/ 16 October 1998

Zuma defends AZT policy

Howard Barrell and Stuart Hess

Minister of Health Nkosazana Zuma has vigorously defended her decision not to allow the state to pay for pregnant HIV-positive women to be treated with AZT, an expensive drug that could reduce the risk of their children being born with the virus.

The decision by Zuma and the nine provincial health MECs to stop administering AZT to pregnant mothers was greeted with anger by doctors and HIV-positive people.

Zuma told the Mail & Guardian her decision had been a difficult one, fraught with ethical issues. But, as health minister, she had to take the wider picture into account and ensure that the limited resources at her disposal were spent to the best effect.

Making AZT generally available to HIV- positive pregnant women would prove expensive and did not amount to an optimal use of resources to fight the disease.

“It is good that the issue is now out in the public domain because we need to debate it,” she added.

It would cost about R8-million to treat all mothers known to be HIV- positive, she said. But, desirable as it was to save any life under threat, the success rate would be comparatively small.

She said that 100 HIV-positive pregnant mothers would produce about 30 children who were HIV-positive at birth. If they were all treated with AZT during pregancy, the same 100 mothers would produce about 15 HIV- positive children. AZT treatment would thus reduce the HIV transmission rate from mother to child from 30% to 15%.

She could understand how any medical researcher or parent of a child who might be HIV-positive at birth would want a different policy.

“But I have to look at the whole picture. If you have limited resources, you may decide to put your resources into preventing mothers getting infected in the first place. These are difficult issues we have to face.”

Zuma said she “really wanted to encourage” a serious proposal being developed by a group of South African medical researchers and scientists around Dr Walter Prozesky, a prominent virologist who steps down as president of the Medical Research Council later this year, to develop a vaccine to counteract one of the strains of the virus more prevalent in Africa.

Meanwhile, the pharmaceutical company Glaxo Wellcome said this week it was willing to cut the prices of drugs such as AZT and 3TC to bring them into line with the economic circumstances of poorer countries.

The company has already reduced the price of AZT by more than 70% of the world average, which would enable mothers to be treated for under R400 over a period of weeks.

Glaxo Wellcome’s medical adviser, Brett Haumann, believes the AZT treatment should be part of a multi- faceted approach to treating the disease.

A study conducted in Thailand showed that adminstering AZT during the last four weeks of pregnancy reduced the chances of mother- to-child transmission by 51%.

The Thai tests occurred in a population where milk formula feeding was prevalent. However, in communities like rural South Africa where breastfeeding is still the norm, even if AZT was administered, 33% of babies would still be infected with the virus.

Haumann believes rural mothers who are HIV-positive need to be educated about the benefits of formula feeding after birth.

“The problem with formula feeding is that people will see women feeding formula to their babies and assume she has Aids,” said Haumann.

A study conducted in the United States earlier this year showed that administering AZT during the third month of pregnancy reduces the rate of transmission by 67%.

Haumann said this study used intravenous AZT, which significantly pushed up the price of treatment and was far too expensive to administer in South Africa.

A Department of Health survey in 1997 showed that more than 16% of pregnant women tested at state-funded antenatal clinics were HIV-positive. This was an increase of nearly 2% on the previous year. KwaZulu- Natal had the highest number of HIV-positive mothers.

According to Glaxo Wellcome, mother- to-child transmission rates are between 25 and 35% in Africa.

The president of the South African Society of Obstetrics and Gynaecology, Fred Hayward, believes the state is correct in emphasising prevention. “The chances that a baby could die in spite of treatment is still too high and therefore it’s logical that the department place importance on prevention,” said Hayward.

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