Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.

Reuters NewMedia - November 29, 2006
Wendell Roelf

South Africa's AIDS battle has been two-fold, with doctors and community groups struggling to help an estimated 5 million people infected with the virus and government officials fending off critics who accuse them of mishandling the disaster.

The criticism peaked at this year's world AIDS conference in Toronto, where South Africa was accused of "lunatic" negligence on HIV/AIDS by activists, doctors and even a U.N. official.

The government was clearly stung, and has promised it will use World AIDS Day on Friday to outline a new five-year plan to fight the disease.

"We believe in good faith that there has been a real change of heart," said Sipho Mthathi, general secretary of the activist Treatment Action Campaign, often a harsh government critic.

President Thabo Mbeki, who enraged AIDS activists by questioning the link between HIV and the disease, has dropped out of the public debate.

The new approach has been led by Deputy President Phumzile Mlambo-Ngcuka, who has been named head of South Africa's National AIDS Council and promised to cooperate with activist groups such as the TAC.

Deputy Health Minister Nozizwe Madlala-Routledge has also moved into the spotlight, overshadowing Health Minister Manto Tshabalala-Msimang who critics say has come to personify the government's failure on a disease that now kills at least 900 people in the county every day.

READY FOR CHANGE?

Tshabalala-Msimang -- once dubbed "Dr. No" for her reluctance to approve the widespread use of anti-retroviral drugs against HIV -- will join Friday's AIDS policy launch, leading some experts to wonder if South Africa is really making a serious change.

It appears early goals for the new policy, including specific numerical targets for AIDS patients in treatment, may not be part of the initial package.

"The idea was to publish the whole plan, but this couldn't be finished. It was too ambitious to think it could be done in two months," said the TAC's Mthathi.

South Africa now has about 200,000 people receiving ARV drugs, but a further 800,000 need them.

Marta Darder of non-governmental group Medicines Sans Frontiers in Khayelitsha township outside Cape Town said initial drafts of the policy were poor and lacked sufficient input from the grassroots level.

But she said that the government's new drive on HIV/AIDS appeared to be headed in the right direction, with an emphasis on expanding treatment and preventing new HIV infections.

"This is about science-based strategy and facts-based policy making, something which has not been happening to a large extent," she said.

South Africa has rolled out one of the world's biggest ARV treatment programs and ramped up spending to some 3 billion rand ($422 million).

But while policy analysts will be watching closely to see what the new plan reveals, some say Mbeki's continued silence on AIDS hints that South Africa's top leader is still not convinced that a new approach is needed.

"The big issue that remains is what does the president think and want," said Mark Heywood of the AIDS Law Project. "He may delegate the AIDS question to the deputy president, but to not say a thing continues to jar and make people suspicious.

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