Hardline health authorities in two of South Africa’s provinces hardest hit by HIV/Aids continue to defy high court orders to provide potentially life-saving drugs.
Officials in Limpopo and Mpumalanga are instead still persecuting anyone who provides nevirapine to pregnant women. They have limited the supply of anti-retroviral drugs for rape survivors to existing stocks and then only to serve medical staff exposed to “needle stick” injuries.
The nevirapine ban, enforced on the grounds that provincial hospitals lack staff or facilities for proper treatment, continues in apparent defiance of President Thabo Mbeki’s about-turn on HIV/Aids five months ago.
Growing numbers of state doctors at Mpumalanga’s 26 hospitals are, however, ignoring provincial policy and administering nevirapine and other anti-retrovirals to rural women they say would die if untreated.
“We can’t stand by because of ideological debate. As doctors we’re sworn to save or prolong lives. Twenty-nine percent of pregnant women here test HIV-positive. We can find drugs even if the government won’t officially supply them,” said Dr Fikile Sithole of the Philadelphia hospital.
“Provincial authorities claim hospitals lack manpower or facilities to dispense nevirapine in particular. But doctors are volunteering to counsel patients, and organisations such as the Treatment Action Campaign [TAC] are supplying drugs.”
Confirming that other anti-retrovirals were theoretically available for rape survivors, Sithole said they were only “sporadically” administered because of shortages.
Philadelphia, Mpumalanga’s largest hospital, took up the fight for public access to anti-retroviral drugs after Rob Ferreira hospital’s administrator Dr Thys von Mollendorf was fired earlier this year for allowing volunteers to give free counselling and dispense drugs to rape survivors.
Dumisani Mlangeni, Mpumalanga’s health spokesperson, condemned the doctors’ growing rebellion and warned that the province would be forced to charge anyone found dispensing nevirapine on hospital premises.
“Hospitals can only dispense these drugs if superintendents rule the hospital is capable — including confirmation that it has the necessary milk formula stockpiles for all affected babies,” said Mlangeni. “Hospitals must pay for supplies from their own budgets.”
Conceding that Philadelphia, Rob Ferreira and Witbank hospitals had all requested authorisation to dispense anti-retrovirals, Mlangeni said they withdrew their applications after provincial authorities “helped them realise they were not ready yet”.
He also conceded that superintendents at all of Mpumalanga’s hospitals had been instructed to reapply for their jobs as part of a management shake-up that places budgetary power in the hands of non-medical CEOs.
“We have advertised all the posts and current superintendents are welcome to apply for the new clinical manager positions. Their stance on anti-retrovirals will not influence the appointments,” said Mlangeni.
Superintendents, speaking anonymously, complained that Mpumalanga had not yet developed a treatment protocol for nevirapine.
In Limpopo, where 14,5% of pregnant women test HIV-positive, a senior doctor at the Elim hospital near Louis Trichardt said “nothing was being done. Staff have been trained and the hospital has the capacity to test, treat and counsel — but there are no drugs. We cannot even help rape survivors.” The doctor and nursing colleagues refused to be named for fear of persecution.
Doctors say the only legal source of nevirapine in the province, the Mankweng and Siloam test sites, were not accepting patients from outside the hospitals’ immediate area.
Buyi Mdlovu, a director of Elim Care Group and a TAC executive committee member, slammed the province for inaction and a “wall of silence”.
“Many nurses have been trained to administer nevirapine and counsel patients, but nothing more is happening. All questions are met with silence from Health MEC Sello Moloto’s office,” said Mdlovu.
Charlie Nkadimeng, Limpopo’s health spokesperson, insisted the province was obeying the letter of the law. The problem was “a lack of capacity in terms of infrastructure and personnel”.
Dr Elma de Vries, spokesperson for the Rural Doctors’ Association, said constraints on personnel and infrastructure were a problem, but she insisted they were not severe enough to delay life-saving treatment.
“Budgets and spending priorities can be changed, or additional discretionary funds can be obtained,” she said. — African Eye News Service