STATE-sponsored AIDS denialism is finally a thing of the past, after years of obfuscation on one of SA’s most pressing challenges. Almost 10 years to the day after former president told the National Council of Provinces it would be irresponsible for the government to provide AIDS drugs because they were supposedly toxic, his successor, , frankly admitted the scale of the epidemic and pledged to tackle it head on.
Former health minister , who was bent on promoting quack remedies for HIV as patients died for lack of AIDS drugs, has been silenced. In her place is Aaron Motsoaledi, who has publicly acknowledged the terrible legacy of the Mbeki administration.
While research suggests the rate of HIV infection is slowing, particularly among young people, about 5,3-million South Africans, or a little more than a tenth of the population, are already infected. The latest government figures suggest about 700000 people have been enrolled in AIDS-treatment programmes, but many more are still on waiting lists.
Too many people who are infected with the virus still don’t know it as testing is not routinely offered by doctors and nurses.
A study by the Harvard School of Public Health estimated 330000 lives could have been saved and 35000 HIV-positive babies protected from infection between 2000 and 2005 if the government had not stalled on treatment.
Figures from Stats SA tell a similar story: the number of deaths recorded by the Department of Home Affairs almost doubled between 1997 and 2006, rising from 317000 to 612000, as AIDS took hold. As infection spread, Mbeki’s administration continued to deny treatment.
Even when the official AIDS drug roll-out began in 2004, there was little oversight of the provinces from the Department of Health, and progress in many areas was lacklustre.
The first steps towards a turnaround were taken by , who replaced Tshabalala-Msimang last September and freely confessed to the government’s past failings.
Hogan started rebuilding trust with exhausted and demoralised doctors, scientists and activists, brought in experts to analyse the state of the provinces, and laid the technical groundwork for her successor.
Motsoaledi has taken up where Hogan left off. Two weeks after Zuma’s address, he gave reporters a detailed technical briefing on HIV/AIDS, describing the death toll attributable to the epidemic as akin to that of a war. “Our attitude toward HIV/AIDS put us here where we are,” he said, an admission that would have been unthinkable under Mbeki. There was no place, he said, for beliefs that had no basis in scientific fact.
He also rid the department of its director- general, Thami Mseleku, who was tainted by his close association with Tshabalala- Msimang and his overt support for the vitamin promoter, Matthias Rath, who touted his unproven products as an alternative to AIDS drugs and conducted illegal experiments on HIV patients in the Cape Town township of Khayelitsha.
Mseleku, who left the department in September, two months before his contract expired, has yet to be replaced.
Unlike Tshabalala-Msimang, who spent a large amount of her time flitting from one public event to the next, Motsoaledi has kept ribbon-cutting to a minimum.
In September, he confirmed activist claims that the government’s AIDS programme was facing a R1bn shortfall this fiscal year. Evidence of his success in lobbying the Treasury and donors for help swiftly followed: Finance Minister Pravin Gordhan allocated an extra R900m in the October adjustment budget to this year’s funds, and added an extra R5,4bn to the HIV/AIDS conditional grant over the medium term to take account of an expected rise in demand for AIDS drugs. And an announcement is expected later today that the US government will significantly increase its HIV/AIDS funding to SA.
The US President’s Emergency Plan for AIDS Relief is SA’s biggest external HIV/AIDS donor, and has already channelled 2,56bn towards SA since the programme was launched in 2003.
Money alone is not enough: providing decent HIV/AIDS care to the millions of people who need it means fixing the public health system, something Motsoaledi clearly understands.
It is no secret that too many of SA’s public hospitals are staffed by people who behave as though it is a crime to be ill: the tabloids are filled with stories of everyday cruelty in hospitals, where women are shouted at in labour, nurses sit eating takeaways while their waiting rooms overflow with sick patients, and hospital managers are rarely held accountable for the needless deaths that occur on their watch.
Motsoaledi has admitted as much, telling radio listeners last week that poor infection control rendered many hospitals veritable death traps.
And so, when he said last month that the government wanted all South Africans to take an HIV test, in the hope that those identified with HIV would take care not to spread the virus and seek care before they became desperately ill, Motsoaledi emphasised that careful planning would be required beforehand.
The health system was already struggling to provide services to the hundreds of thousands of patients who were currently on treatment, and a badly managed surge in demand could be a disaster, he said.
With that in mind, he asked the South African National AIDS Council to assess the country’s capacity to conduct a large voluntary HIV-testing campaign.
Motsoaledi has already taken the first steps towards improving the quality of public hospitals. He has met hospital managers and warned them teams of inspectors are about to descend on their facilities and will report back to the department on what they find; R10m has been set aside for the audit, and a new watchdog agency is to be established to make sure clinics and hospitals adhere to new quality standards.
Significantly, this agency is to be independent of the department.
Ultimate responsibility for approving detailed AIDS policies, such as treatment guidelines, has also been taken away from the department and given to the South African National AIDS Council. This is important, because it creates distance between the delivery agencies and those that monitor and evaluate services.
Work that began under Hogan to overhaul the Medicines Control Council is gaining pace. A R12m cash injection from the British government has enabled the government to bring in a top team to speed up the assessment of clinical trials and deal with a backlog of applications to register new drugs.
And so it seems that the government’s tough talk on HIV/AIDS is being backed up with action, giving South Africans more than a little reason to be hopeful that the corner has been turned in tackling the epidemic. The turnaround is long overdue.
n Kahn is science and health editor.
Motsoaledi confirmed claims of a R1bn shortfall; evidence of his success in lobbying for help swiftly followed