A South African government-commissioned study released Wednesday recommended that all HIV-positive pregnant women be given immediate access to a key AIDS drug, but it acknowledged the government had valid concerns about its ability to administer the medication properly. The study, conducted by the independent Health Systems Trust (HST), added to mounting public pressure on the government to distribute the drug nevirapine nationwide.

The government has tried to restrict the drug to two research sites in each of the country's nine provinces. Those sites serve about 215 of the country's more than 3,300 clinics and hospitals. HST found that research data varied widely between the sites, indicating that a uniform nationwide response to combating mother-to-child HIV transmission was called for.

Just 17 percent of pregnant women agreed to be tested for HIV in some areas, while in others the rate was 96 percent. The HIV infection rate among those who submitted to tests ranged between 5 percent and 47 percent. David McCoy, a trust researcher, said the availability of counseling was a major determinant of whether women agreed to be tested for HIV and take nevirapine.

The trust also validated government concerns that HIV-positive women who received nevirapine could still pass the virus on to their children through breast-feeding, and that feeding infants milk formula was problematic. The trust said the government should study giving a short course of AIDS drugs to mothers and, perhaps, to babies to reduce the chances of transmission through breast milk.

"There is no clinical reason why nevirapine would not be made available," said McCoy. Nono Simelela, chief director of the health department's AIDS program, said the trust's finding would be evaluated, and conceded, "We have not picked up any side effects in mother and baby." The Treatment Action Campaign, an AIDS activist group, urged the government to abide by the report's recommendations, make nevirapine available countrywide, and extend its program to prevent mother-to-child transmission. The government estimated last year that 4.7 million South Africans -- one in nine -- are HIV-positive.

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