Clinicians Support South African Doctor in Dispute Over Providing AIDS Therapy for Pregnant Women

Health workers and activists have rallied to support a doctor who could face disciplinary action in a dispute over the treatment he gave HIV-positive pregnant women to prevent them from passing the AIDS virus on to their unborn children.

Colin Pfaff, who works in a rural hospital in KwaZulu-Natal, where nearly 40 percent of women in ante-natal clinics have the AIDS virus, used a combination of two drugs to prevent mother-to-child transmission because the single drug therapy used by his local Health Department is regarded as out-of-date and ineffective. The treatment Pfaff used is recommended by the U.N.'s World Health Organization.

The KwaZulu-Natal Health Department was angered that Pfaff ignored protocol and obtained donations of the two dual therapy drugs without first asking permission or informing his superiors.

Supporters have come to his defense.

"Dr. Pfaff should be saluted as a hero — he demonstrates the level of commitment, creativity and care for his patients that we should be demanding from all health care practitioners," the Southern African HIV Clinicians Society said in a petition that gained nearly 500 signatures by Monday.

"To discipline him for doing his ethical duty is disgraceful. We demand the immediate dropping of all charges against him."

The Treatment Action Campaign, a network of activists, also supported him and said, instead, local health bosses should be called to account.

The uproar highlights the ongoing tension between doctors and top health officials who are accused of slowing progress in the fight against AIDS. About 5.4 million South Africans are infected — the highest rate in the world. The disease kills nearly 1,000 people each day in the country.

Health Minister Manto Tshabalala-Msimang has, in particular, attracted international criticism for her mistrust of antiretroviral medicines and her espousal of nutrition as a therapy — hence her nickname Dr. Garlic.

After much delay, the Health Department earlier this month published guidelines for preventing mother-to-child HIV transmission by using dual therapy — a combination of nevirapine and AZT — in accordance with long-standing World Health Organization recommendations.

Many clinics in the country, including those in KwaZulu-Natal, have until now relied on just nevirapine and suffer from mother-to-child transmission rates of more than 20 percent. Hospitals in the Western Cape province, which ignored the central government and pressed ahead with dual therapy in 2004, have slashed transmission rates to less than 5 percent.

The dual therapy will be phased in as and when provincial health departments have the budget, supplies and know-how to do so, Tshabalala-Msimang told journalists last week. She said she would not impose any deadlines.

She also said she would not intervene in the case of Pfaff as it was a matter between him and the local authority.

Pfaff, whose Manguzi hospital is in a dirt-poor area devastated by AIDS near the Mozambican border, decided to circumvent government bureaucracy to save lives last year — before the new national guidelines. He secured donations of dual therapy from a British non-governmental group and started giving it to women at the clinic.

The KwaZulu-Natal Health Department spokesman Desmond Motha said that Pfaff had violated policy stipulating that health authorities have to approve donations to ensure that they are from a reliable and viable source that can guarantee stable supplies and not suddenly stop if funding runs out.

"He works in a small hospital and he has no right to receive donations on behalf of the South African government and provincial government," Motha said. "He didn't discuss it with us."

Motha said that Pfaff hasn't formally been suspended, although he hasn't been at work since the dispute erupted. He said he was due to appear before a disciplinary committee last week but didn't know if this had taken place. Pfaff has refused to speak to the press — apparently for fear of further angering his employers.

The Southern African Clinicians Society said support was pouring in from all over the world — with many South African doctors now working in Britain, Australia and New Zealand, signing the online petition.

"I don't want to see babies with HIV anymore," wrote Gail Faller, a South African pediatrician.