In a  dramatic turnaround, the KwaZulu-Natal provincial government has withdrawn from government’€™s appeal today (1 March) against the court ruling compelling it to provide Nevirapine to pregnant HIV positive mothers — and has instead joined forces with government’€™s court opponent, the Treatment Action Campaign (TAC).

TAC, now supported by KwaZulu-Natal, has applied for  the court order granted in its favour on 14 December be enforced — even if government wins the right to appeal against it.

This court order, handed down by Judge Chris Botha on 14 December, compels government to allow health workers to provide all pregnant women known to be HIV positive with the Nevirapine and to develop a credible plan for the roll-out of the drug to all pregnant HIV positive women.

Both applications are due to be heard before Judge Botha in the Pretoria High Court today. (1 March)

In an affidavit due to be made public today, Premier Lionel Mtshali said his province did not support government’€™s application as KwaZulu-Natal wanted all pregnant women with HIV to have “universal access” to Nevirapine.

Mtshali said his province faced a “calamitous” HIV/AIDS pandemic with an estimated infection rate of 35% and regarded the “urgent and immediate administration of Nevirapine (as) a moral imperative of government”.

His stance comes in the wake of an increasing cooling in relations between the ANC and it’€™s partner in government, the Inkatha Freedom Party, over HIV/AIDS.

Mtshali acknowledged that the infrastructure was not in place in all provincial health facilities to offer all pregnant women voluntary HIV counselling and testing before giving them the chance to take Nevirapine, the anti-retroviral drug that can cut HIV transmission from mothers to babies by up to 50%.

However, he proposed that “in the poorest areas” where such testing and counselling was not possible, pregnant women would immediately be offered Nevirapine “as a prophylactic measure”.

“Intervention should be based upon the universal administration of Nevirapine to pregnant women during childbirth, and to their children, save only where there is a decision by the women in question to decline the administration of Nevirapine,” said Mtshali.

He added that he had been advised that the universal prophylactic use of Nevirapine was in line with other practices “to deal with the possible infection of persons with suspected prevalent infectious disease”, such as anti-tetanus injections and polio vaccines.

HIV/AIDS expert Professor Jerry Coovadia said while he understood and supported Mtshali’€™s wish to provide universal access to Nevirapine, most African AIDS experts felt it was essential that people had, “as a minimum”, access to HIV counselling, if not to HIV tests.

“Counselling reduces the spread of HIV by encouraging behaviour change. It also encourages people to deal with their HIV status rather than driving it underground,” said Coovadia, who added that South Africa had the capacity to quickly train lay counsellors to meet the need.

Meanwhile, the Treatment Action Campaign welcomed Mtshali’€™s announcement and has planned a victory march to the Premier’€™s office leaving from the Durban City Hall at noon tomorrow (sat).

TAC, which initiated the case to force government to roll out Nevirapine, said it would be monitoring KwaZulu-Natal’€™s roll-out of Nevirapine. The organisation is also launching a campaign for prophylactic anti-retroviral treatment for all rape survivors and for a pilot study on anti-retroviral drugs for people with HIV.