KwaZulu-Natal is rolling out the provision of nevirapine to HIV-positive pregnant women, but other provinces aren’t following suit
Jaspreet Kindra
The Eastern Cape and Free State health MECs indicated this week they would not roll out nevirapine provision to HIV-infected women, further highlighting the weakness of last week’s “tacit” deal between Minister of Health Manto Tshabalala-Msimang and provincial ministers.
In the past Mpumulanga MEC Sibongile Manana and her Northern Cape counterpart, Elizabeth Dipuo Peters, have questioned the efficacy of anti-retrovirals.
In an apparent response to growing pressure on anti-retrovirals, Tshabalala-Msimang is understood to have given a tacit nod at a meeting with MECs last week to rollout if provinces are in favour.
Acting Eastern Cape MEC for Health Max Mamase said this week that extending the programme was not a priority, claiming that only 30% of HIV-positive women transmit the virus to their children because of medical negligence during caesarean sections.
Appearing cautious about the effects of the drug, Mamase said the two pilots in the province in East London and Mzimkhulu had been hampered by poor infrastructure. At a press conference on Wednesday he said the province would consider expansion after a year.
Anna Coutsoudis, an associate professor in paediatrics at the University of Natal, said 20% of HIV-positive pregnant women still transmit the virus in a normal vaginal birth. She said 7% of unborn babies contract the virus from their mothers, while a further 15% become infected during breastfeeding.
Asked for comment, Mamase’s spokesperson, Bandile Mageda, said the minister had worked as a professional nurse before he joined politics, “so he knows what he is talking about”.
African National Congress insiders in the health sector offered as a mitigating circumstance the fact that Mamase took over as acting MEC in October last year and was a latecomer to the debate on nevirapine.
The Free State MEC for Health, Ouma Tsopo, said extending the programme from the current two pilot sites in the province was not a priority. The focus, she said, would be on strengthening existing clinic services.
Tsopo worked as a teacher before joining politics. Known by some in the province as a “no-nonsense woman” bordering on the arrogant, she has served previously as the leader of the legislature and headed several portfolios before moving on to health.
Tsopo said she was “positive” about the programme and the efficacy of nevirapine. Asked why she was not implementing it across the board, like her counterpart in KwaZulu-Natal, Zweli Mkhize, she said: “It was not his decision, it was the decision of the executive council announced by the premier.”
Mkhize has broken ranks by supporting a provincial executive council decision to provide nevirapine to all infected mothers in the province in three months.
Tsopo’s comment is indicative of the tremendous pressure on ANC members in the health arena to toe the national party line. Sources say that even Tshabalala-Msimang is looking for political direction from the top.
Gauteng’s MEC for Health Dr Gwen Ramokgopa, a medical doctor seen as a supporter of nevirapine, was non-committal about expanding the programme, but said she was finalising a proposal for presentation to the provincial executive council this month on what to do with the mother-to-child transmission programme.
In another significant development, the Cabinet is to hold discussions on HIV/Aids with the ANC’s health secretariat towards the end of this month.
The move follows the acknowledgment of the secretariat last week “that all spheres of the government [are] under severe public pressure to roll out the [mother-to-child transmission] programme”.
The health secretariat had been instrumental in pushing for the 18 pilot sites on the prevention of mother-to-child transmission programme across the country. It also played a significant role in helping extricate the party and the Department of Health from controversy over the link between HIV and Aids.
The ANC’s health secretary, Dr Sadiq Kariem, described the Cabinet move to hold discussions as a “positive development towards building debate around the issue and bringing the epidemic under control”. It is hoped that the meeting will underline the vital need for clear political direction on the mother-to-child transmission programme.
Remarked one ANC member: “At the moment they all seem to be playing their own games, while those who are committed to helping the people have to do so secretively. But then who cares about what the rank and file think?”