The South African Government's policy on the use of nevirapine to prevent mother to baby transmission of HIV has been thrown into further disarray with the government of Gauteng province announcing that it is to defy President Mbeki and initiate a programme to make nevirapine available to all HIV-positive expectant mothers. And in an unrelated development, the South African national budget statement for 2002-03 this week included a clear indication that the national government will itself be sanctioning wider availability of the drug, with substantial resources allocated to financing nevirapine programmes.
Starting tomorrow, HIV-positive women attending the state Ga-Rankuwa-Soshanuve Complex in Pretoria will have access to nevirapine, with another eight major hospitals making the drug available over the next three months.
Gauteng province, which is South Africa's wealthiest and contains the cities of Johannesburg and Pretoria, has equipped 40 per cent of state run hospitals with the technology and equipment to distribute the drug over the past year and has ear-marked nearly R2 million to a programme of nevirapine access.
Gauteng is now the fourth South African province to make nevirapine available to pregnant women in defiance of the wishes of the national government, which is still refusing to provide the drug despite a court order to do so. A national Health Ministry spokesperson is quoted as saying that there was a need for "further study and consultation" before nevirapine could be made available on a national level beyond the 18 hospitals where it is currently provided as part of a clinical trial.
However, the national government has allocated R1 billion to HIV prevention, care and treatment programmes in the next financial year and Finance Minister Trevor Manuel said that the money would finance a "progressive roll-out programme to prevent mother-to-baby transmission at the conclusion of the current trials."
Although the funding has been welcomed, Aids activists are warning that it is essential to see that the money is spent appropriately, with health economist Dr Di McIntyre of Cape Town University pointing out that "last year the conditional grants for HIV/AIDS were not weighted sufficiently. For instance, KwaZulu-Natal should have received a sizable share, but this was not the case. A key factor will be to see that the funds are heavily weighted to support those who need it the most."
The AIDS Consortium, which represents over 400 HIV organisations also gave the funding allocation a cautious welcome, saying that it was essential to use to money to develop a comprehensive national programme to prevent mother-to-baby transmission, taking into account the needs of women living in townships and rural areas.
The national funding is in addition to the R4 billion which provincial governments are expected to spend on HIV in the next 12 months.