Health minister sparks controversy
The minister drew attention to recent research findings which suggest that a single dose of nevirapine given to mother and child at the time of delivery produce resistance to the medication and blamed civil society organizations for forcing this regimen upon the health department.
Reading from a prepared statement Dr Tshabalala-Msimang said that as a country, ‘we tried to interrogate the use of nevirapine as a monotherapy to mothers and babies. However due to pressure from some civil society organizations, our court ruled that we needed to extend beyond the research programme that we had.’
However, she made no mention of the Constitutional Court decision in 2002 which ruled that nevirapine was an optional regimen for medical doctors in the public sector outside the government test sites. Where public health doctors deemed other regimens of antiretroviral therapy appropriate for the prevention of mother to child transmission, such as was the case in the Western Cape, this was permissible.
Asked to respond to the health minister’s comments, Treatment Action Campaign chairperson Zackie Achmat said that Minister Tshabalala-Msimang ‘did not understand science’. He said the parliamentary record showed that she had advocated the use of Nevirapine as a cheap and simple option to prevent mother to child provision.
‘We followed her choice. We all know that the best drugs to use is a combination of drugs ‘ all three for treatment or a dual therapy of nevirapine and AZT [for pregnant women],’ said Achmat.
Minister Tshabalala-Msimang went on to raise questions about the best means for HIV positive mothers to feed their children claiming that ‘the challenges around infant feeding have also not been resolved’.
However, scientists are in broad agreement that the most dangerous form of infant feeding is to combine breast milk with formula feed. Where clean water is available and mothers are able to prepare formula milk, doctors working at Medecins Sans Frontieres in Khayelitsha, Cape Town are adamant that formula feed is the safest way for HIV positive mothers to feed their babies.
However, the health minister has questioned this protocol.
‘We invested on providing infant formula for this programme, however the recent findings are supportive of the breastfeeding option,’ said Tshabalala-Msimang. ‘We hope that this conference will provide sufficient data to enable us to reflect appropriately on these matters. We will soon convene a national consultative meeting to discuss the outcomes of this conference in relation to our PMTCT programme.’
Minister Tshabalala-Msimang will spend little more than 24 hours at the AIDS conference having to return home for budgetary meetings. However the South African delegation, including acting Director-General Nthari Matsau, will stay for the duration of the five-day event and will follow closely the findings presented by scientists on both mother to child transmission and breast feeding of infants.
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