Nine-Month-Old Rape Victim Receives Course of AZT, Drawing Attention to Varied Post-Exposure Treatment Practices in South Africa
Officials at a hospital in South Africa's Northern Cape province have been "scold[ed]" by provincial health officials for administering AZT to a nine-month-old baby who had been raped, but some medical professionals say that doctors in several provinces have "quietly" been giving post-exposure antiretroviral treatment to rape victims "for some time," against national government policy, the Johannesburg Mail & Guardian/AllAfrica.com reports. The South African Department of Health in 1999 issued national guidelines for antiretroviral treatment that barred doctors from giving the drugs in government hospitals, even to victims of rape. According to the guidelines, post-exposure antiretroviral treatment is only supposed to be given to health care workers who may have been exposed to HIV-contaminated blood. However, doctors at a Kimberley hospital gave a full course of antiretroviral treatment to the infant who had been raped. After "widespread media coverage" of the incident, Northern Cape Health Minister Elizabeth Dipuo Peters called hospital CEO Deon Madyo to "cross-questio[n] him" on why the baby received the drugs and whether "the practice was widespread" or represented an isolated incident. The Mail & Guardian/AllAfrica.com reports that Madyo has repeatedly said that the baby's treatment with AZT was a "mistake" and that the hospital is "the only state institution in the province where such an incident had occurred." Provincial health officials have said that the baby was given antiretroviral treatment because an "outdated circular" issued by the province for doctors in 1997 -- two years before the creation of the national guidelines -- said that "doctor discretion should be used" in the administration of antiretroviral treatment in rape cases. The doctor who gave the drugs to the baby told Madyo that he was not aware that the policy on antiretroviral treatment had changed. After the recent case was publicized, the hospital released a circular on Dec. 4 "reminding" doctors that they cannot dispense antiretroviral treatment to victims of rape.
Isolated Incident or Widespread Practice?
Although Madyo described the baby's treatment as an isolated incident, the Mail & Guardian/AllAfrica.com reports that "other sources" say that the policy recommending that physicians use discretion when prescribing antiretroviral treatment in cases of rape "was never reviewed and continued to be followed [by the hospital] -- with the full knowledge of the health authorities -- until the media arrived" to cover the event. The Mail & Guardian/AllAfrica.com reports that "[i]t appears that as in many other provinces, doctors had been administering antiretroviral drugs despite national government policy." Beatrix Weber, a doctor who recently worked at the Kimberley hospital, said that the facility "had a policy of administering the drugs" and had prescribed them at physicians' discretion "for some time" before recent case came to light. AIDS activists and doctors say that several provinces have "quietly" continued to provide post-exposure antiretroviral treatment, but Weber said that the media attention of this case "may well be fatal to future Northern Cape rape victims" because it prompted the hospital to announce formally that antiretroviral treatment would not be provided (Magardie/Deane, Johannesburg Mail & Guardian/AllAfrica.com, 1/11).
Opposition Party Expresses 'Disgust'
Members of opposition parties expressed "disgust" at Peters' reaction to the infant's treatment with AZT. "[Peters] should be charged with attempted negligence," Dr. Costa Gazi, a health spokesperson for the Pan Africanist Congress, said. Gazi said that the doctor who gave the drugs to the baby should "stand his ground" because there is "plenty of support" for his actions. Dr. Ruth Rabinowitz, a spokesperson for the Inkatha Freedom Party, called Peters' reaction "appalling," adding, "It suggests the government has no desire to help anybody." Officials from the Greater Nelspruit Rape Intervention Project (GRIP), which provides post-exposure antiretroviral treatment to rape victims, also criticized Peters' action. GRIP CEO Barbara Kenyon said that it was "absolutely ridiculous to tell doctors not to do what they have been trained to do -- prescribe medication" (South African Broadcasting Corporation, 1/11).