Philippa Garson
The government is in a double bind over whether to screen pregnant women for HIV, and key policy decisions are being delayed by intense debate around the issue.
Although new research shows that steps taken during and after pregnancy can reduce the risk of HIV- positive mothers transmitting the virus to their babies, the government lacks the resources to implement them.
Some health workers say there is no point testing for the virus if no follow-up action can be taken.
Most of the steps which include administering the AZT and 3TC drugs, disinfecting the birth canal, or delivering babies by Caesarian section, and bottle- feeding rather than breastfeeding are costly and require resources that don’t exist.
Routine testing for the disease in pregnant women also requires counselling and follow-up procedures that our overloaded, cash-strapped health system is unable to offer.
Currently, hospital testing procedures are uneven: some state hospitals, particularly the academic hospitals, do routine testing; other poorer hospitals do not. Some hospitals in Gauteng, like Edenvale and Coronationville and Alexandra clinic, have stopped testing until broad policy decisions have been taken. Johannesburg Hospital stopped testing for several weeks, but has now taken a decision to resume testing.
Although testing for the virus without the patient’s consent is illegal, according to the National Aids Plan, people requesting the test should be able to have it.
There is no national policy on the issue, however, and provinces are struggling with the controversial policy area for which there is no easy answer, says Liz Floyd, Gauteng director for Aids and communicable diseases.
New policy is likely to be in place mid-year, with the following options being debated: to test every pregnant woman with her consent, to test no one at all, or to promote voluntary testing and follow-up with appropriate interventions.
Commented Floyd: Lots of women testing positive are very vulnerable socially, economically and psychologically. Research shows that most women are infected by their husbands. Yet if a women tells her husband she often gets blamed and even evicted at a very vulnerable time in her life.
Health officials report much of the HIV testing that goes on is to protect doctors and health workers, is not in the interests of the patients, and often happens without the informed consent of the pregnant women themselves.
Government figures show that an estimated 11,95% of pregnant women were HIV-positive last year compared with 1,35% in 1991. In some parts of the country, like KwaZulu Natal, the rate of infection is as high as 20%
Research conducted by James McIntyre, who heads up the Perinatal HIV Research Unit at Soweto’s Baragwanath hospital, shows that costly drugs like AZT and 3TC can reduce the risk of transmission from 25% to 9%, findings born out worldwide. However, at a cost of R3 000 per patient, the drug is not a viable state option for African countries, including our own. Research is being done on reducing the amount of time needed to administer the drug. A cheaper but politically loaded option is steering HIV-positive mothers away fron breastfeeding.
McIntyre’s findings bear out the distressing news that breastfeeding may be contributing to the spread of Aids, at a time when the hard-fought battle of weaning women in developing countries away from less healthy and more expensive formula-feeding had almost been won.