[procaare] Under Fire, South Africa Shakes Up Its Strategy Against AIDS

["New York Times" <procaare@healthnet.org>]

Under Fire, South Africa Shakes Up Its Strategy Against AIDS
By MICHAEL WINES
New York Times: Nov 3, 2006
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JOHANNESBURG, Nov. 2 - Departing from years of indecision and, on occasion, 
denial, South Africa's government is considering a new and sweeping assault 
on an AIDS pandemic that already includes one in eight of the world's H.I.V. 
infections.

Every day, 1,000 South Africans are infected with H.I.V., and 800 more are 
killed by AIDS, the government says. With that backdrop, the deputy minister 
of health, Noziza Madlala-Routledge, said in an interview on Thursday that a 
new AIDS strategy to be announced in December might include proposals to 
broaden the distribution of life-saving antiretroviral drugs, remedy the 
shortage of health care workers and improve treatment of H.I.V.-positive 
pregnant women.

The new strategy will be overseen by a restructured national AIDS council 
charged with halving the number of new H.I.V. infections by 2011.

The issues top a list of what AIDS activists and nongovernmental experts 
have long called serious shortcomings in the government's AIDS program. In a 
striking departure from the past, government officials are drafting the plan 
in close consultation with those same critics, who have long been all but 
excluded from past considerations.

Ms. Madlala-Routledge said critics "have identified blind spots" that the 
government, preoccupied with building a new nation, had missed.

"We've definitely reached a turning point in our country, with civil society 
and government working in concert," Ms. Madlala-Routledge said. "We 
recognize that the campaign against AIDS needs all of us."

Experts and activists outside the government said they were heartened by the 
government's new approach, but would wait to see what new programs were 
announced and how vigorously they would be carried out.

"I don't think we're popping the Champagne corks quite yet," Jonathan 
Berger, who directs the AIDS Law Project at the University of the 
Witwatersrand, said this week. "There are still going to be, on certain key 
issues, quite significant differences of opinion."

The most important change, he said, may be that the two sides are now 
talking seriously about how to resolve those differences.

Practically, the signal change may be that the government's lightning-rod 
health minister, Dr. Manto Tshabalala-Msimang, has been sidelined from 
day-to-day control of AIDS policy.

President Thabo Mbeki ordered the current deputy president, Phumzile 
Mlambo-Ngcuka, to oversee a cabinet-level review of AIDS policies in 
September, saying the AIDS crisis "is bigger than any individual, minister 
or department."

Soon afterward, Dr. Tshabalala-Msimang entered a hospital for a respiratory 
infection, and little has been heard from her since. Her deputy, Ms. 
Madlala-Routledge, has taken over AIDS issues for the ministry.

To many here, Dr. Tshabalala-Msimang's fall from grace is proof of 
democratic pressures at work. Mr. Mbeki, who once questioned the scientific 
link between H.I.V. and AIDS, fell silent on the issue years ago after being 
internationally criticized. Until now, Dr. Tshabalala-Msimang was the public 
face of his government's AIDS policies.

An unrelenting advocate of vitamin and nutritional defenses against H.I.V., 
the virus that causes AIDS, she has been widely derided for calling 
antiretrovirals "poison" and for advocating a diet heavy in garlic, beetroot 
and other traditional remedies to forestall AIDS. Under her tenure, the 
government resisted giving pregnant women drugs to reduce the transmission 
of H.I.V. to fetuses until it was forced by a court order.

The government has since begun mass distribution of anti-AIDS drugs at major 
hospitals. But the slow pace of that rollout and Dr. Tshabalala-Msimang's 
resistance to drug therapies have ballooned into political issues here, 
where one in nine South Africans - and one in four adults - is infected with 
H.I.V.

The discontent became evident this year within the African National 
Congress, the dominant political party, when Parliament's chief whip urged 
Mr. Mbeki to work "intimately" with AIDS activists in the interest of 
millions of H.I.V.-positive citizens. And it bubbled over last August at an 
international AIDS conference in Toronto, where South Africa's national 
exhibit, featuring baskets of garlic and beetroot, shocked many.

The United Nations' special envoy to Africa on AIDS, Stephen Lewis, 
denounced the country's AIDS policies as "worthy of a lunatic fringe" before 
20,000 delegates at the conference. At the same time, 81 international 
scientists sent Mr. Mbeki a petition urging him to dismiss Dr. 
Tshabalala-Msimang.

Since the Toronto conference, AIDS activists and experts say, the government's 
position has undergone a sea change. Last weekend, the deputy president and 
the deputy health minister were the marquee speakers at a Johannesburg 
conference of AIDS activists and public interest groups; both called for a 
united assault on AIDS.

South Africa's Treatment Action Campaign, an organization of 20,000 mostly 
H.I.V.-positive AIDS activists, has been by far the most vocal critic of the 
government's programs. In an interview from Cape Town on Thursday, the group's 
general secretary, Sipho Mthathi, said there was now "a growing enthusiasm, 
across the board, around the possibility of what we can do as a country in a 
united fashion" to combat the pandemic.

Online: NY Times
http://www.nytimes.com/2006/11/03/world/africa/03safrica.html?_r=1&oref=slogin