A programme being run in Paarl in the Western Cape to reduce the risk of babies contracting HIV from their mothers during birth is setting standards not only for the rest of South Africa, but for the world.
The programme is offered at the provincial administration's TC Newman healthcare centre, one of 18 sites countrywide designated by the national health ministry as pilots for testing operational issues around the use of the antiretroviral
The centre's antenatal clinic has had 1000 visits since it began the mother-to-child transmission (MTCT) prevention programme in May this year.
Of those women, a staggering 96 percent have opted for HIV testing and the counselling that goes with it.
The test tells a woman whether she and her child need Nevirapine at birth to lessen the chance of transmission.
This is the highest acceptance rate in the whole world, provincial deputy director-general of health Dr Fareed Abdullah said at the centre on Thursday.
He said that by comparison, the uptake at an MTCT programme launched in Khayelitsha just under three years ago had initially been as low as 49 per cent.
Figures for Zimbabwe and Botswana, both of which have alarming infection rates, were 23 and 30 percent 18 months ago.
According to Abdullah, the quality of the counselling that women are offered is directly linked to their acceptance of the
At Khayletisha, pre-test counselling had initially been given to women in groups of 15. Now that they were being offered individual counselling, the figure had gone up to 85 percent.
At TC Newman, which serves communities ranging from farms and informal settlements to established working-class residential areas in Paarl, women are offered one-on-one counselling in a homely building set apart from the rest of the
The whole thing of offering a client privacy, that offers them a whole lot of respect and dignity, said Iris Cupido, chief professional nurse in charge of the MTCT programme at the
The counsellors are sourced from Agape, a non-government organisation that also has an office at the centre. The centre has a large notice on the door saying free condoms available here.
After counselling the women go to the clinic itself for testing - a process that takes a bare 15 minutes, or slightly longer if the initial result is positive and there is a need for a confirmation test.
If the result is positive, the woman is told by a sister, with a counsellor present, in a private room.
Cupido said women reacted in different ways to being told they were HIV-positive. Some accepted it quite okay, particularly if they were Christians and took it as God's will.
But we get a lot of anger and disbelief... and sometimes that anger is taken out on us, she said.
According to Dr Terrence Carter, the provincial health department's director for the West Coast and Winelands regions, of the women who have been counselled and tested since May, 34 or seven percent, were HIV-positive.
Of these, 25 had already given birth, and two opted for termination of pregnancy.
No figures are available from the Paarl programme on the effectiveness of the Nevirapine, because the babies get tested only after nine months when their mothers' antibodies have disappeared from their systems.
Administering Nevirapine - a tablet for the mother at onset of labour, and a dose of syrup for the newly-born baby - is only one step towards an HIV-free child.
Mothers also have to decide whether they are going to feed their infants either exclusively from the breast, or from the bottle - and stick firmly to that decision.
Although there is a possibility that a mother may infect her baby by breastmilk, the risk increases when the two feeding methods are mixed.
Abdullah says the province is already providing 90 percent of the care that an HIV-positive mother should get before, during and after birth, in the form of in- and out-patient care, and medication for opportunistic infections such as pneumonia, skin rashes, cryptococcal meningitis and tuberculosis.
A person who was really sick was given the expensive drug (fluconazole)
He said though Paarl and Guguletu day hospitals were the two designated national pilot sites for Nevirapine in the province, his department was also offering the drug to mothers in George, Langa and Worcester. Mothers at Khayelitsha get another antiretroviral, AZT.
He said two more sites would be added next month, and by June next year the whole province would be covered by MTCT
The Western Cape is controlled by the Democratic Alliance, and its MTCT programme has been a source of tension with the ministry.
However, staff at TC Newman said a number of senior figures from the national department had visited to see the programme in action, and had been impressed.
An estimated 5 000 babies a month are born HIV-positive in South Africa because their mothers pass the virus on to them at birth.
Source: SAPA, 23 August 2001