"People are tired of hearing excuses about infrastructural barriers and stigma that just lead to paralysis in the development of the services", said Dr. Goemaere of MSF. "Our recent experience in the Eastern Cape shows that in the first days MTCT prevention service was available in a rural hospital, there was a clear demand from women to be tested and to enroll in the programme."

Reacting to the inaction of the South African government to implement HIV/AIDS services, MSF is starting a new HIV program in rural South Africa in collaboration with the Nelson Mandela Foundation. The former Transkei homeland, birthplace of Nelson Mandela, in the Eastern Cape Province is one of the poorest and most destitute regions in the country. According to many, the area would be too remote to allow the successful running of an HIV/AIDS treatment program.

However, it is one of the areas worst hit by the HIV pandemic, with at least a third of the pregnant women testing positive for HIV/AIDS. The new program aims to assure the scaling up of prevention of mother-to-child transmission (MTCT) of HIV. "In South Africa MSF has already successfully demonstrated the feasibility of providing a full package of AIDS care, including antiretroviral (ARV) treatment, for the poorest through the programme in Khayelitsha, a township near Cape Town," said Dr.

Eric Goemaere, Head of Mission for MSF in South Africa. "We now want to replicate the program by treating hundreds of HIV positive people in former Transkei as well." In July 2002 the Constitutional Court in Pretoria ruled that prevention with ARV to decrease the risk of MTCT, constitutes essential health care. This definition is vital given that access to essential care is enshrined in the Constitution as a universal right.

The ruling compels the government to implement MTCT-programs in all maternities in the country. Half a year later, hardly anything is happening on the ground. "The government is unacceptably delaying implementation, which is causing the delivery of more than 5,800 infected newborns every month in the country," continues Dr Goemaere.

MSF began MTCT prevention at the beginning of 2003, aiming to cover two densely populated districts of the former Transkei. After a few weeks, the programme is already running in two health centres. In the next four months, it will expand to all the health centres in the area "People are tired of hearing excuses about infrastructural barriers and stigma that just lead to paralysis in the development of the services", said Dr. Goemaere.

"Our recent experience in the Eastern Cape shows that in the first days MTCT prevention service was available in a rural hospital, there was a clear demand from women to be tested and to enroll in the programme." The second phase of the programme is due to start in June and will see the introduction of the life-saving ARV treatment into the Transkei.

By the end of this year MSF aims to treat 300 HIV patients with ARVs in St Elisabeth Hospital, Ingquza district. In South Africa more than five million people are infected with HIV. AIDS is responsible for a thousand deaths every day.