Sunday Times, South Africa - Sunday, January 10, 1999
Natalie Kammies

Kariem, head of the Western Cape's AIDS programme, this week launched a pilot project to treat pregnant HIV-positive women with the drug AZT, giving their children a 50-50 chance of surviving.

The project was launched at Site B and Michael Mapongwana hospitals in Khayelitsha and will continue for 12 months.

Although the drug has proved to be effective, the national Health Department decided last year that it could not afford to administer it on a national scale.

But the Western Cape government decided to fork out R650 000 to fund the project.

The authorities believe the cost of AZT will work out at a quarter of the cost of treating AIDS babies till their deaths.

Pregnant women at the hospitals are given the option of an AIDS test and if they test positive they are treated with the drug.

Two women who went ahead with the tests were Nokubonga Maxhayi and Rose Dukumbana. They will be given the results this week, but both say the project has given them peace of mind.

Maxhayi, 21, who is six months' pregnant, said: "I'm very interested in my baby's life and I'm glad there's something that might save the baby from contracting the virus should I have it.

"I've got a bit of fear but I'll take the news as it comes because everything has been explained to me clearly."

Dukumbana, 36, a single mother, said her latest pregnancy was unexpected. She read about the AZT project in newspapers and agreed to go for the HIV test after attending a talk at the hospital.

"I didn't know that you could pass HIV on to your unborn child," she said.

Midwife Tozama Qomfo said: "I'm very happy because the project gives hope to the unborn baby."

All mothers who had tested HIV-positive in the past would be told about the programme when they came in for routine checks. Around 5 000 women would be tested at the two clinics over the next 12 months and doctors expected 750 of them to be HIV-positive.

Kariem said 98 percent of pregnant women agreed to be tested.

Those who were HIV-positive would take three tablets twice daily as well as during labour and delivery.

After birth, the baby would be monitored until it was 18 months old.

HIV-positive mothers would be discouraged from breast-feeding as there was a 25 percent chance of HIV being transferred through breast milk.

Kariem said setting up the pilot project was a "frustrating process, largely because you've got to get the support of everyone".

"We could not have done it if the Khayelitsha community did not want us to. Ultimately we'll save these babies' lives and that to me is what it is about."

Dr Fareed Abdullah, provincial chief director of Health Care said the project would help determine national policy. Abdullah said the AZT programme could substantially reduce the infant mortality rate in the province.

He said the project was initiated in the Western Cape because HIV was less prevalent here than in other provinces and would cost less.

Another reason was that the cost of hospitalising infants in the Western Cape was one of the highest in the country.

The programme would mean fewer infants would be hospitalised, leading to an expected saving of some R2-million.

Dr Harm Pretorius, national acting director general of health, said: "The information from the Western Cape trial will inform policy making on a national level."

Regional ANC leader Ebrahim Rasool, who was involved in initiating the Western Cape AZT project when he was MEC for Health in the government of national unity, said this week that during the planning stage they had looked at the cost implications - such as whether AZT could be provided for every mother.

"We also looked at the ethical implications, like what happens to the baby when the mother dies.

"I think it's a good idea if it is affordable but if the Western Cape is going to be the only supplier and other provinces do not have the resources, one could see an influx of pregnant mothers to the Western Cape."

At King Edward Hospital in Durban a similar trial called the Perinatal Transmission Reduction Study is being done on pregnant woman who are HIV-positive.

Dr Jack Moodley, head of obstetrics and gynaecology at King Edward said all pregnant mothers coming to the hospital were counselled and asked if they wanted an HIV test. If they agreed and were found to be HIV-positive they could be put on a course of anti-viral drugs like AZT.

The programme was started two years ago and is funded and co-ordinated by the World Health Organisation and has no provincial funding.
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