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Saturday, 11 May, 2002, 00:57 GMT 01:57 UK
Soweto HIV transmission success
Soweto clinic
The programme operates in the Soweto township
Doctors in South Africa are piloting a cost-effective programme to reduce HIV transmission between mothers with the disease and their children.

They are carrying out trials in Soweto, a township in Johannesburg, using a combination of relatively cheap medication and education.

South Africa is the country with the largest number of infections and Soweto is the hotspot of the epidemic

Dr Avy Violari
Under the scheme, mothers are given a powerful anti-retroviral drug during labour to reduce their viral load and the risk of transmitting HIV to the baby.

When the baby is born, it too is given a dose of the drug, which is called Nevirapine.

The treatment is estimated to cost just $1 per patient.


Dr Avy Violari, a paediatrician and director of clinical paediatric trials in the township, said the relative cheapness of the treatment was key to the decision to make it available to women.

She said: "In South Africa, there is no national programme to prevent HIV transmission from mother to baby.

"Since 1996, we have been looking at ways of preventing transmission. We knew there were ways but we had to find affordable ways of doing it."

It is really highly cost effective to do this

Dr Diana Gibb
Gt Ormond St Hospital
She added: "The treatment reduces viral load in the mother rapidly during labour and that cuts down the risk of the baby acquiring the infection."

Speaking on the BBC World Service programme Health Matters, Dr Violaria said doctors believed the treatment was crucial in fighting the spread of HIV in the country.

"South Africa is the country with the largest number of infections and Soweto is the hotspot of the epidemic," she said.

Dr Diana Gibb, consultant paediatrician at Great Ormond Street Hospital in London, said the Nevirapine was much cheaper than many alternative therapies.

"Nevirapine is much much cheaper - about $1 per woman," she said.

Dr Gibb said studies had shown that the treatment was cost-effective not just in the short term but also over the longer term of the child's life.

"It is really highly cost effective to do this because the costs of looking after children even in the west are extremely high."

Breastfeeding programme

The Soweto programme is also focusing on reducing the risks of HIV transmission through breastfeeding.

However, Dr Violari said encouraging mothers to use formula milk instead of breast milk was fraught with problems.

She said there were significant cultural issues involved, with women afraid that if they are not seen to breastfeed they will be stigmatised as having HIV.

There are also problems if the local water supply is not clean since this can cause serious health problems and even death in children if it is used in the formula milk.

"The tragic side of this is the vulnerable population affected by HIV and Aids are the same vulnerable people affected by the side effects of breast milk substitutes, like formula feeding," said Dr Violari.

More than 4.5m South Africans are thought to be HIV-positive - the largest infected population in the world.

The South African government announced last month that it was committed to the widespread distribution of Nevirapine, which it had previously argued was dangerous.

That decision was broadly welcomed by aid organisation and Aids groups. It also gives hope to doctors like Avy Violari.

This story is featured in the radio programme Health Matters on the BBC World Service.

Click here for listening times

See also:

04 Apr 02 | Africa
South Africa to supply Aids drug
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