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In January, Thamsanqa Mseleku took control of the department as director-general. The same month, respected HIV specialist Dr Nomonde Xundu was appointed as the department's chief director of
HIV/AIDS and TB. Both positions had been vacant too long. And behind the scenes, Deputy Health Minister Nozizwe Madlala-Routledge is integrating HIV/AIDS treatment into the areas of healthcare assigned to her. I have got increasingly involved in the [antiretroviral] roll-out, she this week told delegates at a Johannesburg conference on healthcare improvement and the expansion of
AIDS treatment. In my experience as deputy defence minister, I was delegated HIV/AIDS as one of my areas of responsibility. I have seen incapacitated people get treated and back on their feet.
By combining forces and experience this new team could be the catalyst needed to accelerate national AIDS treatment this year.
The deputy minister's support for antiretroviral treatment is important given the government's muted statements on the drugs' efficacy versus their side effects. Her political will shines against the lacklustre leadership around HIV/AIDS of President Thabo Mbeki. While Health Minister Dr Manto Tshabalala-Msimang worked constructively, and long hours, on the Comprehensive Plan on HIV and AIDS launched last year, publicly she doesn't single it out as a priority. In her parliamentary briefing last month the
HIV/AIDS programme was one of about a dozen issues on the agenda - even though 2004 was the inaugural year of the roll-out. In this context both the tone and content of Madlala-Routledge's speech are significant. Uncharacteristically for the government, she acknowledged the deadly impact of HIV/AIDS, citing the latest Statistics SA report on mortality, the time lost and the benefits of treatment.
She also expressed a willingness to work with all partners and to listen to experts and critics alike. She affirmed the Treatment Action Campaign (TAC) as an ally, a departure from how the government has responded to organizations demanding urgency in the struggle against HIV. We are on the same side, Madlala-Routledge insisted. We need them as much as they need us.Her stand could herald unprecedented co-operation between leaders of the ruling party and the TAC. On Thursday she met TAC leaders, including chairman Zackie Achmat, in what he termed a very good meeting.
The deputy minister clearly understands the issues. We are speaking on the same page ... We hope this will be transmitted through every level of government, Achmat said. The TAC has long had a positive working relationship with provincial health departments but it has, once again, threatened litigation against the national department for dragging its feet on the delivery of all HIV/AIDS programmes. In 2001, the TAC won a landmark court case to compel the government to
expand its mother-to-child HIV-prevention programme. The meeting this week may avert further legal confrontation. Achmat said he would recommend to the TAC that it reconsider litigation provided it secured a clear indication from the director-general on the mother-to-child prevention programme and the rollout. A senior health official in the ANC, who does not wish to be named, said Mseleku recognized the contribution civil society could make to transformation. He said the director-general had had a hand in recent reconciliatory developments. Mseleku has the right political grasp and comes from a background of closely working with non-governmental organizations, he said. A comrade in the
United Democratic Front in the 1980s, Madlala-Routledge has not abandoned the radical approach she had then, and appreciates the TAC's drive.
In her speech to the conference this week, the deputy minister urged South Africans to start a revolution from below to stop needless deaths. Slogans like An injury to one is an injury to all and Each one teach one are as relevant today, in the era of Aids, as they were during apartheid, she declared. At her right hand was Xundu, who has moved from being head of the Gauteng HIV/AIDS programme to lead the national programme. The deputy minister said of Xundu: She has courageously stepped into the shoes of Dr Nono Simelela who got burnt out. It is important she gets all our support. Xundu, an active member of the Southern African HIV/AIDS Clinicians Society, was widely respected, said society president Dr Des Martin. He said the society was thrilled with her appointment. Martin said he was hopeful 2005 could see a change in tackling the epidemic head-on. One year into the treatment roll-out, South Africa is behind on its targets. The government's plan was to put 53000 patients on antiretroviral drugs by March last year. By the end of January this year, however, only 29000 patients were receiving the treatment in public facilities - more than 75% of them in the Western Cape, Gauteng and KwaZulu-Natal.
A civil society forum monitoring the roll-out commended the Free State, Northern Cape and North West for their tireless efforts to get the programme off the ground. Countrywide, 113 sites are providing treatment services. The forum identified the main barriers to accessing treatment as shortages
of staff, lack of treatment information among people with HIV/AIDS, the unsustainable supply of drugs and lack of access to laboratory services. Madlala-Routledge said: I don't think we will be able to meet our targets in the second year ... The target of 400000 people on treatment by 2007
gives us a huge challenge. She highlighted the need to train healthcare professionals at all levels to
manage AIDS like any other chronic disease. The department is developing a human resources framework to deal with the scarcity of health professionals. The allocation of rural and scarce skills
allowances, and last year's appointment of Dr Percy Mahlathi as the deputy director-general of human resources, were steps in the right direction. But ultimately the leadership to solve the human resource crisis, as with HIV/AIDS, must come from above.
The government took an outspoken stand on HIV/AIDS until 1999, when AIDS dissidents deflected the attention of Mbeki, then deputy president. As far back as 1995 Mbeki addressed all levels of government about the need for serious attention and action against Aids. In 1998, he urged South Africans to deal with HIV or our dreams as a people will be shattered. Former President Nelson Mandela and former Health Minister Dr Nkosazana Dlamini-Zuma also put HIV/AIDS firmly on the agenda. Even Tshabalala-Msimang promised the National Assembly she would do more about it when she became Health minister in 1999. To be fair, the government's HIV/AIDS programme has made substantial progress during her term, yet it seems to have taken external pressure to achieve this. Researching the government's changing response, Human Sciences Research Council HIV/AIDS executive director Dr Olive Shisana said the progressive policy took a turn in 1999.
Shisana, the director-general of health from 1994 to 1999, wrote that the government's determination to confront the epidemic shifted to almost ignoring it or emphasizing technical issues to explain why this or that intervention could not be implemented. Before a breakthrough in November 2003 - when Cabinet agreed in principle to AIDS treatment - the government seemed to adopt what the world regarded as a denialist position on HIV/AIDS. Those days of equivocation could be over, if positive developments so far this year are a sign of what lies ahead, 2005 could mark the point when South Africa began reversing the toll of an estimated 400000
AIDS deaths annually.
(Source: Sunday Times, March 13, 2005)