South Africa’s health minister takes the heat

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By ROBYN DIXON, Jerusalem Post, 03 Oct 2006

JOHANNESBURG – The UN special envoy for AIDS has likened her to the “lunatic fringe,” while a well-known comedian derides her as the “Angel of Death.” She is South Africa’s top health official and one of the most important front-line fighters against AIDS in this country beset by an epidemic. But controversial Health Minister Manto Tshabalala-Msimang has been widely criticized for questioning the effectiveness of antiretroviral drugs to combat AIDS, advocating beets, lemon, garlic and sweet potatoes as treatment instead. Activists had to take legal action to force the government to provide the medication to pregnant women and prisoners.

She has been criticized in international forums and recently faced a call from dozens of international health experts to be fired. Still, South African President Thabi Mbeki has remained steadfast. Some analysts suggest it is his stubborn loyalty to a longtime political ally, others that he is satisfied by her performance because her views are similar to his own.

In the late 1990s, Mbeki warned of the toxicity and harmful side effects of the antiretroviral treatments, and in 2000 he questioned the link between the human immunodeficiency virus and AIDS. He has never publicly disavowed those views, although government spokesman Themba Maseko said earlier this month that the government does believe HIV causes AIDS.

“I don’t think he understands how much it has damaged his presidency,” said William Gumede, the author of a critical biography on Mbeki. “Even his closest allies, if you speak to them, don’t see it.”

Other observers believe that the more pressure from activists and international experts, the less likely Mbeki is to dismiss TshabalalaMsimang because he finds it difficult to admit he was wrong on AIDS.

“I think there’s a certain degree of vanity here,” said political analyst Tom Lodge, formerly head of politics at Witwatersrand University in Johannesburg. “He’s like a lot of politicians: He really finds it difficult to say, ‘Look guys, I made a mistake.’”

Last month, Mbeki ignored a call for her dismissal from 81 international AIDS experts, including Nobel Prize laureate David Baltimore and Robert Gallo, who developed the first blood test for HIV and identified the virus as the cause of AIDS.

In the letter to the president, they called for an end to South Africa’s “disastrous, pseudoscientific policies,” saying the minister was an embarrassment to South Africa who had no international respect.

The most damaging recent criticism came at the International AIDS Conference in Toronto last month from UN envoy Stephen Lewis, who described the South African government’s approach as “wrong, immoral, indefensible.’’ “It is the only country in Africa,” he said, “whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state.”

With 600 to 800 dying daily in South Africa of AIDS, Lewis said the government has much to atone for. But he said: “I’m of the opinion that they can never achieve redemption.”

In South Africa, 5.5 million people are infected with HIV, more than any country except India. The government estimates it treats 140,000 South Africans with antiretroviral medicines. Of those, 40,000 are funded through President Bush’s PEPFAR initiative on AIDS.

Biographer Gumede said Mbeki did not want to fire Tshabalala-Msimang under public pressure, but noted that her power had been curbed recently when the government set up a committee of ministers this month to oversee the AIDS treatment plan.

“Mbeki is very sensitive,” he said. “If he feels one of his loyal supporters or loyal allies is under siege, it’s real unlikely that he will fire such a person.’’ Mbeki and Tshabalala-Msimang go back to the early 1960s, when they and other students fled together into exile. Mbeki is also close to her husband, Mendi Msimang, now treasurer of the ruling African National Congress, who was the ANC London representative when Mbeki was in exile in Britain during apartheid.

Mark Gevisser, author of a soon-to-be-published biography on Mbeki, said he had heard one story that Mbeki had been asked why he made Tshabalala-Msimang health minister, and the president pointed to a photograph of himself, her and other young exiles, saying: “She’s been with us from the start. And she’s a doctor, she could have gone into private practice, she could have left the movement, but she has stayed with us.”

“It’s history that the two of them as youngsters went into exile together, and that’s significant, but not as significant as the fact the he feels that she’s someone that he can completely trust,” Gevisser said. “I would imagine that there’s a deep, enduring bond and a sense of loyalty, and a sense of ‘We were with each other in the trenches so I can trust this person absolutely.’ That becomes a measure, as much as a minister’s competency in a portfolio.”

Political analyst Lodge, now based at Limerick University in Ireland, said Tshabalala-Msimang held conventional views on HIV/AIDS before she was health minister but that she had since echoed Mbeki’s opinions, adding her own spin about garlic, lemons and beets as treatments.

“In the case of the president, who likes to think independently of experts and who often is in quite an isolated position intellectually, it is possible to see – and it’s also possible to regret – where he has ended up.

“It’s in some ways all the more unforgivable in her case because, unlike the president, she has a conventional medical training,” Lodge said. “She is going against the conventions and the professional protocols of her own background.“

(Los Angeles Times)