South Africa begins to see the light on HIV/AIDS


The South African Government is seeking to shake off years of international denunciation for its handling of the AIDS epidemic - including a fixation on the supposed protective powers of beets and lemons - while expanding treatment, testing and prevention programs.

Over the past six weeks, the Deputy President, Phumzile Mlambo-Ngcuka, has emphasised that the Government now believes unequivocally that HIV causes AIDS, a link that the President, Thabo Mbeki, once publicly questioned. She has also said antiretroviral drugs must be the centrepiece of the Government's response while playing down the dietary recommendations long cited by the Health Minister, Manto Tshabalala-Msimang, as central to fighting AIDS.

"The beetroot and all that lemon stuff is out the window," an adviser involved in recasting the Government's policy said. "These guys are now serious about getting it right."

Driving the recent change is a growing realisation of the severity of AIDS in South Africa - an estimated 5.4 million of 47 million citizens have HIV, among the highest totals in the world - and concern that the controversy surrounding the disease was damaging the country's reputation.

The Treatment Action Campaign, the country's leading AIDS activist group, said that after years of hostility and legal battles, government officials were working co-operatively with members to realise some of their long-standing demands, such as setting targets for dramatically expanding the availability of antiretroviral drugs through the public health system. Ms Mlambo-Ngcuka, who has taken control of the national AIDS commission, has met the group privately.

"There's clearly a shift taking place," said Zackie Achmat, the head of the campaign.

Officials say Dr Tshabalala-Msimang, often ridiculed as "Dr Beetroot", will maintain some role in AIDS policy, but activists say they are confident she has been effectively marginalised by the appointment of Ms Mlambo-Ngcuka to oversee the Government's response to the disease.

Government officials privately acknowledge that Dr Tshabalala-Msimang had become an embarrassment, and activists say the tenor of conversations with the Government has changed dramatically since the Deputy President took over. "I'm still sceptical, and I'm still waiting for the proof," said Francois Venter, head of the Southern African HIV Clinicians Society. "But there's been a switch, the most hopeful switch in years, over the past four or five weeks."

A turning point came in August, at the International AIDS Conference in Toronto, where Dr Tshabalala-Msimang sponsored a display featuring lemons, beets and garlic but no antiretroviral drugs. An interview she had on US television that same week renewed fears that she and Mr Mbeki did not accept the two-decade-old scientific consensus that HIV causes AIDS.

"President Mbeki said, 'It cannot be the virus alone. We must look at other, other issues that predispose people to the immune system being depressed,' and I am of the same view also," she said.

The next day, Stephen Lewis, the UN special envoy for HIV/AIDS in Africa, denounced the South African Government's view as "wrong, immoral and indefensible". Two weeks after that, 81 AIDS scientists from South Africa and around the world signed a letter calling on Mr Mbeki to sack Dr Tshabalala-Msimang.

He refused. But those events, combined with a government report blaming AIDS for a huge surge of deaths among South Africans in their 20s, 30s and 40s, prompted him to appoint Ms Mlambo-Ngcuka to lead an urgent review of AIDS programs, pushing Dr Tshabalala-Msimang out of the spotlight.