Sunday Times, South Africa - April 16, 2000
Laurice Taitz

"I did not expect it," she said. Like other Cabinet ministers, Tshabalala-Msimang got the call from President Thabo Mbeki notifying her some time before dawn on June 17 - the day of the public announcement.

Despite her trepidation at taking the helm of one of the most controversial government departments, and of filling the shoes of her predecessor, Dr Nkosazana Zuma, whose every act had been publicly held up for scrutiny and whose adversaries seemed to outnumber her allies, Tshabalala-Msimang thanked the President and accepted her fate.

At the time, she vowed to put her weight behind stemming the spread of HIV/AIDS, to work towards minimising tensions and to bring in those who had been alienated by her predecessor's modus operandi.

"There is no use in working in little corners," she said. "There is a lot of commitment out there and it needs to be recognised."

In the weeks that followed, the minister was welcomed by people from different sectors of the medical fraternity - pharmaceutical company representatives, AIDS activists, doctors, scientists and researchers. The same people who had been marginalised by Zuma were now jostling for a meeting with Tshabalala-Msimang. The clamour around directions taken in health policy died down. As one prominent AIDS activist said: "This is not the time to be critical. We have to give her a chance."

Then came the visit to Uganda. It was a political triumph because it affirmed African strategies for dealing with the HIV/AIDS pandemic, and a personal triumph for the minister as it allowed her to carve out a role for the Department of Health in determining what course of action the government should take.

Her excitement and enthusiasm were palpable. She said then: "I was so excited after the first day, I phoned Brigitte [Mabandla, the Deputy Minister of Arts, Culture, Science and Technology], who was in the room next door, at 4am and said: 'We can do this. We can make it work.' "

Towards the end of October last year, after a thorough consultative process, the Department of Health released its draft HIV/AIDS Strategic Plan for South Africa - an actionoriented five-year blueprint. A strategy for preventing mother-to-child transmission of the virus - an issue that was close to the minister's heart at the time of her appointment - was clearly spelt out.

And then something happened to derail the minister's good intentions.

The President spoke.

Since Mbeki's statements on the toxicity of AZT, the minister's responses have been obfuscatory. When confronted on the issue, she has responded - on the same platform - by saying that the drug is toxic and too costly for the government to afford, and that it is not a cure.

In the final version of the national plan released in January, the objective of reducing mother-to-child transmission was no longer as much of a priority. Since then, her responses on this issue have floundered.

The arguments about costs and toxicity have become interchangeable.

But they make no sense. If AZT has been proven to be toxic and the reports compiled by the Medicines Control Council endorse this view, then cost is irrelevant. But it has been months since the minister received the documentation, and, so far, she has not acted on it, leaving the status of AZT as an effective means of preventing mother-to-child transmission unchanged.

The government's lack of a consistent view on this issue has only served to confuse further. Pharmaceutical companies which are seen as "poisoners for profit" are at the same time being enjoined to lower the prices of their drugs. AIDS activists are continually fobbed off by the Department of Health and told to take their requests for accessible treatment to the doors of the pharmaceutical giants. But the department is reluctant to join them. As one critic pointed out, the government has an incomprehensible agenda, "that at some moments will sound like it is on the side of the protesters, and other times like it is leading the opposition against them".

At the time of her appointment, the minister lauded the idea of "robust debate", saying "it is only through debate that we will find solutions". But last week she told journalists that she would not answer questions on whether she believed HIV caused AIDS and said she thought the President was "a little bit irritated" with the debate.

The events of last week further served to confuse the issue. The minister's statements about Nevirapine, an alternative to AZT in preventing mother-to-child transmission, cast doubt over the drug's safety profile. And only after there were calls for all drug trials using this drug to be halted - following the five deaths - did the minister explain that the trial had nothing to do with mother-to-child transmission.

The subjects who died were not pregnant women, and they were involved in testing the drug in combination with other anti-HIV drugs.

In the past few months, there have been many statements and many denials on the issue of HIV/AIDS, and these have only served to mask the lack of delivery on this issue.

Perhaps now would be a fitting time to remind the minister of her words at the time of her appointment, when she said: "Government has a responsibility to take decisions and to implement them. When things go wrong people will not say it is the fault of the pharmaceutical companies who did not deliver health care. They will say our government has failed us. The buck stops here."

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