Nawaal Deane
The HIV storm has erupted in Aids-wracked KwaZulu-Natal after Minister of Home Affairs Mangosuthu Buthelezi said the province would give nevirapine to all pregnant women, whether or not they could be tested for the virus.
Last week Buthelezi criticised national government’s Aids policy, noting that KwaZulu-Natal has the highest prevalance of HIV/Aids in the country. He said the Inkatha Freedom Party has advised the premier, Lionel Mtshali, to distribute nevirapine “even in those areas where testing and counselling cannot take place; it should be made available to all mothers whether or not they are HIV positive”. The province cannot wait for years to build an infrastructure wherein the HIV status of women can be determined and counselling provided, he said.
Moving now would directly contradict the government’s Aids strategy which puts nevirapine at the heart of a package of care and counselling. Yet the national government has failed to publicly attack Buthelezi as it has done Gauteng Premier Mbhazima Shilowa.
Giving nevirapine without offering voluntary counselling and testing for the virus is a controversial issue.
Glenda Gray, director of the peri-natal HIV research unit at Chris Hani Baragwanath hospital, says administering nevirapine without VCT raises ethical questions. “This may be acceptable as a short-term approach or in a crisis situation,” says Gray. “But women have a right to know their HIV status”.
Mark Heywood of the Treatment Action Campaign (TAC), which has sued the government for failing to provide nevirapine nationwide, says such an approach is an emergency short-term measure. “TAC’s position is that VCT is an essential part of the overall mother-to-child-transmission programme and cannot be divorced from the anti-retroviral intervention.”
But testing positive can mean women facing stigma. A study in Kenya found a significant proportion of women would prefer to take nevirapine without knowing their HIV status.
In KwaZulu Natal confusion continues to swirl about what is actually being provided for pregnant women. Health MEC Dr Zweli Mkhize contradicts Buthelezi, saying: “If a hospital says they need nevirapine, we will support them if they have implemented a programme that includes voluntary counselling and treatment. Nevirapine cannot be taken in isolation.”
The provinces seem bewildered by how to respond to the politically sensitive issue of nevirapine.
In Gauteng Shilowa has taken a public hammering from the ANC and Minister of Health Manto Tshabalala-Msimang after he announced that the province’s Aids programme would roll out within the next 100 days. He said nevirapine would be made available in all facilities in the next financial year. Department of Health Director General Ayanda Ntsaluba had previously said the much praised Gauteng programme was within national guideline parameters.
Western Cape
The Western Cape has been the forerunner in administering nevirapine to HIV-positive mothers. “Our pilot phase is completed. Currently we have 38 sites and two national sites which are part of our system,” says Faried Abdullah, deputy director of health in the Western Cape. He points out that the Western Cape has been rolling out since January 2001 and at present is reaching 70% of women, looking at 100% in March 2003.
Abdullah says infrastructure and the cost of the drugs are not huge hurdles. “Our roll out took place in phases with formal counsellors and testing facilities at every site. At present we have 101 follow-up baby facilities where we monitor the child up to 18 months.” Asked what he thinks of other provinces’ positions on administering anti-retroviral drugs, he says, “We stuck to our guns and my advice would be to get on with it.”
Eastern Cape
The Eastern Cape’s Makhenkesi Stofile seems to be “getting on with it” with his announcement that a roll out plan making nevirapine available in all health facilities would begin once the results of pilot sites have been analysed. He said the province is embarking on the training of midwives to administer the anti-retrovirals.
“There is no national or provincial policy which says anti-retroviral drugs in general or nevirapine in particular should not be given to HIV-positive mothers,” said Stofile. No time frame was placed on the programme.
Free State
At the opening of the provincial legislature, Free State Premier Winkie Direko implied that the nevirapine programme could be extended throughout the province. “The Free State provincial government will extend the present two prevention of mother-to-child transmission of HIV research sites by increasing the number of clinics per site to fulfil the national criteria,” she said. However Health MEC Ouma Tsopo said this was only to bring its two pilot sites into line with national criteria.
Limpopo
It was reported that Limpopo formerly Northern Province is considering extending its anti-retroviral treatment to six major district hospitals beyond the pilot projects. In a statement Premier Ngoako Ramatlhodi said there is evidence that its HIV/Aids campaigns are successful. “We are drawing lessons from the two sites,” says provincial spokes- person Aluwani Netsianda.
North West
North West will continue to support the national pilot sites to study the effects of nevirapine on HIV-positive mothers. Premier Popo Molefe said the infection levels at antenatal clinics had stabilised and there had been a 2% drop in sexually transmitted diseases.
Northern Cape
Provincial health MEC Dipuo Peters has come out in strong support for national guidelines. She said: “We are rightfully within the national guidelines and we are analysing the process at the sites. We are going to stick to the guidelines until the national decision is changed.”