The Treatment Action Campaign is trying to make the goverment supply anti-retrovirals to pregnant women
Belinda Beresford
A large cocoon of worn baby blankets swaddles a thin, tiny brown body, scowling at light and sucking furiously on his thumb.
Baby A is about to become world famous, even if his identity is never publicly known. This month-old, 1,7kg boy is one of the central exhibits in the latest court battle between Aids activists and the South African government.
The Treatment Action Campaign (TAC) has asked the courts to order that Minister of Health Manto Tshabalala-Msimang ensures the anti-retroviral drug nevirapine is available at all public health facilities. Nevirapine has been shown to reduce the chances of a child catching HIV from its mother during birth by 50%. The papers filed by the TAC also demand that the government sets out and implements time frames for a national programme to prevent mother-to-child transmission of HIV. This would include voluntary counselling, testing, anti-retroviral drugs and the provision of milk formula for the child if appropriate.
Nevirapine was registered for use in reducing an infant’s chances of getting HIV from its mother in April. Last year the drug’s manufacturer, Boehringer Ingelheim, offered nevirapine free to the governments of developing countries for this use in the private sector. The South African government has yet to take up the offer.
Although Baby A’s primary concern right now appears to be his next meal, his mother’s biggest worry is whether or not he has been infected by the HI virus that is destroying her own body.
Susan* is one of the deponents in the TAC’s lawsuit against the Department of Health. Thirty years old and with a 12-year-old daughter, she has known she has HIV since 1997.
Living in Sebokeng and working as an Aids counsellor, she knew the importance of nevirapine in tipping the odds in favour of her baby. When four months pregnant she managed to get the money to make a trip to Chris Hani Baragwanath hospital. This is one of the government’s pilot sites in testing the use of nevirapine to cut mother-to-child transmission of HIV, so it stocks the drug. The doctors there gave her the single 200mg tablet she needed to take during labour.
Three months later, sick and in pain, Susan collapsed. By the time an ambulance took her to Sebokeng hospital she was about to give birth. Not expecting Baby A to arrive two months early, his mother had left the nevirapine tablet at home. Sebokeng hospital is not one of the nevirapine trial sites and so it had none to give her.
Nor was there nevirapine for Baby A, who was immediately put into an incubator where he was to spend almost a month. His desperate mother was too weak to make the journey to get the anti-retroviral for her child.
On the third day after Baby A’s birth, when he should have had the drug, a hospital official said she had arranged for a bus to take the baby to Chris Hani Baragwanath. There was no ambulance available.
Faced, as she saw it, with the chance that her 1,4kg, baby would die if not transported in an ambulance, Susan decided to gamble that her child would be one of the lucky 50% not to face the death sentence of HIV from his mother. So Baby A received no nevirapine.
But the odds are not that good for Baby A. To avoid getting HIV a baby has to be able to destroy any virus particles that might make their way into his body during his journey down the birth canal. But being born prematurely meant that Baby A’s immune system was likely to be weaker.
Baby A was also born when his mother was ill with a very weak immune system. Her CD4 count was about 70: CD4 counts are a measure of the strength of the immune system and anything less than 200 is generally considered an indicator of Aids.
Susan almost certainly had very high levels of HI virus in her blood, and unfortunately for Baby A, the higher this viral load, the greater his chances of being infected.
Giving nevirapine to the mother reduces the amount of virus circulating in her body, cutting down her infectiousness. The treatment is to help the child, not the mother, although multiple studies have shown that the treatment appears safe for both mother and infant.
Baby A’s story is part of the court case because his potential tragedy demonstrates the realities facing pregnant women.
The TAC wants nevirapine to be available in all public health centres so that if justified medically and backed by voluntary counselling and testing, doctors can provide the drug to pregnant women who want it.
The government says that it wants to roll out a programme of preventing mother-to-child transmission of HIV, and it has 18 pilot sites nationwide that are intended to assess the programme. Over the years the government has voiced concern about the potential toxicity and effectiveness of anti-retroviral drugs to reduce mother-to-child transmission. It has also expressed concern about the creation of drug-resistant viruses and of potential dangers to mother and child.
Government officials have also raised concern about only being able to provide voluntary counselling and testing and the constitutionality of only being able to provide such care to women in some areas and not others.
Part of the TAC’s argument is that it is unconstitutional and a breach of human rights that wealthy women have access to nevirapine through the private health system while women forced to use public health services don’t.
* Name has been changed