Over the past few weeks, government’s more vigorous approach to HIV/AIDS has been hailed as a “sea change”, with Deputy President Phumzile Mlambo-Ngcuka and Deputy Health Minister Nozizwe Madlala-Routledge as the new captains.

Madlala-Routledge acknowledges that there is a “new energy” in government to address HIV/AIDS and that the “catalyst” for this was the international AIDS conference in Toronto in August.

At the conference, South Africa was written off as the lunatic fringe by Stephen Lewis, the United Nations Special Envoy on AIDS. This was after the health ministry put up what resembled a vegetable stall, and the health minister punted beetroot and garlic as AIDS treatments.

“Toronto galvanised government to be on a new footing, particularly around streamlining of communication on our strategy and our plan and greater mobilisation of all partners,” explains Madlala-Routledge.

“In particular, there was recognition of the fact that this atmosphere of perpetual conflict with civil society is not helping.”

Government sources confirm that health minister Manto Tshabalala-Msimang kept her deputy out of HIV issues.

But after holding her tongue for almost three years, Madlala-Routledge has been speaking bluntly about the challenges and shortcomings of government’s programme in the past few weeks.

Where has her new courage come from?

“I don’t have officially new, defined role, but certainly I have seen spaces being created for me. I think I’ve been given the space to support the improvement of relationships,” says Madlala-Routledge.

“As chairperson of the South African National AIDS Council (SANAC), the Deputy President has indicated that she is aware of my abilities and strengths and she’s drawn on these.”

The two deputies go back a long way, both having been leaders of the Natal Organisation of Women (NOW) in the 1980s.

Throughout her term of office, Madlala-Routledge has kept the door open to the Treatment Action Campaign (TAC) – even when insults were flying thick and fast between government and the TAC.

She has thus been able to mediate between the two, drawing the TAC into government efforts to revitalised SANAC and draw up a new strategic plan on HIV/AIDS for 2007-2011.

While Tshabalala-Msimang remains political head of the health department, which is the lead department dealing with HIV/AIDS programme, the Inter-Ministerial Committee (IMC) on AIDS with Mlambo-Ngcuka as chairperson, has been revived. This will co-ordinate government’s overall responses to HIV.

“We beat apartheid so we must be able to beat AIDS.” – Nozizwe Madlala-Routledge

A revived SANAC, also chaired by Mlambo-Ngcuka, will be launched on AIDS Day to guide the partnership between government and other organisations.

For the first time, SANAC will not simply be a talkshop but will also have its own programmes.

“The real work starts now. We must get the people off the [antiretroviral] waiting list. There are just too many people waiting. When people come forward under the present conditions of stigma it is most discouraging when they must then wait in a long queue. So that is the very immediate challenge.”

The second burning issue is for more people to take HIV tests.

“The sooner a person knows their status, the sooner they seek help. The earlier they seek help, the more chance they will have of success.”

Two of Madlala-Routledge’s cousins, Thandeka and Phyllis, died recently of AIDS-related illnesses. Neither disclosed their HIV or started treatment until it was too late.

The deputy minister acknowledges that government has not done nearly enough to prevent new HIV infections, and that the old ABC – Abstain, Be Faithful, Condomise – is not always appropriate and that poverty and violence have to be addressed.

“Consider the high rate of sexual and gender-based violence in the country. ABC is clearly not relevant in a situation where a person is being violated.”

The new strategic plan on HIV to take us to 2011, sets pages of tight and ambitious targets that increase every year.

“There’s a huge commitment to set targets. To quote the Deputy President, ‘if you can’t see the figures you can’t count it’.

“The major target that we are all agreed on is halving new infections by 2011. It’s an ambitious target but it’s one that we need to find very possible way to implement.”

Charlatans promoting untested AIDS remedies may soon find little space for themselves.

The health department’s foodstuffs and medicine control units are working hard to develop regulations to give effects to two laws that define medicines and foods, and criminalise making untested claims about foods and supplements.

“South Africa is flooded with untested remedies, and this environment of no proper regulation has allowed this flooding.

“I know people ask why traditional medicine should go under scientific scrutiny. We are providing the laboratories and asking them to test their so-called remedies.

“But South Africans must ask themselves: is it correct that traditional medicines should be tested on people? We have allowed a situation where a person whose training we don’t know can see patients and prescribe for them and the way that the traditional practitioner can see if this [remedy] works is if the patient lives or dies. This is unacceptable because it is testing untested medicines on human beings.

“I also feel it is unethical for senior people in the government to themselves promote these remedies. It confuses people. People say ‘I heard it over the radio. Minister so-and-so; MEC so-and-so was saying this is good. We can use it.’

“I think that is irresponsible in the extreme. As MECs, ministers and government, especially in the health sector, we have a responsibility to protect our people and I think we must take this responsibility very, very seriously.”

Despite the many obstacles, Madlala-Routledge is optimistic. “We beat apartheid so we must be able to beat AIDS.”

Kerry Cullinan

Health-e News Service.

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