A few short months ago, the Treatment Action Campaign (TAC) and government were joined in court action against the pharmaceutical industry. But tomorrow (26th) they meet in the Pretoria High Court as adversaries in what promises to be a bitter and emotional case.
At stake is the fate of some 70 000 HIV infected babies born in our country every year, most of whom will lead pain-filled lives and die before they reach their teens.
Government stands accused of delaying treatment that could prevent mothers from infecting their babies.
Technical arguments such as fiscal constraints and operational difficulties simply don’t wash with the public when babies’ lives are on the line.
As a result, government officials fear that the public will judge them before hearing their arguments. Health director-general Dr Ayanda Ntsaluba says in his replying affidavit: “It is most unfortunate that this very serious issue had to be resolved through the courts.”
But growing impatience at government’s slow progress in offering the anti-retroviral drug Nevirapine to pregnant women with HIV has prompted TAC’s action.
Supporting TAC is a formidable array of organisations including the Congress of SA Trade Unions (Cosatu), paediatricians and a wide range of religious and human rights organisations.
One Nevirapine tablet to a woman in labour and half a spoonful of Nevirapine syrup to her baby within 72 hours of birth can prevent about half of all mother-to-child HIV infections, according to two authoritative studies.
TAC has resorted to court action to achieve two goals. The first is to win public health doctors the right to prescribe the anti-retroviral drug Nevirapine to pregnant women with HIV.
The second is to get the court to compel government to provide a “comprehensive national plan” to prevent mother-to-child HIV transmission (MTCT), including the provision of voluntary counselling and testing and formula as a substitute for breastfeeding.
TAC’s argument rests on the belief that it is unfair and unconstitutional to deny Nevirapine to pregnant women and their babies as it violates the babies’ right to life.
It has also lined up an impressive array of academics to support its argument that the drug works, it is cost effective and that the majority of government clinics and hospitals have the operational capacity to run the programme.
But Dr Ntsaluba describes TAC’s action as “misconceived and impractical”.
“They ignore the vital infrastructural and operational considerations which accompany treatment with Nevirapine, such as voluntary counselling and testing and the monitoring and evaluation of the mother and child to ensure effectiveness and to alert to the development of resistant viral strains which may lead to other public health crises,” says Ntsaluba.
TAC has responded by saying this is untrue. It says it realises that the drugs cannot be given “tomorrow”, but it wants to see a plan from government that shows its intention to reach all pregnant HIV positive women over a set time period.
One of the cornerstones of government’s arguments is the fact that breast milk can also transmit HIV, so any effective programme has to ensure that babies saved by Nevirapine don’t simply get infected from their mothers’ milk.
This matter is complicated as formula milk is expensive and a woman needs to have access to clean running water. Unless she does, her baby runs a very high risk of getting gastro-intestinal infections that can be as deadly as HIV.
At present, only 18 “research sites” countrywide have the official state blessing to offer Nevirapine. Government’s plan is to run these sites for two years to see whether the health system has the capacity to offer the HIV prevention programme as part of its normal maternal and child health programme.
It also wants to follow the babies for two years to see whether Nevirapine can prevent mother-to-child transmission and reduce infant mortality.
These are the reasons, argues Ntsaluba in a lengthy affidavit, why government is not simply rolling out Nevirapine country-wide.
Interestingly, two provinces – the Western Cape and Gauteng – are fast expanding the facilities that offer the drug. In addition, more and more ANC leaders are stating public support for a national Nevirapine programme.
The public pressure generated by the case is likely to influence more ANC members to join the chorus for more Nevirapine to be delivered to more women even faster.
– Health-e News Service.