South African Press Association - September 11, 2009

"It's not a secret that we didn't do well," he told a South African National Aids Council (Sanac) meeting in Johannesburg.

"If the scourge of HIV and TB [tuberculosis] is a snake, the head is South Africa. If you want to kill a snake, you start with the head and it will die."

Motsoaledi said South Africa's slow response to the pandemic was raised at a meeting in New York in June.

UNAids executive director Michel Sidibe called him in for a meeting to discuss this, said Motsoaledi.

"He said: 'Look, I've got a message for you. I've met several leaders in Africa and they say that if South Africa doesn't wake up to fight this epidemic, the whole continent will go down'."

He received a similar message from former Botswana president Festus Mogae at a summit of African health ministers in Kigali last week, said Motsoaledi.

"Festus Mogae said: 'We can understand the poor statistics in the rest of the region, but how do we explain South Africa, a highly industrialised country?'."

The minister said South Africa wasted too much time "debating" the pandemic.

"Many African countries are implementing; South Africa is still debating."

South Africa wanted to reach 80% of people who need treatment with antiretroviral drugs by 2011, he said.

"That will mean 2,3-million people. At the moment we have 700 000 [people on ARVs] and the country is already feeling the weight.

But because there was no cure in sight, the key to dealing with the pandemic in the future was to focus on prevention, which was not always that simple.

"We are buying 400-million condoms per annum," the minister said.

However, there was an ongoing debate over whether condoms should be handed out at schools, or whether the government should preach abstinence from sex to children.

"[We are] debating how moral would it be for us to go there [to schools] and line up kids and give kids condoms ... it hasn't been resolved yet, because we are a country that debates."

Also, research showed circumcision could reduce Aids rates, but this was another prevention option that South Africa was still debating, while other African countries were implementing it.

Motsoaledi said he was concerned about a series of articles that appeared in the British medical journal the Lancet, which said South Africa had been hit by four pandemics -- Aids and TB; a high infant mortality rate; lifestyle diseases; and violence and injury.

"They [Lancet researchers] say these four are reaching proportions that are unmanageable," Motsoaledi said.

The latest figures showed 73% of people in South Africa suffering from TB were HIV positive, he said.

Deputy President Kgalema Motlanthe, who also addressed the Sanac summit, agreed that changes in behaviour were the only way to deal with Aids.

He called on sportsmen and entertainers, who were attending the summit, to use their status to influence people to change their behaviour.

"We emphasise prevention as the most effective weapon in the offensive against HIV/Aids," Motlanthe said.

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