Kerry Cullinan

The Treatment Action Campaign (TAC) may suspend its call for Manto Tshabalala-Msimang to quit as health minister — if the government "shows the leadership on HIV/Aids we have been asking for over the past five years". TAC general secretary Sipho Mthathi made this declaration after a remarkable week in which Deputy President Phumzile Mlambo-Ngcuka and Deputy Health Minister Nozizwe Madlala-Routledge pledged to work with Aids organisations to fight HIV.

Jeannette, a slender young woman with a squint, tries to shuffle out through the security gate behind us, but is roughly restrained by a stocky woman who puts a heavy forearm around Jeannette’s neck and pulls her back. When I remark that the security guard seems unnecessarily zealous, I am told that the stocky woman is an auxiliary nurse.

The 550-bed Kimberley general hospital has won a number of awards for management and innovation, and is considered a case study in transformation. In the past six years, it has expanded from employing 38 fulltime doctors to 115, plus 40 community service doctors and 30 interns.

HIV/Aids programmes in sub-Saharan Africa cannot be implemented by doctors and nurses alone if they are to expand to meet the treatment needs of citizens, according to United States global Aids coordinator Dr Mark Dybul, who is in South Africa to attend a meeting of the implementers of the US President’s Emergency Plan for Aids Relief.

The KwaZulu-Natal health department’s recent appeal for retired nurses to return to work to help alleviate staff shortages was condemned as unsustainable and "an abuse of the elderly" by delegates at a recent provincial health forum. The shortage of nurses dominated the forum’s agenda.

Three-year-old Elihle Xulu shrieks with delight when he sees his mother, Nompumelelo, in the clinic’s garden. She kicks a soccer ball for him and he runs panting after it. Then he plants himself on the swing: "Push! Push!" he calls. The little boy’s exuberance is still like a miracle for Nompumelelo, who feared she might never see her son grow up. Both she and her son are living with HIV.

The front-runner for the position of director general of health, Dr Victor Litlhakanyane, has withdrawn, apparently frustrated by the long delays in the finalisation of the post. The Department of Health has been without a director general, its highest official and chief accounting officer, for more than a year.

In the past decade the best-equipped hospital in Africa, the new Inkosi Albert Luthuli central hospital, has been built in Durban, along with almost a third of the KwaZulu-Natal’s 366 clinics. In addition, two new district hospitals are being built in the eThekwini area. Yet the province is critically short of doctors and nurses to tackle the highest rate of HIV/Aids infections in South Africa.

When Victor Litlhakanyane became the first black doctor to qualify in the Free State he was not welcome to eat with his white colleagues in the dining room of the province’s biggest hospital, Pelonomi, in Bloemfontein. Now, many of those who refused to eat with him have to report to him as provincial head of health. Health services in the Free State are stable and the quality of care is improving.

It’s lunchtime in Mdantsane and Mama G, along with about 30 others, is waiting outside the small clinic at NU13 as storm clouds gather. "The nurses sometimes have an hour for tea. They can close again at noon and only open at 3pm, while we must sit outside like dogs, rain or shine." Staff shortages and poor basic care are pressing problems in the Eastern Cape health system.

After 10 years of democracy we have many things to be grateful for, not least of them the fact that South Africa is preparing to launch the world’s biggest public sector anti-retroviral treatment programme. But our president does not want to celebrate that his government may well have extended the lives of over 4,5-million people living with HIV by more than 10 years.

With Mozambique’s poverty in mind, it is surprising to learn that it is already a step ahead of South Africa when it comes to HIV/Aids treatment. Mozambicans have been able to get free anti-retroviral drugs at two sites since the beginning of the year.

The South African man’s reputation is in crisis: he is held responsible for one of the world’s highest rape rates; he perpetrates domestic violence; and now experts tell us he is a womaniser who prefers condomless sex and is driving the HIV/Aids epidemic.