Statement by Western Cape Minister of Health Nick Koornhof
on  Prevention of Mother-To-Child Transmission of HIV/AIDS:

            Roll out of programme in Western Cape

29th August 2000

The Western Cape Department of Health is preparing to extend its programme
to promote Prevention Mother-To-Child-Transmission (PMTCT) of HIV/Aids. The
Chief Director: Professional Support Services Dr. Fareed Abdullah, who is
directing the programme from Khayelitsha where PMTCT interventions have
been conducted for the past 20 months, will also be charged with
implementing the programme in the following new areas

· Gugulethu (4th January 2001)
· Langa/Bonteheuwel (4th April 2001)
· Paarl (4th April 2001)
· Worcester (4th April)  and
· George ( 4th April 2001).

Some important lessons have been learnt from the intervention in
Khayelitsha. AZT is now given at 34 weeks gestation as it was found that
HIV positive women deliver earlier. A task team under the chairmanship of
Professor Gary Maartens of the University of Cape Town Infectious Diseases
Unit, will decide if AZT, Nevirapine, or any other proven anti-retroviral
drug should be used for the longer term in the MTCT programme. The same
task team, which will consist of about 12 members, will report back within
four weeks on the feasibility of extending AZT, or any other proven
anti-retroviral drug, to rape victims. A budget of R6 million a year will
be allocated for the roll-out programme.

Since commencing the first PMTCT programme in Khayelitsha on 4th January
1999, more than eight thousand of the ten thousand antenatal attenders have
been tested for HIV/Aids, with a positivity rate of 16%. Khayelitsha was
selected because it is the highest seroprevalence area in the Western Cape.
During the period under review full dose compliance by users was low but
partial compliance was high. Some of the unplanned spin-offs have been

· Good data on antenatal attenders
· support groups have operated openly in the past year, and
· the stigma of HIV/Aids has been reduced.

 Use of the anti-retroviral drug AZT in Khayelitsha has meant that several
hundred lives may already have been saved. In this regard, I would like to
extend my heartfelt thanks to Dr. Lawrence Bitalo, Sister Zanele Mazwi and
Mrs. Lokiwe Mtwazi, the head of Department of the Tygerberg Municipal
Health team.

I would also like to make special mention of the work done by Medicines
Sans Frontieres. You may know that they have opened an office in
Khayelitsha. Their role is to offer mothers and fathers in the
Mother-To-Child Transmission programme in Khayelitsha, hope beyond HIV
positivity. They will enhance preventive lifestyles and focus on positive
attitude changes. Following their intervention thus far, 950 HIV positive
women are better able to face the challenges of living with the HIV disease
and Aids. If the role of MSF in the Khayelitsha project is successful and
shown to be feasible, it could become a model for Africa.

The new sites selected for the expanded MTCT programme all have a
combination of high seroprevalence and availability of personnel and
facilities for this intervention. It will be appreciated that great drive
and commitment are required from counsellors and staff. The single biggest
weakness in the start-up period was to ensure supplies at referral centres
and this has been addressed. Every step in the new programme will be
carefully assessed, and where possible the regimen will be standardized, to
empower personnel. It must be stressed that we are not testing the efficacy
of the drugs concerned, but rather extending a programme which has been
implemented and proven over a period of 20 months. We started early, and
this has made it possible for us to have this roll out to six sites, rather
than the two sites each planned for the other provinces. We will share our
experiences with the other provinces and other SADC countries.

I understand that this announcement may cause controversy in certain
circles, but we have taken this decision because it is the right thing to
do, and not to play politics. I will never allow HIV/Aids to be politicised
in this province. However, it was former President Mandela who warned us
all in his closing remarks at the 13th International HIV/Aids conference in
Durban that "we have to rise above our differences and combine our efforts
to save our people. History will judge us harshly if we fail to do so now,
and right now".

Due to timeous planning and decisions, we were ready in the Western Cape,
and it would have been immoral for us not to proceed. We only hope it is
not too late. I urge all other provinces to follow suit as soon as
possible. I re-iterate: we are ready, willing and able to assist them. We
cannot conduct health services in this province in isolation from the rest
of South Africa. We are already "paying a price" for doing business
differently. Only last year we had an influx of more than 500 000 patients
over and above our normal load in the metropole. We cannot and we do not
refuse them but by the same token, it is impossible to budget for such an
influx, and it is putting our budget under strain.

This announcement will make us even more attractive, so it is in our
interest that the rest of South Africa follow suit as soon as possible.
I would also like to request the Medicines Control Council to expedite
their decision on the general use of Nevirapine. Such a decision could help
to fast-track similar programmes in the rest of South Africa.

Finally, it must be emphasized that the MTCT programme can never be a
substitute for responsible sexual behaviour. We need the help of the
community and our church leaders to assist us. The church can play an
important role in breaking down the stigma attached to the disease. By
doing that, people will be more inclined to do voluntary testing.

Everyone should know their HIV/Aids status. It must become as common as
knowing your blood pressure. I am concerned that the terrible threesome of
HIV/Aids, TB and alcohol abuse, particularly in the Western Cape, can play
havoc in our poor communities if not addressed immediately, by communities
and individuals. That is why I urge church leaders to become more active
and more involved in this crusade.


Nick Koornhof
Minister of Health, Western Cape.


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Judith Soal
Cape Times
021-488-4743 (tel)
021-488-4717 (fax)
083-456-2597 (cell)