By Farah Khan

JOHANNESBURG, Feb 28 (IPS) - Pressure is growing on government to extend anti-AIDS drug treatment to the most vulnerable - pregnant mothers and newborn babies.

The treatment, known as mother-to-child-transmission (MTCT), could save as many as 70,000 young lives a year through providing a dose of the drug Nevirapine (or generic equivalents) which has been shown to cut infection risk by over half.

But government's conservative approach is placing President Thabo Mbeki in the midst of a fresh AIDS controversy; one his administration can ill afford. The state says it will take at least two years to extend a national programme. Four developments threaten to catapult Mbeki's stilted response - the gravest crisis of his time - into the limelight again.

A report into the use of the drug has given government the green light and the parliamentary women's committee is pushing for tougher action as well.

In addition, a court case later this week will seek to order government enforce a ruling last December that it implement a national programme.

Government has taken the case on appeal. And, finally, the premier of the KwaZulu-Natal province, Lionel Mtshali has entered the court appeal as a formal supporter.

A groundswell of resistance is building. This week a report, commissioned by government, into its existing research sites, has found that government's cautious approach is in fact, over-cautious.

Nevirapine, says research co-ordinator David McCoy, is non-toxic in single doses. A programme should be phased in. ''There are no good reasons for delaying the phased expansion of MTCT services in all provinces,'' he added.

In another development, the parliamentary women and children's committee will call the Health Minister Manto Tshabalala-Msimang before it to assess progress on implementing a set of recommendations to improve HIV/AIDS policy.

The committee is chaired by the ruling African National Congress (ANC), suggesting a deepening rift on how to tackle the pandemic.

Among the recommendations was a call to provide anti-retroviral drug treatment to pregnant women and newborn babies as well as to rape survivors.

Government confirmed this week that it would not provide such a ''universal access'' programme for these vulnerable sectors, indicating that the parliamentary meetings may be heated. Instead it will extend pilot projects.

The news that parliament's Joint Monitoring Committee on the Improvement of Quality of Life and Status of Women will act on its report - released last November - is the latest development in a week when South Africa's AIDS policies have again been in the spotlight.

When President Mbeki delivered his annual state of the nation address earlier this month, his aides punted it as a breakthrough in his HV/AIDS policies. They said it paved the way for the extension of the programme to prevent mother-to-child-transmission.

Health authorities say more than 100,000 babies are born HIV-positive each year. South Africa has the highest number of people living with AIDS in the world.

But the week after his speech, Mbeki's government was mired in controversy again when it cracked down on a provincial leader who promised to expand the treatment for pregnant women and children.

Last Monday, Gauteng premier Mbhazima Shilowa made a widely acclaimed speech in which he promised to expand the research sites to nine more hospitals in the next 100 days; and to extend coverage throughout the province.

''During the next financial year, we will ensure that all public hospitals and our large community health centres provide Nevirapine for the prevention of mother-to-child-transmission,'' he pledged.

That same night, the Health Minister Tshabala-Msimang came down on him like a ton of bricks, saying she could not support his statement. Alleging he had jumped the gun, the minister said she ''disassociates herself form Gauteng's pronouncement''.

The ruling party headquarters made a thinly veiled accusation of political populism against Shilowa - and said he had overstepped the mark.

After a week of contortions and tough talk, Shilowa and Tshabalala-Msimang issued a statement that has been interpreted in different ways. One view is that Shilowa was given ''a nudge and a wink'' to carry through his programme, for which the provincial government has already budgeted R30 million (2.7 million U.S. dollars) this year.

The trade-off is that he should not call it a ''universal access'' programme, but merely an extension of research sites.

Sources in the ANC suggest there is still a ''current of dissidence in the ANC'' and that it comes from senior people.

At the end of 1999, Mbeki began to court dissident scientists - based primarily in the United States and Australia, but with a presence in South Africa - who do not believe that HIV causes AIDS; and who do not support the use of anti-retroviral drugs.

He instituted a scientist panel in 2000 to explore AIDS causation, even though the debate was deemed by scientists to have been solved in the 1980s.

Mbeki's grappling with AIDS has taken two forms. He was an AIDS dissenter, but his aides claim that he now does not dispute that HIV causes AIDS.

The second leg of his argument, much more widely supported, is that AIDS wreaks a greater havoc among the poor who cannot afford the treatment that has downgraded AIDS from a death sentence to a chronic and manageable disease among the wealthy.

To this end, he has pushed a policy that diseases like tuberculosis, malaria and pneumonia be placed on an equal footing with the AIDS pandemic; and that more resources be diverted to the vaccine initiative - government has doubled its allocation to R20 million (1.8 million U.S. dollars) this year.

But, he is often portrayed as not having divested himself entirely of his dissident views.

And, without leadership, health authorities are not implementing the state's AIDS strategy with the focus and dedication the pandemic demands.

Mbeki's supporters and officials often confuse and conflate his two arguments.

That is why the national government is facing a growing rebellion in its ranks as provinces like Gauteng and the women's committee push for better policy implementation and for leadership.

Pregs Govender, who chairs the women's and children's committee, says ''We decided it was time to take a serious look at HIV/AIDS and the real intersection of the pandemic with gender-based violence and poverty.''

Her committee evaluated government's strategy through a gender lens and made its findings accordingly. "We want to make sure that women have a choice at every stage. They must have a choice about whether to take anti-retrovirals,'' she says.(END/IPS/AF/HE/HD/FK/MN/02) .