With Health Minister Manto Tshabalala-Msimang in her seventh week of sick leave, the delicate rapprochement between civil society and the government over HIV/Aids continues against a background of political infighting.
Aids activists insist the political wind is blowing firmly towards action and cooperation with civil society — despite Tshabalala-Msimang’s extraordinary public attack on her deputy in last week’s edition of ANC Today, where she denied there was Aids denialism in the government.
”The incident of my illness was portrayed as an opportunity to turn others into champions of a campaign to rid our government of the so-called ‘HIV and Aids denial at the highest level’,” Tshabalala-Msimang wrote.
The Treatment Action Campaign (TAC) and other Aids groups are keen to support — and be seen to support — government’s newfound determination to fire up its responses to the pandemic.
Key to this is the revival of the moribund South African National Aids Council (Sanac), in theory the guiding hand against the disease, but in reality a white elephant that has wallowed in the doldrums for years.
Now that Deputy President Phumzile Mlambo-Ngcuka has taken charge of Sanac, and Deputy Minister of Health Nozizwe Madlala-Routledge is speaking about HIV in place of her controversial superior, Aids activists are optimistic that the government is finally demonstrating commitment.
One of the challenges is finally to draw up the ”HIV and Aids and STI Strategic Plan for South Africa 2007 to 2011” — the critical blueprint for combating interrelated epidemics.
By setting out national strategy and outlining monitoring and evaluation targets, the document is intended to pull together disparate responses to HIV/Aids from international donors, the private sector and the state, as well as gauging performance.
The new strategic plan was due to be launched next Friday, Aids Day, but will now only be released in outline because Sanac has yet to approve it. A detailed plan is likely in the first quarter of 2007, more than a year since the last one expired.
The TAC, the Reproductive Health and HIV Research Unit and the Southern African HIV Clinicians’ Society are politely scathing about the draft, reflecting ongoing complaints that the government’s responses to the epidemic are too vague, impractical and uncoordinated.
A major point of concern is the low targets set for antiretroviral therapy, which suggests that each year only about 20% of people eligible for the treatment would receive it. An estimated 800 000 people are currently thought to need anti- retrovirals and the number will grow each year as people with HIV progress to Aids-related illnesses.
At the end of September 213 828 South Africans were taking anti-HIV drugs, 21 000 of them children. The vast majority are in Gauteng (55 580) and KwaZulu-Natal (59 404), with the Eastern Cape, Western Cape and Northern Cape each having about 20 000 people on ARVS.
Another major flaw in the draft plan is the absence of private sector and workplace-based HIV programmes, even though the health department is supposed to provide strategic guidance for private and public healthcare.
The private sector consumes 55% of healthcare spending in South Africa, benefiting seven million people of a total population of 46-million. Coordination between the private and public sectors is widely seen as crucial for an effective national response to Aids and other public health problems.
HIV explosion
This week saw the release of the latest UNAids Global Epidemic Update. While it was the massive increase in China’s HIV epidemic that caught the world’s headlines, the report made grim reading on the impact of HIV/Aids in Africa.
According to UNAids, 37% of new infections take place in the Southern African Development Community, as do 41% of deaths. And the region also has an estimated 41% of all children under the age of 17 orphaned by the epidemic.
In South Africa, 5,5-million people are thought to be HIV-positive, including almost a quarter of a million children. With a third of its adults carrying the virus, Swaziland has the world’s highest HIV prevalence, closely followed by Lesotho where one in four adults is thought to be HIV-positive.
In Botswana half of pregnant women aged between 30 and 34 are estimated to have HIV, although nationally, among all pregnant women, HIV levels have fallen slightly from 36% in 2001 to 33% last year.