SOUTH AFRICA: Government ordered to provide nevirapine

The government has been ordered by the country's highest court to provide the antiretroviral nevirapine immediately to HIV-positive pregnant women.

The Constitutional Court on Thursday upheld an earlier Pretoria High Court ruling that the government provide the drug. This is part of a protracted court battle between the government, which refuses to extend provision of the drug beyond its 18 pilot sites, and lobbyists who want the drug prescribed at all public health facilities.

The government went to the Constitutional Court to overturn part of the Pretoria High Court decision - that it begin providing the drug even before returning to court in May to appeal the overall ruling.

The government reacted by saying that Thursday’s order specifically pointed out that it was not required to undertake the "wholesale extension" of the nevirapine programme, but was expected to enable the drug to be prescribed at health facilities where necessary conditions already existed.

This would include voluntary counselling and testing services, as well as in cases where attending doctors and medical superintendents considered it medically advisable.

The national health department said it would send a circular to all public health facilities to "ensure that facility managers and health professionals in ante-natal clinics are in a position to respond appropriately to the latest development".

The government wanted to make sure women received proper advice on breastfeeding, which could re-infect babies, and that women made informed choices, it said, adding that a task team being constituted to guide the further development of the programme on mother-to-child transmission would communicate and monitor actions taken as a consequence of Thursday’s order.

The battle for provision of the therapy, which prevents the transmission of HIV from mother to child, has raged for months.
Doctors at state hospitals which are not part of 18 government pilot project sites are not allowed to prescribe it, but three provinces are already defying the national health department.

In addition, some state doctors are sourcing their own funds to give the drug to mothers. The government says it does not have the capacity to provide the drug beyond the pilot sites and also wants to wait for the results from the test sites.

The Constitutional Court was told on Wednesday by TAC lawyer Gilbert Marcus that about 70,000 babies were born to HIV-positive mothers in South Africa each year and that nevirapine had been offered to the public health sector free of charge.

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