Mail & Guardian Online - November 28, 2007
Warren Foster

The past year recorded South Africa's lowest moments yet in its fight against HIV/Aids, but there were also some significant triumphs. The year started on a positive note. The South African National Council on HIV/Aids (Sanac) was reconstituted last December and convened for the first time this year. Previously, Sanac comprised the ministries of health, education, social development, public service and administration, as well as provincial and local government and the Presidency.

According to a statement issued by the Presidency, the new body includes multiple sectors of civil society "to make it more effective, accountable and able to play a leadership role in our efforts to overcome the HIV/Aids epidemic". Zackie Achmat, chairperson of South Africa's Treatment Action Campaign (TAC), was encouraged: "The end of 2006 and beginning of 2007 signalled a new commitment from the Deputy President [Phumzile Mlambo-Ngcuka] and Cabinet, a greater openness to rebuilding relationships with society and engaging more openly with civil society ... there was a different spirit of cooperation."

The year's most significant progress came in April when Sanac and the Cabinet formally approved the National HIV/Aids and STI Strategic Plan (NSP), 2007-2011. The plan aims to "achieve a 50% reduction rate of new infections by 2011 and provide an appropriate package of treatment, care and support services to at least 80% of people living with HIV and their families by 2011". The package includes counselling and testing services, healthy lifestyle interventions, treatment of opportunistic infections and antiretroviral therapy. Again Achmat was optimistic: "We see a serious commitment to the NSP; the TAC worked on it with the Department of Health. There was remarkable cooperation from the department to develop with broader civil society a comprehensive programme, one that is ambitious but entirely achievable."

In June, Health Minister Manto Tshabalala-Msimang returned to work after three months' medical leave. There was immediate drama. In the week of her return the minister refused to attend the third South African Aids Conference in Durban because her then deputy, Nozizwe Madlala-Routledge, was allocated a higher seat at the conference. "The conference opened and the health minister applied to have other officials' participation cancelled," said Achmat. "She was back and she was back with a force ... it was like something out of a horror movie: just when you thought the bad thing was dead, it resurfaces."

The tension between the minister and her deputy at the conference was an omen for what was to come. In August, the Health Department faced a barrage of obstacles in its fight against HIV/Aids. In early August, the popular and respected Madlala-Routledge was fired -- ostensibly for travelling to an Aids conference in Spain against the wishes of the president. The move came one month after a public row between Tshabalala-Msimang and Madlala-Routledge over conditions at the Frere Hospital in the Eastern Cape. Aids activists, the Congress of South African Trade Unions and the TAC, among others, came out in support of Madlala-Routledge, seeing her dismissal as a blow to the struggle against HIV/Aids. 'It came as an enormous blow because it showed a collapse in healthcare services," said Achmat. "Much more, that the minister is grossly incompetent, a liar and responsible for sickness and deaths ... The president is an Aids denialist and [what Tshabalala-Msimang says is an interpretation of] what the leader wants."

In the same month, Callcom, which supplied the Health Department with rapid HIV-testing kits, dragged the department to court. Callcom claimed the most recent tender agreement had been unfairly distributed and should be rescinded altogether. At the end of August, the Health Department called back 4,5-million defective condoms supplied to it by Zalatex. In October, a second batch of condoms, supplied by Kohrs Medical, failed to pass South African Bureau of Standards air-burst tests. A million of these were quickly quarantined, while another four million made it into distribution.

October saw Tshabalala-Msimang announce at the Global-World HIV/Aids Alliance conference that a decline in new infections among the under-20s, from 15,9% in 2005 to 13,7% in 2006, "suggests a possible reduction in the number of new infections in the population". The minister also stated that South Africa had the largest number of people on ARV therapy in Africa, if not the world, and admitted that there was a lack of adequate health professionals in the country.

Last week, South Africa came under the international spotlight for all the wrong reasons again: the United Nations Joint Programme on HIV/Aids annual report revealed that South Africa has the highest number of HIV/Aids infections in the world. The Health Department quickly released a statement reiterating the figures Tshabalala-Msimang had referred to in October. Asked what he thought would be the way forward for South Africa in 2008, Achmat said: "HIV/Aids is in a crisis of governance in South Africa -- primarily because the president is an HIV denialist. The first thing we have to do is get a new president for the ANC, then we have to continue doing what all of us do daily -- work at the prevention of HIV/Aids. Make Sanac work and force change where government is being obstructionist."

Pulse on the pandemic

The United Nations Joint Programme on HIV/Aids annual report shows that: more than 33-million people in the world are HIV/Aids positive; internationally new Aids infections are levelling off; global HIV incidence -- the number of new HIV infections a year -- is estimated to have peaked in the late 1990s at more than three million new infections a year and is estimated to be 2,5-million this year; about 68% of Aids-related deaths occur in sub-Saharan Africa; of the 2,5-million people newly infected overall, more than half come from sub-Saharan Africa; Southern Africa is the worst affected in the region with a national adult HIV prevalence of more than 15% in eight countries; and in many parts of Africa, adult HIV prevalence is either stable or has started to decline.

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