Statement by the Southern African HIV Clinicians Society. 23/01/08

TAC campaign regarding PMTCT

The South African guidelines for the prevention of mother-to-child transmission (PMTCT) have not been revised since 2001, despite multiple revisions to recommended protocols by international agencies, including WHO.

Paediatric HIV has almost been eradicated in many countries in the world. Poorer countries with far worse infrastructure than South Africa have made significant progress in decreasing transmission. In South Africa, a middle income country where the majority of women give birth in state facilities, the fact that HIV-infected women have access to a sub-standard regimen for protection of their children is a sad reflection on our health system.

We support the Treatment Action Campaign’s call for the rapid application of new guidelines, and echo their support for medical professionals to utilise better regimens. These guidelines have been promised repeatedly and have been widely consulted, yet have not been released, meaning that children continue to be infected unnecessarily. Many provincial departments of health and health professionals have expressed frustration to our Society at not receiving formal permission to implement improved guidelines.

Furthermore, we call for more focused attention on HIV-infected pregnant women and their needs for HIV care and antiretrovirals. HIV is now the commonest cause of death amongst pregnant women.  Almost 1 in 3 pregnant women are HIV positive in South Africa, yet HIV testing, CD4 staging, opportunistic illness prevention and initiation of appropriate antiretroviral therapy remain unacceptably low, in both the public and private sector.

Women continue to place their trust in the health system. Some provinces have applied better antiretroviral regimens for PMTCT for years.  It is completely unacceptable that children become HIV infected due to the inability of the Department to finalise a relatively simple change in a PMTCT regimen that has international support and extensive local experience.