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[procaare] Under Fire, South Africa Shakes Up Its Strategy Against AIDS
- From: "New York Times" <email@example.com>
- Date: Fri, 3 Nov 2006 15:01:42 -0000
Under Fire, South Africa Shakes Up Its Strategy Against AIDS
By MICHAEL WINES
New York Times: Nov 3, 2006
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.
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
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
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
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.
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