The New York Times - August 9, 2007
Sharon Lafraniere

South African anti-AIDS advocates called the firing of the deputy, Nozizwe Madlala-Routledge, a setback to efforts to curb the spread of AIDS. South Africa has one of the largest H.I.V.-positive populations in the world, but until recently its programs to provide drugs and counseling to people with AIDS have lagged behind those of some poorer nations.

"This is a dreadful error of judgment that will harm public health care and especially the response to the H.I.V. epidemic," said the Treatment Action Campaign, South Africa's main anti-AIDS lobby group, in a statement. "It indicates that the president still remains opposed to the science of H.I.V. and to appropriately responding to the epidemic."

Ms. Madlala-Routledge was welcomed by AIDS experts after her superior, Manto Tshabalala-Msimang, the health minister, came under international criticism for advocating nostrums like vitamins, garlic and beet root to prevent the advance of AIDS.

Mr. Mbeki's office confirmed the firing on Thursday, but gave no reason publicly. Ms. Madlala-Routledge's supporters said he had told her that he was firing her for her handling of a controversy over care at a government hospital and an official trip she took to Spain, at government expense, without his permission.

For nearly a year, Ms Madlala-Routledge has been leading the Health Ministry's campaign against AIDS while the health minister was sidelined by illness. AIDS workers say that Ms. Madlala-Routledge was partly responsible for ending five years or more of government indecision and occasional denial of the scope of the epidemic.

During her interim leadership of the Health Ministry, control of national AIDS policy was removed from Dr. Tshabalala-Msimang, a close ally of Mr. Mbeki, and placed under a governmentwide council led by Mr. Mbeki's deputy president, Phumzile Mlambo-Ngucka. At the time, many analysts saw the move as an effort by Mr. Mbeki to distance himself from Dr. Tshabalala-Msimang after her views on H.I.V. treatment generated international condemnation.

As many as 5.4 million of South Africa's 47 million citizens are infected with H.I.V., which causes AIDS. That figure is among the highest in the world.

Ms. Madlala-Routledge acknowledged that the criticism of the government response to the epidemic was at least partly justified. She has said that the government had created confusion over the need for antiretroviral treatment, and she urged leaders to encourage H.I.V. testing by getting tested themselves. She and the deputy president together unveiled a plan to attack AIDS.

Her position was jeopardized once the health minister returned to work in June after a liver transplant. Dr. Tshabalala-Msimang withdrew from a health conference after organizers asked Ms. Madlala-Routledge to speak at an important session and relegated Dr. Tshabalala-Msimang to a lesser gathering.

Then in July, the two clashed over allegations of high infant mortality at a government hospital. Ms. Madlala-Routledge paid a surprise visit to the hospital and condemned the standard of care, saying it reflected a national emergency in health care. Dr. Tshabalala-Msimang, who soon sent a team to investigate, insisted the infant death rate was comparable to other hospitals.

In his weekly newsletter, Mr. Mbeki sided with the health minister, saying the allegations of poor care had been exaggerated.

This month, Ms. Madlala-Routledge ran into more trouble when news reports revealed that she, her son and an aide had flown to Spain for an international AIDS meeting at a cost to the government of nearly $23,000. Her supporters said she had asked Mr. Mbeki for permission beforehand and believed that he had granted it or that he would do so. He refused permission, and she came home, apologizing for a breach of protocol.

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