  

“In Durban, the hospitals involved have about 1 000 births each per month. This means 1 000 HIV tests, and the possibility of 300 HIV positive women per hospital every month,” said Moodley. Each woman has to be counselled before and after the HIV test. HIV positive women need to be followed up, and their babies tested for HIV at 15 months.

In the Durban area alone, hospital staff will need to keep track of 7 200 babies a year to monitor the success of the nevirapine intervention.  

“A lot of work has to be done to prepare staff,” said Moodley, who started staff training this week. “Special attention will be paid to preparing staff to counsel and support patients.”

Government has permitted 12 lay counsellors to be employed for the entire programme, but this is clearly inadequate. In addition, such counsellors will not be allowed to administer the HIV test as they are not health workers.

Research has shown that a single nevirapine tablet given to a pregnant woman during labour and another tablet given to her baby with 24 hours of birth can cut the transmission rate by 50%.

About a third of HIV positive women transmit the virus to their babies, mostly during labour.

The Treatment Action Campaign’s Mark Heywood said this week that government’ s offer of nevirapine at selected sites throughout the country was inadequate, as only about 90 000 women would benefit whereas 1,2 million women gave birth each year in the country.

“Every pregnant woman who already knows that she is HIV positive should also be able to get nevirapine, wherever she might be,” said Heywood.