The long wait is over. South Africa's HIV-positive pregnant women will now have access to medication that could further reduce the risk of passing the virus to their babies after the health department released guidelines for administering more effective dual therapy instead of single antiretroviral (ARV) treatment.

After  growing pressure from frustrated activists, the Policy Committee of the National Health Council held a special meeting on 25 January 2008 to adopt the new guidelines, which include providing pregnant HIV-positive women with zidovudine, also known as AZT, from their 28th week until labour, and a single dose of nevirapine during labour. The infant receives a single dose of nevirapine, and then AZT for seven days.

Earlier that week, the AIDS lobby group, Treatment Action Campaign (TAC), and the Southern African HIV Clinicians Society, which represents 14,000 members working in the HIV/AIDS field, called on the health ministry to finalise its changes to the new regimen to give infants greater protection.

"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 substandard regimen for protection of their children is a sad reflection on our health system," TAC said in a statement.

The World Health Organisation guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV advise using a combination of ARVs, which can reduce the risk of transmission to as little as five percent.

The challenge now is to make sure that healthcare workers at public health facilities receive the guidelines and the medicines so that new mothers and babies will benefit as soon as possible.

New treatment "not rocket science"

Prof Glenda Gray, co-director of the Perinatal HIV Research Unit at the University of Witwatersrand in Johannesburg, admitted that while urban areas with adequate infrastructure would have no difficulty in implementing the new directive, rural areas could find it problematic.

"Obviously the more rural areas, where there are less doctors and human resources, and where there will be issues of drug procurement, will struggle ... but it doesn't mean it can't happen." Despite the challenges, the new regimen was "not rocket science", and "where there's a will there's a way", she told IRIN/PlusNews.

The government said in a statement that infant feeding "remains a challenging area". The guidelines acknowledge that there is still lack of conclusive scientific information to guide policy formulation in this area, and encourage a choice of six months of exclusively breast feeding or infant formula feeding for six months.

"Until breast-feeding is HIV free ... [and] there's no risk of HIV transmission, there's going to have to be a choice. You can't commit mothers to breastfeed when there are other options, and you can't expect poor mothers to formula-feed ... we should be giving them a choice," Gray suggested.

Formula feeding carries the lowest risk of transmission, but only if mothers have access to clean water, electricity and an uninterrupted supply of formula milk; without these, breast-feeding is usually the safer option.

Implementing the guidelines will require increasing the 2008/09 budget for PMTCT from R85 million (US$11.8 million) to R281 million ($39 million), and the health department will be asking the Treasury for additional funds for the programme.

The PMTCT programme would also have to strengthen its system for recording patients, ensure adequate access to laboratory services, and provide uninterrupted supplies of drugs, formula and other nutritional support, the health department said in a statement.

Department of health spokeswoman Charity Bhengu told IRIN/PlusNews that the guidelines were undergoing final editing and would be posted on the
department's website later this week.