Since she took office in 1999, Health Minister Manto Tshabalala-Msimang has plunged the country into at least 13 crises about HIV/Aids, obscuring the Cabinet’s multibillion-rand efforts to end the damaging era of denial and confrontation.
Though President Thabo Mbeki has failed to provide leadership in the past year, what more must the minister do before she is removed from office? At the bottom end of the Mantometer scale are outbursts like “Don’t call me Manto”, levelled at local talk-show host John Robbie.
Then there was the coquettish statement that “as government we cannot outlaw sexual contact. It is too exciting to do so.” She trumped that with the view that anti-retrovirals were not affordable because the country needed to buy arms. “Look at what [United States President George W] Bush is doing. He could invade,” she explained. Later she equated Aids with asthma.
All four statements were responses to serious questions about a government policy that had fallen out of focus and become a mystery nationally and internationally.
The government often claims that its efforts to combat HIV/Aids are not recognised, but this is because the politicians in charge of communicating the message fail each time they take the podium.
At the politically precarious end of Tshabalala-Msimang’s are the international crises she has caused.
In July 2002 she told a Newsday journalist that anti-retrovirals were “poisons” killing “our people”.
Last month she invited the dissident Aids scientist Roberto Giraldo to be her adviser. This happened in the month the Cabinet issued its report card on its efforts since it returned to the conventional view of Aids. Surprise, the Giraldo saga overshadowed the report.
Last week she hijacked an event to welcome Richard Feacham, the Global Fund for HIV/Aids, TB and Malaria representative, and turned it into a racial slanging match with Treatment Action Campaign chairperson Mark Heywood.
Early this month the minister caused alarm when she told an interfaith initiative that “perhaps HIV and Aids is God’s way of challenging us to care for our people, to support the dying and to appreciate the gift of life”.
Tshabalala-Msimang has become a caricature, a figure provoking derision instead of the leader needed to fill the gaps left by Mbeki’s lack of interest in the pandemic. In popular polemic, she is a “mampara”; in activist discourse, she is a “murderer”; to diplomats and the international Aids intelligentsia, as well as the ranks of her own party, she is an “embarrassment”.
Her impact ripples beyond the sphere of HIV/Aids. Numerous surveys to determine why South Africa does not attract more foreign investors have found that the country’s management of the pandemic is considered a disincentive to investment.
How did Tshabalala-Msimang, a physician, become an Aids dissident and how much longer will she stay in that camp? By all accounts, she was a hard-working chairperson of Parliament’s portfolio committee on health, with an orthodox view of HIV/Aids and how it should be tackled. But without the power of argument and without a constituency of her own, Tshabalala-Msimang has been unable to bring Mbeki around to accepting the conventional view of Aids spelt out in the Cabinet’s statement on April 17 last year.
The statement was presented as a watershed. A strong leader was needed to take the gap it created and to use the authority and momentum it provided to set things straight. But the minister is politically weak and has been backed into a corner and forced to defend a minority position.
In many countries she would not have survived these crises.
“It’s perfectly true that President Mbeki has set a virtual international record in loyalty to his Cabinet ministers,” says Steven Friedman of the Centre for Policy Studies.
But Friedman does point out that Tshabalala-Msimang’s position on the pandemic may have presidential approval.
Ministers of state get axed when they cannot grasp their portfolios and when they lose the confidence of key constituencies. Analyst Adam Habib of the Centre for Civil Society says the health minister’s constituencies include the broader public, the intelligentsia and role-players in HIV/Aids from the medical fraternity to the Aids movement.
“Even if the minister gets over her idiosyncrasies, it’s my calculated judgement that she’s passed the point of no return. It may be time to let her go, not only for the sake of democracy, but because her capacity to undertake responsibility has passed,” Habib said.
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