21 February 2002
Cabinet yesterday (20 February) received a briefing on a request by the United Nations for SA to contribute additional personnel to the staff of the UN Peacekeeping Mission in the DRC. It was agreed to deploy an additional maximum of 25 staff officers to MONUC HQ in Kinshasa and 48 Military Police Officers to the Mission.
The meeting approved South Africa’s accession to the Council of Europe’s Convention on Extradition and two additional Protocols. It was also agreed that SA should approve the Regional Fisheries Convention for Fishing Resources of the South East Atlantic Ocean.
The meeting approved the following appointments:
- Board of Directors of the National Integrated State Oil Company (PETROSA);
- Three Chief Deputy Commissioners in the Department of Correctional Services.
Cabinet received a briefing on the situation in Zimbabwe and expressed appreciation at the contribution being made by various sectors of South African society to the SA Observer Mission in that country. Initial reports indicate that the Mission is undertaking its mission with integrity and with the support and co-operation of Zimbabwean authorities and other role-players in the election process.
Cabinet reaffirmed government’s comprehensive approach to the campaign against HIV/AIDS, as reiterated by the President in his State of the Nation Address. The meeting was informed that, with regard to the programme against mother-to-child transmission in particular, communication would be stepped in the coming period to ensure that there are no ambiguities [The text of an advertisement on this matter is attached]. The meeting was also informed that the Minister of Health would confer with the Premier of Gauteng, to clarify any misunderstanding that may have arisen in the recent period.
Issued by: Government Communications (GCIS)
21 February 2002
Government, working in partnership with all sectors, particularly the SA National AIDS Council (SANAC), will intensify its comprehensive programme against AIDS, sexually-transmitted diseases, tuberculosis and other communicable diseases.
In implementing the agreement we reached with the pharmaceutical companies, we have initiated discussions with some of them to examine new ways of making drugs more affordable and to strengthen our health infrastructure. They are responding positively indeed - President Thabo Mbeki, State of the Nation address, 8 February, 2002.
Government’s programme to reduce HIV infection in babies
Preventing mother-to-child transmission of HIV forms part of Government’s programme of HIV/AIDS prevention. It is also part of a broader strategy to combat HIV/AIDS that depends critically on building partnerships across society.
"Our focus remains a massive prevention campaign directed at ensuring that the high rates of awareness translate into a change in lifestyles; care for the affected and infected; treatment of all diseases, including those associated with AIDS; and research into a vaccine.".-- President Thabo Mbeki, State of the Nation address, 8 February, 2002.
Our programme to prevent sexual transmission of HIV and in particular our prevention programme amongst young people has been described by the head of UNAIDS, Dr Peter Piot, as the largest and most comprehensive in Africa and one of the largest in the world; a programme, he says, with very high levels of government investment, which is starting to show results.
At the International AIDS Conference in Durban in July 2000, research was presented on the use of Nevirapine to reduce mother-to-child transmission of HIV.
Based on these results, Government developed a more comprehensive programme to reduce HIV transmission to babies and to conduct further research on the subject. In May 2001, the first of 18 national research sites began to operate. By the end of 2001, these sites involved 215 clinics and hospitals.
What happens at the research sites?
Women attending these sites are offered counselling and voluntary testing for HIV. Mothers who are HIV-positive are also offered Nevirapine for themselves and their babies; vitamins to improve their health during pregnancy; preventive measures and prompt treatment of infections in mother and baby; and formula-feed if they choose not to breast-feed.
All mother-and-baby pairs will be followed up comprehensively at one year and beyond to check if the benefits are as good as expected and if there have been any unforeseen problems.
About 70 000 women have so far received antenatal care at the hospitals and clinics in this research programme. More than 38 000 opted to take the HIV-test and about 9 500 of them were HIV-positive. Over 3 700 of the HIV-positive mothers have received Nevirapine and where they have already given birth -- in more than 2 600 instances -- their babies also received Nevirapine syrup within 72 hours of birth.
What have we learned from the research?
Research is a key part of building this new service so that we fully understand the implications of using Nevirapine. We need to know what changes must be made to our existing mother-and- child clinics to run a Nevirapine programme that is accepted by our communities and smoothly operated. What is required in terms of space, information, staffing, and community support? We also want to be sure what the longer term impact and efficacy of using the drug is, both for baby and mother.
We have learnt a lot about what it takes to run a good mother-to-child HIV prevention programme.
- Good quality counselling in private conditions is critical to success. This may require us to build new rooms, relocate ante-natal clinics, hire additional staff, form partnerships with NGOs.
- Many factors affect mothers’ choices around safe infant feeding. There is a need for community and family support where a mother wishes to use formula-feed. Lack of access to clean water and electricity has a major impact.
Continuing work will be done to monitor the efficacy of anti-retroviral interventions against mother-to-child transmission in the sites already operational and any new ones that may be decided upon. .- President Thabo Mbeki, State of the Nation address, 8 February, 2002.
When will this service reach more people?
The information from the research sites has been studied by decision-makers in every province and, on the basis of this, some have recommended an increase in the number of hospitals and clinics where Nevirapine is available. Any new services decided collectively should be an expansion of the research progamme and must be done in accordance with national guidelines and protocols.
In some provinces, it may take slightly longer to extend the research sites because services are less developed. But universal access will be decided on when important questions have been answered by the research.
We have got to address the deficiencies in the public health system that have shown up as a result of this (HIV research programme). But, in an instance where an area is ready to move, let us move . . . I don’t think they (the health authorities) would say let us wait for the slowest. They would have to say, let us make sure that the slowest catches up with the rest. – President Thabo Mbeki , News Hour interview, 10 February 2002.
Why is Government appealing against the court ruling?
In December 2001, the Pretoria High Court said Government should make Nevirapine available to pregnant women in all public health institutions, beyond the pilot sites.
Government is appealing against this judgment. This is not because we are against expanding the mother-to-child programme – that process continues. It is because we need to gain clarity on whether the courts or the elected government decides on the detail of providing health services:. This is a critical question about the division of powers in our democracy. The wisdom of the Constitutional Court should be applied to it.
The appeal process will not stand in the way of health authorities expanding the programme. Any expansion of the pilot sites will continue to be guided by research results and by available resources – including human resources and the standards we have set for comprehensive care.
Issued by: Government Communications (GCIS)