Sunday Times, South Africa - Sunday, October 11, 1998
Carol Paton

Last week, Zuma and the nine provincial health ministers decided that the government would not provide pregnant women who are HIV positive with the drug AZT, which can cut the transmission rate of HIV to babies by half.

As a result, pilot projects at four clinics and a hospital in Gauteng, which were due to start this month, have been indefinitely postponed.

A consequence of the decision is that as many as 200 babies a day will continue to be born with HIV. Many are abandoned by their parents who are unable to look after them.

If the drug - officially known as zidovudine - was given to pregnant women in the ninth month of their pregnancy, 100 of these babies would be saved.

Zuma, who made the announcement on Friday at the launch of an R80-million AIDS awareness campaign by Deputy President Thabo Mbeki, said that the government had chosen to concentrate its resources on raising public awareness.

"It [the drug treatment] is not cost-effective because we don't have the money," said Zuma.

"What we are focusing on is trying to get the prevention message across, because . . . what will work is when people take precautions and babies are saved because men and women are using condoms."

But doctors treating HIV-positive mothers and children strongly disagree that the drug is not cost-effective, arguing that it is far cheaper to treat the mothers than it is to treat HIV-positive children.

Glenda Gray, director of the Perinatal HIV Research Unit at Chris Hani Baragwanath Hospital and one of the doctors who designed the scuttled pilot study, said that AZT was one of the few concrete steps that could be taken against AIDS.

"Here's a real way we can prevent transmission and the government is not intervening. They prefer incoherent campaigns instead of things that will really turn the tide against AIDS," said Gray.

Doctors at hospitals in Johannesburg said a month-long course of the drug would cost between R368 and R750.

However, the treatment needs to be accompanied by HIV testing and counselling, and by formula or replacement feeding for babies, to prevent transmission via breast milk, which would add to the cost.

"But it makes good business sense. Whatever money you put in, you get out, in terms of the costs of treating HIV-positive babies," said Gray.

It would cost about R80-million to provide a short course of AZT to pregnant women with AIDS, she said.

One Johannesburg hospital, which does not want to be named because of fear of an influx of new patients, feels so strongly that AZT therapy should be used that it is supplying the drug free to all HIV-positive expectant mothers.

Dr Arthur Manning, the superintendent of the hospital, said the obstetrics department had made budget cuts in other areas to afford the treatment.

But in the light of the government's decision, Manning said the hospital may have to review its policy.

"There is a debate and we are on the one side and the department is on the other. We are hoping that we can prove to them that it works," said Manning.

Doctors say the consequences of being unable to provide the drug free are disastrous.

Dr Trudy Smith, a consultant in the obstetrics department at Johannesburg Hospital said that while more than 30 percent of women attending the antenatal clinic were HIV positive, women had to pay for their own AZT - and, as a result, only five patients were using it.

"For these people, it is a considerable amount of money that they have to pay and, as a result, a minuscule number are using AZT," said Smith.

Sandra Anderson, UN AIDS care and support adviser for Africa, said: "It is something concrete that can be done. As a public health intervention it shows a lot of promise."

Zuma is also sceptical of the value of the programme because she says a relatively large number of women have to be treated to save a relatively small number of babies.

In South Africa, between 38 and 46 percent of HIV-positive women transmit the virus to their babies.

But all HIV-positive mothers would have to be treated as it is impossible to predict who will transmit the disease.

Of those who do, AZT provides a 50 percent success rate of blocking the transmission.

"If you take all that into account and compare it to the benefit you would get from prevention [through greater awareness] then we really have to deal with prevention," said Zuma.

Dr Ralph Mgijima, superintendent-general of Health in Gauteng, said that the pilot studies would have been too expensive.

"The whole thing is unaffordable as far as we can tell. Not only do you have to provide the AZT, you also need breast milk substitutes," he said.

981011
ST981002

Copyright ©1980, 1998. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .