Sunday Times (Johannesburg) - Sunday 16 December 2001
Gillian Anstey
THE Minister of Health, Manto Tshabalala-Msimang, and her provincial deputies will meet this week to plan the government's response to the landmark nevirapine judgment.
Pretoria High Court Judge Chris Botha on Friday ordered the government to make the antiretroviral drug available to HIV-positive pregnant women who give birth at public hospitals.
The court set down a three-month deadline for the government to present "an effective, comprehensive national programme" to cut down the transmission of HIV/Aids from mother to child.
Until now, only 10% of the population has had access to the drug, which is said to reduce the risk of passing on the virus from mother to child by 50%.
Department of Health director-general Dr Ayanda Ntsaluba said yesterday that a meeting was scheduled for "Tuesday or Wednesday" to consider the implications of the judgment on the nine provinces.
"We cannot start speculating. We are studying the judgment and will explore our options. Obviously we will look at elements therein which can be challenged," he said.
Dr Haroon Saloojee, a specialist paediatrician at Soweto's Chris Hani Baragwanath Hospital, said: "There is no reason why nevirapine should not be available at hospitals in the next few weeks. If a mother knows her HIV status, she should have access to the drug."
About one million babies are born in South Africa every year - 25% of their mothers are HIV positive resulting in 70 000 of the babies contracting the virus. "Access to nevirapine would reduce this figure by half," said Saloojee.
Babies born to HIV-positive mothers are either infected during pregnancy or at birth. A single dose of nevirapine syrup should be given to the baby within 72 hours after birth. Results then depend on whether a mother abstains from breast- feeding her baby.
The judgment has signalled hope for three pregnant women at Mpumalanga's Philadelphia Hospital. Matron Maria Mtombela said: "We are going to ask the MEC to make nevirapine available to these three."
In his ruling, Judge Botha said: "About one thing there must be no misunderstanding: a countrywide MTCT [mother-to-child-transmission] prevention programme is an ineluctable obligation of the state."
The state argued that if public sector doctors prescribed nevirapine, the health system would be thrown into chaos and that "budgeting distortions" would result.
"I cannot agree with these arguments," said Judge Botha, pointing out that one dose of nevirapine costs R10.
Tshabalala-Msimang and all nine provinces must present a report before March 31 stating, under oath, what they had each done about implementing this programme, what they would still be doing and when.
Sarah Hlalele, whose son Kgotso has a strong chance of being HIV-positive, said she was happy.
Hlalele had told the court that her son might die because he was born in the wrong place. His birth was planned for Chris Hani Baragwanath Hospital, which administers nevirapine. Instead, he was born prematurely at Sebokeng Hospital, 50km away.
But for some HIV-positive mothers, the court ruling is too late. Busisiwe Maqungo, 29, has described the agony of losing her nine-month-old daughter, Nomazizi, in January 2000 because she had no access to antiretrovirals.
"I gave birth to an HIV-positive baby who should have been saved. That was my experience and I will live with it until my last day," she said.
- Additional reporting by Jessica Bezuidenhout, Mzilikazi wa Afrika and Rafora Rangongo
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