A top government official has barred doctors from giving anti-retrovirals even to raped infants Khadija Magardie and Nawaal Deane As South Africa was reeling at the news of an alleged gang-rape and sodomising of a nine-month-old baby in Upington last November, the Northern Cape MEC for health was blasting a Kimberley hospital for giving the infant anti-retroviral medication. It emerged this week that after widespread media coverage of the incident, MEC for Health Elizabeth Dipuo Peters telephoned the Kimberley hospital to scold its CEO for having given the infant the drugs. Deon Madyo confirms he received the phone call after television and newspapers quoted the hospital’s medical director Hamid Shabbir saying the child had been treated with AZT. Madyo says Peters “raised the matter very sharply with me”; “in a very serious way” cross-questioned him on why the incident had been allowed to occur, and demanded to know whether the practice was widespread, or whether doctors had given the drugs only in this case. One doctor who recently worked at the hospital, Beatrix Weber, claims it had a policy of administering the drugs, but had to stop when the “national government” intervened after the case of the nine-month-old hit the headlines. It could not independently confirmed that national, as opposed to provincial, government intervened. Madyo, who says he had to file a written report on the matter, believes Peters’s reprimand was justified “out of concern”. The hospital subsequently released a circular reminding doctors they were barred from administering the drugs to rape victims. The circular, released on December 4, says: “In accordance with the National Department of Health HIV/Aids policy, anti-retroviral drugs should not be issued to the victims of rape or sexual assault. Please refer to policy guidelines.” It appears that as in many other provinces, doctors had been administering anti-retroviral drugs despite national government policy banning the provision of the drugs in government hospitals. The national government’s ruling against providing anti-retroviral drugs even in the case of rapes or pregnant women is one of the more controversial aspects of the government’s stance on the disease. However, Aids activists and doctors say several provinces have quietly continued providing the drugs. In a letter to the Mail & Guardian, Weber says doctors in the province had been prescribing the drugs at their discretion for some time, until the media interest generated by the Upington baby case. Weber says: “The media attention had the serious side-effect that the Northern Cape policy was reviewed. Once media attention shifted away from this rape story, a new policy was introduced, which may well be fatal to future Northern Cape rape victims.”
Weber says she was suspended from the hospital for, among other things, questioning President Thabo Mbeki’s beliefs about HIV/Aids. The Kimberley hospital’s Madyo denies receiving any reprimand from national government, but adds that “even if there had been, it would be expected” since the provision of AZT in Kimberley hospital would constitute a deviation from national policy. “I see nothing wrong in that: it’s rightfully their role,” he says. Repeatedly referring to the administering of AZT to the raped infant as “a mistake”, Madyo says Kimberley hospital was the only state institution in the province where such an incident had occurred. This, he says, provided conclusive proof that the action taken by the paediatrician was “a mistake”.
The “mistake” has been blamed by the provincial health authorities on an outdated circular issued in 1997 by the then deputy director general for health in the province, Dr Barry Kistnasamy. Owing to the lack of a formal policy on anti-retrovirals at the time the national Department of Health issued official guidelines only in 1999 Kistnasamy ruled that doctor discretion should be used in the administering of anti-retroviral medication in rape cases. The doctor who treated the infant told Madyo he was not aware that the policy had changed, and, according to other sources, this policy was never reviewed and continued to be followed with the full knowledge of the health authorities until the media arrived. “The truth of the matter,” Madyo says, “is that it was never about the child. We are not recommending it [AZT] for any rape victims.” Anti-retroviral medication is kept in most hospitals as a matter of course, as it is used as a prophylactic for health-care workers in the case of needle-stick injuries, or other cases where doctors or nurses have been exposed to HIV-contaminated blood. Zachie Achmat, chairperson of the Treatment Action Campaign, says: “Gauteng, KwaZulu-Natal and the Western Cape are taking a stand but Mpumalanga and Northern Cape are toeing the political line.” He says: “It is tragic that Peters put political expediency above the safety of women and children.” The child has since been transferred to the Red Cross childrens’ hospital in Cape Town, where she is due to undergo reconstructive surgery. She received a full course of anti-retroviral treatment at the Kimberley hospital.