Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
Mail & Guardian (Johannesburg) - September 23, 2006
Belinda Beresford
This week the department of health released a positive statement in response to the TAC's invitation to a "people's Parliament". Apparently first issued in the name of the Deputy Health Minister, Nozizwe Madlala-Routledge, and later in the department's name, it took a surprisingly conciliatory stance on the TAC.
"TAC has a right to protest. We are all in pain. On average ... every day in South Africa over 800 people die and a thousand are infected," it said.
The statement follows a September 7 Cabinet announcement that the inter-ministerial committee on HIV/Aids (IMC) would be re-established under the leadership of Deputy President Phumzile Mlambo-Ngcuka. The move was construed by the media as indicating that Tshabalala-Msimang, who has earned widespread notoriety on HIV/Aids, has been sidelined.
Mlambo-Ngcuka has since moved to centre stage in government public statements on Aids.
At this week's Cosatu's congress she projected an orthodox and conciliatory stance, telling delegates to "abstain, be faithful and condomise" and calling for Cosatu's help in fighting the virus.
She conceded that Sanac -- a moribund state body that supposedly drives the official Aids strategy -- had "underperformed" and promised a Sanac meeting within six weeks.
The Cabinet this week pledged an appeal to "all stakeholders to participate in Sanac meetings" and, significantly, "endorsed interaction" with the TAC.
Compounding the confusion was this week's Cabinet affirmation that Tshabalala-Msimang continues to lead "implementation of government's comprehensive plan on HIV and Aids". It added that the IMC would "coordinate government action to ensure ... better inter-departmental interaction and timeous attention to obstacles and challenges. Any perception that the IMC will take over implementation of the programme would be misleading."
In her speech Mlambo-Ngcuka acknowledged failures in the implementation of the government's Aids treatment plan. "Our programmes are thin, mainly concentrating on awareness-raising activities, which in some cases, only come during the big-day events like World Aids Day."
Currently South Africa is providing antiretroviral (ARV) therapy to less than half the people it targeted when the programme was launched.
One insider says the release of that statement might indicate the granting of greater authority to Mlambo-Ngcuka, viewed as having a pragmatic approach to Aids. There have been persistent rumours, formally denied, of divisions between Tshabalala-Msimang and her deputy Madlala-Routledge, including claims that the latter has been prevented from speaking publicly about Aids.
The TAC's Mark Heywood said he was inclined to believe government policy had shifted, but added. "It's not good enough. We need a minister of health who deals with Aids, not one who is not allowed to deal with it."
Heywood said the TAC would continue to raise its R4-million war chest for a campaign to pressurise the government on Aids and health care and to fire Tshabalala-Msimang.
Confirming this, TAC general secretary Sipho Mthathi said: "There are people who realise the crisis, people personally affected in the ANC leadership, and it's beginning to hit home. The problem is not just communication strategy -- it is implementation. We need someone who can turn the health system around. Manto doesn't have the right kind of vision."
DA health spokesperson Gareth Morgan said his impression was that Tshabalala-Msimang had been sidelined, but that this was "partially spin to change the government's image and get past the international Aids conference [in Toronto] and associated pressure".
The rise of extensively drug resistant TB has focused world attention on South Africa's failing health system and the impact on people with Aids.
At the Toronto conference last month Tshabalala-Msimang was rebuked from the podium. A letter to President Thabo Mbeki by 82 local and international scientists slammed the minister for expressing "pseudo-scientific views about the management of HIV infection ... to have as health minister a person who now has no international respect and is an embarrassment to the South African government". The government's immediate response was to ban Stephen Lewis, special adviser to the United Nation's Secretary General, from visiting public health facilities.
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