COURT CASE ON MOTHER-TO-CHILD TRANSMISSION OF HIV

Issued by Department of Health

23 November 2001

The court application on the use of Nevirapine to reduce mother-to-child transmission of HIV will be heard in the Pretoria High Court on Monday and Tuesday next week. The action has been brought by the Treatment Action Campaign against the Minister of Health and eight MECs for Health.

We approach the case with grave doubts that it is likely to resolve what is essentially a policy matter. But we also recognise that the legal action has become unavoidable. On the one hand, the Minister and her provincial colleagues remain of the view that that they cannot take the approach that TAC advocates -- and the applicants clearly feel that, in these circumstances, the courts are their only recourse.

We respect the right of any individual or group to use the courts in the fashion that TAC has. At the same time, we are concerned that differences on how we approach the matter of mother-to-child transmission should not divert us from the critical task of building a national movement to combat HIV/AIDS and the associated epidemic of TB.

Three years ago Government launched the Partnership against AIDS in the firm belief that only the widest mobilisation and sustained co-operation of all sections of society could reverse the HIV epidemic and provide the scale of care required for those already infected and their families. Do we still believe that? Yes, and far more strongly even than in 1998. We also believe that Government has to scale-up its role to draw a stronger response from society at large.

This week many of you will have received information about the World AIDS Day campaign that runs almost concurrently with this court case. You should, in the fortnight ahead, become thoroughly familiar with the slogan "I care enough to act . . . do you?"

The campaign is the first major output of a R90-million communication tender for HIV/AIDS, awarded because of our commitment to building public awareness not only to prevent the spread of HIV but also to mobilise involvement in caring for and protecting the rights of those affected.

In October Finance Minister Trevor Manuel announced in his Medium Term Budget Review that funding for HIV/AIDS would be increased on two fronts:

• Through funding for the dedicated national AIDS programmes -- communication, condom provision, research, pilot projects and the like.
• And, for the first time, through increasing the health allocation to provinces so that they can strengthen their hospitals and clinics to cope more effectively with increased demands for service which result largely from the HIV/AIDS and TB epidemics.

Our services already spend billions every year on treatment arising from various infections associated with HIV/AIDS and indications are that this amount will be boosted substantially over the next three years.

We are trying to lay a far stronger foundation for early detection, better support and effective treatment of opportunistic infections.

• 18 months ago the rapid HIV test was not in use in our institutions. Today we have a total of 719 operational sites for voluntary testing and counselling. Much of our counselling is provided through contracts or partnerships with non-governmental orgaations.
• In the space of four years we have been able to move 70% of health districts onto the community-based system of TB management known as DOTS. Among other things, this has meant improving our laboratory services and drug supplies enormously and engagingch more vigorously with community groups. The combined effect of this is better management of TB.
• Two major weaknesses in our ability to treat opportunistic infections promptly and aggressively have been the limited knowledge of our health professionals and inadequate drug supplies. We have begun to tackle both of these in the last year. With the st anniversary of the Diflucan partnership coming up, we have 256 outlets for the drug (and another 80 in the pipeline) and no fewer than 4 270 health workers have been trained through this programme alone in the management of a range of opportunistic infections.
• When it comes to home-based care, we cannot claim rapid or spectacular success. But there is gradual progress, with projects funded by government in six provinces. Next year we will also be funding "step down" beds (probably in existing hospitals) thrh a grant of about R30-million to provinces.
• STI treatment in the public sector is generally strong and effective -- much more so, according to research, than in the private sector. We are engaging the private sector to ensure the overall quality of care improves.
• We continue to provide 250-million free condoms a year, to expand availability of the female condom and to pursue broadly based life skills programmes in schools.

When it comes to reducing mother-to-child transmission of HIV, the 18 research and training sites are up and running in all provinces, providing among them about 200 contact points for pregnant women. This year an amount of about R25-million was set aside at national level for the MTCT programme and this amount was augmented by contributions from provinces. Next year spending will be more-or-less comparable, but substantial increases are planned in the two subsequent years.

On the basis of this, we believe that it is inaccurate to say that Government is refusing assistance to HIV-positive women who are concerned to protect their unborn children. We have adopted a different approach to that demanded by TAC and the other applicants in the court case. It is a more cautious approach, with a strong monitoring component, and one that takes a rigorous view of safety issues and effectiveness.

The rationale for this approach forms the substance of the affidavits on which our court arguments will be based.

Dr Ayanda Ntsaluba
Director-General of Health