Health Minister Manto Tshabalala-Msimang’s expected return to office after three weeks of illness has raised fears that the progress recently made by the government and civil society in the HIV/Aids arena could be jeopardised.
The trepidation arose after Tshabalala-Msimang, who has been heavily criticised for promoting the use of African potatoes, garlic, lemon and beetroot as Aids treatment, launched an attack on her deputy, Nozizwe Madlala-Routledge.
This followed the deputy minister’s admission at the Civil Society Aids Congress in October that the government was failing to fight the epidemic and provide antiretroviral treatment for people who need the drugs. “Our country is in pain. We are all in pain,” Madlala-Routledge said.
Attacking her deputy on an African National Congress website recently, Tshabalala-Msimang said: “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 has been heavily criticised by the Treatment Action Campaign (TAC), scientists, opposition parties and civil society groups, including the Congress of South African Trade Unions, for her denialist approach in fighting Aids and miscommunicating the government’s Aids policy, especially after the Toronto Aids conference where she took centre stage for her views on nutrition.
TAC general secretary Sipho Mthathi told the Mail & Guardian this week that her organisation was “taken aback” by Tshabalala-Msimang’s attack on her deputy and her organisation. Referring to the clashes between the government and the TAC, Mthathi said: “We have put everything behind us. We are particularly disappointed about her [Tshabalala-Msimang] unwarranted attacks,” she said.
Mthathi believes that the new partnership between the government and civil society is in “good faith” and that the Presidency is “fully” behind it: President Thabo Mbeki handed the management of the government’s Aids policy to his deputy, Phumzile Mlambo-Ngcuka, shortly after Tshabalala-Msimang returned from the Toronto conference.
South Africa, which has about 5,4-million people living with HIV, records 1Â 000 new HIV infections and 900 Aids-related deaths every day.
The government and civil society groups are now preparing a new five-year prevention and treatment strategy, which aims to have 600Â 000 people on antiretroviral drugs by 2011. The plan is to be unveiled on World Aids Day.
Mlambo-Ngcuka’s intervention has revitalised the South African National Aids Council (Sanac) by streamlining its operations. The deputy president and Madlala-Routledge have received praise from HIV/Aids experts and civil society groups, including the TAC, after they showed strong political leadership in the fight against Aids.
But the question remains whether the recent interventions amount to change in the government’s Aids policy or in the government’s attitude towards the disease.
Chris Maxon, the assistant corporate communication manager at the department of health in KwaZulu-Natal, believes there is no change in government policy. Instead, he called for the national government to implement the message delivered by Nelson Mandela during the Make Poverty History rally last year. He said: “Recognise that the world is hungry for action, not words. Act with courage and vision.”
Maxon is sceptical about a possible sacking of Tshabalala-Msimang, adding “the struggle against Aids has been characterised by populist character assassinations and legal battles over who has the ‘blue print’ to fighting HIV/Aids”. He says: “This has not produced any positive results as the rates of new infections and numbers of deaths continue to spiral upwards.”
But Mbulawa Mugabe, a United Nations Aids representative, believes that the intervention of the deputy president has yielded positive results.
“Institutions have recently been working hard to build a partnership that would bolster the national response to the pandemic. It is within this context that the relationship between government and civil society should be viewed,” he says.
Mugabe is supported by Denise Hunt, the executive director at the Aids Consortium, who says there is definite evidence of a “shift” in terms of government’s attitude in response to the Aids epidemic “although they [government] are careful to say otherwise. This was demonstrated by the consistent acknowledgement made by both the deputy president and deputy minister of health at the Civil Society Congress in October of the serious shortfalls in the response over previous years,” she argues.
“Their rousing speeches were seen by civil society as a possible new dawn in the Aids struggle in South Africa.”
However, she points out that the next few weeks are critical in assessing “the extent to which the recommendations are followed; as well as seeing the processes that transpire with regard to the restructuring of Sanac”.
Hunt says there are some concerns around the manner in which sectors are selected into Sanac. “A strong and representative Sanac is key to the future response, and a transparent selection process at the heart of that,” she argues.
While some are optimistic about the new national strategic plan, which will set targets for achieving universal access to HIV prevention, treatment and care and support by 2010, others argue that its success depends on the commitment of the government, particularly the Health Ministry.
Hunt says although there is now a climate of open dialogue among all relevant parties, it is “steeped in hope and possibility, the tension and anticipation is running high. [There is] a sense of us all holding our breaths with caution, to see whether the hope created is borne out by responsible action, starting with a strong comprehensive national strategic plan, complete with bold targets and strong indicators, as widely recommended by civil society.”
Snapshot
According to the latest statistics, South Africa has between five million and six million or about 11%, HIV-infected citizens, reports Vuyo Sokupa.
The Department of Health estimated in 2005 that a gradual increase in pregnant women living with HIV should be expected. Studies have showed there are high levels of HIV infection among young people aged between 15 and 24 (20%). But there is also a high HIV pre-valence in men aged 50 and older.
These damning statistics reflect one of the reasons for the declining average life span of South Africans, which sits at 35 years of age.
According to the Centre for Aids Development, Research and Evaluation’s 2006 survey on implications for prevention programmes, females aged between 15 and 29 are three to four times more likely to be infected than males. The HIV prevalence is extremely high in urban informal settlements, with the prevalence estimated at 25,8%.
South Africa is home to one-quarter of all people receiving antiretroviral therapy in sub-Saharan Africa. At the end of last year 190Â 000 people were receiving antiretrovirals.
The 2006 United Nations report says that sub-Saharan Africa houses 64% of all the people living with HIV and two million of them are children under 15, who have already lost parents to HIV.