Colin Pfaff, a doctor imbued with Christian zeal, had reached a moral crossroads.
Pfaff knew that giving HIV-positive women and their newborns two anti-AIDS drugs instead of one would reduce the odds that mothers would pass the virus to their babies.
For months, he and doctors from other hospitals pleaded with provincial health authorities for permission to use the approach, in a province where a staggering four in 10 pregnant women were infected.
"We cannot sit in silence any longer," they wrote last May.
But South Africa had not yet adopted the two-drug strategy, as recommended by the WHO and the doctors' request was rebuffed.
So, Pfaff made his choice. He raised the money on his own.
Then a week after the national health department said in January that it would begin requiring the use of both drugs, health authorities in KwaZulu-Natal Province charged Pfaff with misconduct for raising money from a British charity and carrying out the very same preventive treatment "without permission."
Pfaff's case has stirred a furious reaction from rural doctors and advocates on AIDS issues, raising questions not only about a doctor's duties in the public health system, but also about why it took so long for South Africa to act.
The country has one of the largest HIV-positive populations in the world.
The evidence that two drugs together -- AZT plus nevirapine -- work better than one has been accumulating since a clinical trial in Thailand was published in 2004 in The New England Journal of Medicine.
Even here in South Africa, the approach has worked. The Western Cape Province has deeply reduced mother-to-baby HIV infection rates since 2004 -- to less than 5 percent from 22 percent -- by using both drugs.
AIDS advocates are celebrating the government's new policy. Still, they contend that South Africa, the region's economic powerhouse, should have put it into practice long ago, but lacked the political will.
Sibani Mngadi, a spokesman for South Africa's Health Department, disagreed, saying that the government took the time needed to review the data and consult various players after the WHO issued its recommendation in 2006.
In recent years, South African President Thabo Mbeki has defended the country's consultation of dissident scientists who denied that HIV causes AIDS, while Health Minister Manto Tshabalala-Msimang has promoted indigenous remedies, including diets of garlic, beetroot and African potatoes.
Rural doctors in this district say babies were needlessly infected as a result of the government's slow pace.
"You can't uninfect them once they're infected, can you?" said Victor Fredlund, who has been at the hospital in Mseleni for 27 years.
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