‘€œI was shocked, really shocked,’€ Senzeni Mkhize says quietly, cradling her six-week-old baby as she explains how she felt when she discovered shortly after falling pregnant that she was HIV positive.

With the shock came fear and guilt ‘€“ fear for her future and that of her unborn child, and guilt that she may pass the HI virus on to her baby.

Ironically, Mkhize is one of the lucky ones. She took her HIV test at an antenatal clinic that is part of a government pilot project which offers HIV positive pregnant women a drug to prevent them from transmitting the virus to their baby.

At the Church of Scotland Hospital in Msinga, in rural KwaZulu-Natal, Mkhize was offered the anti-retroviral drug, Nevirapine, during labour. Her baby was given a spoonful of nevirapine syrup within 72 hours of his birth.

This simple regimen can cut HIV transmission by up to 50% among the estimated 30% of HIV positive women who do pass the virus on to their babies.

Mhkize’€™s baby is also being given vitamins and prophylactic medication as a safeguard against the chest and gastrointestinal infections that prey on HIV positive babies. Meanwhile, Mkhize has been counselled about how to live a healthier life and how to feed her baby to avoid infection. She now has to sit out the next 12 months until her baby is free of her antibodies to see whether he has inherited the deadly virus.

Mother-to-child HIV transmission (MTCT) is an extremely emotive issue. An estimated 70 000 South African babies are born with HIV every year. Most experience miserable, pain-filled lives and generally die before their fifth birthdays.

In developed nations, the incidence of MTCT is negligible thanks to drug interventions. Botswana has also introduced universal, free access to drugs to prevent MTCT while there are large-scale projects in Uganda and Kenya.

Nevirapine is easy to administer, and the drug has been offered free to SADC countries for five years by its manufacturer, Boehringer Ingelheim. But instead of a mass MTCT campaign, the SA government has opted for a two-year pilot study at two sites per province (reaching 10% of the potential target) to research whether a mass roll-out is possible and sustainable.

Deeply frustrated with this ‘€œslowly-slowly’€ approach, the Treatment Action Campaign (TAC), backed by a range of paediatricians, pregnant HIV positive women, has challenged Health Minister Dr Manto Tshabalala-Msimang and the nine provincial health MECs to explain why Nevirapine is not available to all women at public health institutions.

‘€œThere is no rational or lawful basis for allowing doctors in the private sector to exercise their professional judgement in deciding when to prescribe Nevirapine, but effectively prohibiting doctors in the public sector from doing so,’€ argues TAC in its court papers.

‘€œIn addition to refusing to make Nevirapine generally available in the public health sector, the government has failed over an extended period to implement a comprehensive programme for the prevention of mother-to-child transmission of HIV. ‘€œThe result of this refusal and this failure is the mother-to-child transmission of HIV in situations where this was both predictable and avoidable.’€

The government has until September 12 to give valid legal reasons why all women at public health facilities should not get access to Nevirapine.

It is clear that, even within government, many officials are also tired of the snail’€™s pace, given that babies’€™ lives are at stake. As expected, the Democratic Alliance-ruled Western Cape will not oppose TAC’€™s court action as it agrees that Nevirapine should be generally available. That province aims to reach 90% of all eligible women by next year.

Interestingly, ANC-controlled Gauteng launched its programme in May before the Health Minister had given the national go-ahead. It has already extended beyond its two pilots and Gauteng health department spokesperson Popo Maja says that ‘€œthere are plans to expand the programme to more places later this year and in the new year’€. About 60% of Gauteng women have agreed to take an HIV test at the Gauteng sites ‘€“ and Maja believes the response is not that good as women are afraid of being discriminated against if they test positive.

KwaZulu-Natal has taken a very broad definition of ‘€œtwo sites’€, and has chosen an entire region as one of its sites. Almost 90% of women in that province have accepted the HIV test, according to figures presented to a national meeting in July — perhaps understandable given that this is the worst affected province.

The poorer resourced provinces are also finally on board, with Mpumalanga only getting organised this week.

Politically, there is a lot at stake with the MTCT programme. It is the first time government is offering any form of anti-retroviral treatment for HIV/AIDS, as it has always maintained the treatment option is too expensive. For many AIDS activists, MTCT offers a foot in the door. Next on the agenda is the push that the mothers are also given anti-retroviral treatment to prevent the babies saved by Nevirapine from growing up as orphans. And then there are the babies’€™ fathers’€¦

Government needs to provide decisive leadership to ensure that the health budget is used wisely and that donor offers are harnessed for the maximum benefit of the nation. ‘€“ Health-e News Service.