Sunday Times, South Africa - Sunday, November 18, 1998
Nkosazana Zuma

Such a pity, then, that it had to be on an issue like that of mother-to-child transmission of HIV and the efficacy of using the drug AZT, because facts were hugely distorted.

As such, the Sunday Times missed a crucial opportunity to take forward what has emerged as a national campaign based on national consensus. It failed to reflect in any meaningful way on the Partnership Against AIDS launched two days earlier.

The main thrust of the government's strategy is prevention through better education and information. The implications of a treatment (AZT) which allows for the possible reduction in the transmission of HIV from mother to child is being investigated by the Health Department alongside other alternatives. Related to this are ethical issues to be confronted when taking this route.

Let us start with some of the basic facts.

First, as I put it to your reporter, the government's strategy is focused on the prevention of the spread of the virus, care for those who are affected and no discrimination against people living with AIDS.

While our starting point is that there is no cure for AIDS, we are encouraging initiatives leading us in that direction.

As Deputy President Thabo Mbeki said in his address to the nation on October 9, there is no cure for HIV or AIDS. The only cure is to prevent the infection in the first place.

For this reason, we have a public-health responsibility to focus on raising awareness and getting people to take responsibility for their behaviour. This will have to be done within the limited health budget at our disposal.

This is what the R80-million is earmarked for - to give effect to that strategy.

The key aspects of the National AIDS Programme include:

The spread of life-skills programmes aimed at the youth;

Improved management of people with sexually transmitted diseases;

Improved access to barrier methods;

Appropriate care, counselling and support for people infected and affected; and

Engaging in public awareness campaigns.

These include setting up partnerships, engaging in advocacy work and mobilising the various sectors.

In implementing this programme, the government last year:

Trained more than 10 000 secondary school teachers and launched the life-skills programme;

Initiated the first phase of the Beyond Awareness Campaign, which served to link affected people with the available resources;

Appointed three traditional healer consultants to train traditional healers in the management of STD and HIV;

Distributed 140 million condoms and began developing an introductory strategy for the female condom; and

Initiated lay counselling and mentorship programmes to strengthen counselling services.

The October 9 event was aimed not only at signalling the political authorities' commitment but at initiating a partnership of various sectors against AIDS. Second, the possibility of an AZT-related programme has not been dismissed.

It has been proven that about 20 percent of pregnant, affected mothers pass on the HIV infection to their children during late pregnancy or during delivery, while another 14 percent do so through breast-feeding. Thus the overall risk is that about one third of expectant women could pass on the virus.

The AZT treatment will have a limited effect on the epidemic, as we are targeting individuals already infected.

The Sunday Times report is silent on how that one third is to be identified. We have arrived at a figure of R80-million on the assumption that it is administered to all HIV-infected pregnant women. Trials in Thailand have shown that a 51 percent reduction in mother-to-child transmission is possible when the mother is treated with AZT during the last four weeks of pregnancy and she is not breast-feeding. Thus the R80-million will be used to solve one part of the epidemic - it'll certainly not be putting an end to the spread of HIV.

The third point to be made is that research into AZT is being carried out here. The R80million includes the cost of the drug, counselling, testing and providing mothers with formula milk for babies.

As your editorial correctly points out, it is the poorest who need this treatment most - and they are the ones who would otherwise have been entirely dependent on breast-feeding.

Thus the state will have to provide the alternative formula feed for at least the first six months of the child's life to reduce transmission.

The fourth point which the government will have to weigh is that of the ethical, legal and constitutional issues which arise if we commit our country to the AZT path.

While a successful intervention can possibly save a baby, it is not going to help the mother infected by HIV.

We need to plan and acquire resources for additions to the already 200 000-strong population of "AIDS orphans".

This burden, which will also require a societal response, costs more than the R80-million touted in your editorial.

Because of the above reasons, the Department of Health has decided against implementing the short-course AZT regimen. It will continuously evaluate the decision as new scientific information on cost-effective interventions appropriate to our situation in South Africa become available.

We hope that the Sunday Times, like all other major newspapers, will, in time, play a meaningful role in the Partnership Against AIDS.

Nkosazana Zuma is the Minister of Health
981118
ST981103

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