Health Minister Manto Tshabalala-Msimang lacks the ability to act decisively and to communicate effectively. That is why there is massive confusion about whether government’s plan to offer the anti-retroviral drug, nevirapine, to pregnant HIV positive women at 18 pilot sites countrywide is going ahead.  

The good news is that the minister did finally confirm last week that provinces ready to do so would go ahead with the nevirapine programme, which can cut the transmission of HIV from mothers to their babies by some 40 percent.

The bad news is, she expressed it in such woolly terms that some commentators misinterpreted her words.  

In her Budget speech in Parliament last Tuesday, the minister listed the many challenges facing the mother-to-child transmission (MTCT) programme.  

“The 18 sites have been set up within a research framework precisely because we want to answer several as yet unanswered questions,” said Tshabalala Msimang. These questions included drug resistance and toxicity and safe infant feeding practices (HIV can be transmitted via breast milk), she said.

Because she had listed the challenges and problems, some commentators interpreted this to mean that government intended to stall the nevirapine programme.

But at the press conference after her Budget speech, the minister clarified the position by saying: “As you know, we have already committed ourselves to the 18 sites, but it became very clear to us that preparations to begin research in these sites needed a lot of preparation.

“We are going to continue [with the 18 pilot sites], but not recklessly and we will support those provinces that don’t have the capacity to do so.”  

She said the Institute of Virology had given some guidance on how to deal with drug resistance and raised pertinent questions about infant feeding practices, which needed to be addressed.

“The last thing we want to do is cause problems for ourselves in an effort to solve them. There are provinces that have moved ahead, but again, given the kinds of resources the provinces have, some of them have not even addressed these [questions] I’m talking about. [The Western Cape] is just giving nevirapine to the baby and mother – which we don’t think is the correct way to move.

“But we have now decided that the provinces would move ahead and those provinces that are not quite ready – we are going to give them a lot of   support on the two sites identified in those provinces. It is going to be very important for us to monitor these women and the children quite closely.”

Sadly, the MTCT pilots have been dogged by controversy and confusion since they were first announced after a meeting between the minister and all health MECs in mid-last year.

After the announcement, all provinces missed several deadlines to identify their pilot sites. Then the starting date of the pilots was shifted from 1 January to 1 April. Then there was a serious breakdown in communication between the Department of Health and the Medicines Control Council (MCC) over the registration of nevirapine, with the department believing that nevirapine had been registered for MTCT while the MCC only approved the drug on 18 April.

Tired already? It gets worse. Tshabalala Msimang then apparently got cold feet in April and said Cabinet needed to approve the programme. However, she now says that the “core group of ministers” dealing with HIV/AIDS have considered the programme and will submit a report to Cabinet. In the meantime, the pilots are going ahead.

Our country has the largest HIV positive population in the world. Over 200 HIV positive babies are born here every day – and most will die painful deaths before they reach the age of five.

What we need is courage and decisive leadership. Foot-dragging and confusion kills what little hope we have that this pandemic can be overcome.