The Treatment Action Campaign (TAC) goes head-to-head with the Health Minister in the Pretoria High Court on 26 November over her apparent failure to implement a national programme to prevent mothers with HIV from passing the virus on to their babies.

The political battle over the case is likely to be intensely emotional. In a scenario similar to pre-1994 anti-apartheid protests, TAC has secured support from a broad range of organisations, including the Congress of SA Trade Unions (Cosatu) and Christian, Muslim, Hindu and Jewish bodies.

Key ANC leaders have also publicly indicated their support for a national drug-based programme to prevent mother-to-child HIV transmission (MTCT). These include ANC Women’s League President Winnie Madikizela Mandela and Pregs Govender’s parliamentary committee on the Quality and Status of Women.

With an estimated 70 000 HIV positive babies being born in South Africa every year, government will have a tough task to persuade the public that its cautious approach is correct.

Two African studies (in Uganda and South Africa) show that a single tablet of the anti-AIDS drug nevirapine given to woman with HIV during labour, and half a teaspoon of nevirapine syrup for her baby within 72 hours of birth, can cut the HIV transmission rate by up to 50%.

These findings were presented at last year’s international AIDS conference in Durban and prompted Nelson Mandela, in a closing address to the conference, to call for the introduction of “large-scale programmes to prevent mother-to-child transmission”.

Boehringer Ingelheim, which manufactures Nevirapine, then offered the drug free to all SADC countries for five years – thus eliminating cost barriers.

Soon after the Durban conference, a meeting of Health Minister Dr Manto Tshabalala-Msimang and her provincial health MECs resolved that all provinces should offer nevirapine at two test sites.

The rationale behind these “test sites” was to explore the “operational issues” of whether the public health system could cope with dispensing the drug as part of its maternal and child health operations.

As government points out, it is not simply a case of dishing out the drug. Women have to be counselled about HIV transmission, tested for the virus if they volunteer, and be advised about feeding options as breast milk can also transmit HIV. Each of these steps is time-consuming and has its own complications.

However, a series of delays in setting up the provincial test sites – coupled with President Mbeki’s ongoing comments about the toxicity of anti-retrovirals – led to a widespread perception that the South African government lacked the political will to drive a mother-to-child HIV transmission (MTCT) programme.

To date, the government has not taken up Boehringer Ingelheim’s offer of free nevirapine. And it took until late September for all nine provinces to set up two nevirapine sites although the initial deadline was 1 January.

Interestingly, two provinces – the Western Cape and Gauteng – are offering nevirapine at far more than two sites. The Western Cape, which aims to offer nevirapine to all HIV positive pregnant women within the next two years, is not constrained by ANC policy.

The ANC-controlled Gauteng effectively forced Tshabalala Msimang’s hand when it launched its two sites before her official go-ahead. The minister had tried to get provinces to wait for Cabinet approval before going ahead but was forced to relent after Gauteng went ahead.

Well-placed government sources insist that Gauteng premier Mbhazima Shilowa consulted “at the highest level” (presumably the President’s Office) before going ahead with the launch. This implies that the delays in implementation of the MTCT pilot programme lie with the health ministry rather than with the president.

Gauteng will soon offer nevirapine in at least one site per district in the province, and has devoted additional funds from its own budget to do so.

Harsh words are likely to be uttered over the case in the next few days. Government’s papers imply that TAC is irresponsible and does not understand fiscal constraints. TAC’s Mark Heywood has responded by saying that “the government papers are full of deceit, deception and contradiction”.
– Health-e News Service.

Related stories:

• TAC: fighting for right to life & health of the poor
• Government: unconvinced about safety & efficacy of Nevirapine