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Another bizarre year for AIDS policy

07 December 2005 Angelo Coppola

This has been another confusing year for those trying to make sense of government's AIDS policy, thanks to the Minister of Health and her oddball connections

Unfortunately, 2005 has been another bad year for HIV/AIDS in South Africa – thanks to Health Minister Dr Manto Tshabalala-Msimang and her bizarre supporting cast of oddball connections with their props of garlic, beetroot, olive oil and vitamin concoctions.

While the Minister’s promotion of untested remedies have inspired hundreds of newspaper cartoons, they have caused confusion for people living with HIV.

Yet what we desperately need is decisive leadership about HIV and AIDS as we are very far from beating the epidemic.

An estimated 5.2 million South Africans are living with HIV, according to latest figures released by the Actuarial Society of SA (ASSA).

There were around 530 000 new HIV infections and 340 000 AIDS deaths between the mid-2004 and mid-2005, according to ASSA.

Our youth prevention programmes are failing. HIV infection in girls aged between15 and 24 has jumped by 5% to 17% in just three years, according to the HSRC/Nelson Mandela household HIV/AIDS survey released this week.

But still the Minister continues to undermine ARV treatment and promote those – such as German vitamin salesman Dr Matthais Rath and Dutch garlic promoter Tine van der Maas – who advocate vitamins and diet rather than medication.

In a clear indication that government’s dilly-dallying about AIDS was no longer going to be tolerated, Cosatu secretary general Zwelinzima Vavi accused Mbeki and Tshabalala-Msimang of “betraying our people and our struggle” for failing to provide leadership on HIV.

"Too many times we hear [the Minister] speaking about spinach,” Vavi told the Treatmnt Action Campaign (TAC) congress in September.

“There is nothing wrong with encouraging our people to eat healthily and to live healthily But there is something very wrong when there is silence about the other government policy such as the need to ensure that people have access to cheap anti-retrovirals.”

Nobody tells people with hypertension, diabetes or other chronic diseases that their medication is “toxic”. The Minister herself encourages tuberculosis patients to swallow their vile tablets.

But for reasons known only to her, she never loses an opportunity to say that antiretroviral drugs are toxic.

Perhaps there will come a time when someone who has lost a family member who was too afraid to take ARVs will sue the Minister for spreading confusion.

After spending two weeks interviewing HIV patients at Durban’s oldest treatment site, McCord Hospital earlier this year, it would not surprise me.

Almost all patients said that they had been terrified to take ARVs initially because they had heard they were “poisonous”. But after a few months on the treatment, they had been amazed at how much better they had felt.

Sizakhele Ndlovu, a counsellor at McCord who educates those about to start ARVs says bluntly: “The Health Minister’s approach to ARVs has impacted so badly on what people think about ARVs. Most patients who come here are desperate for help. But they come with a lot of myths about ARVs.”

But Tshabalala-Msimang has stubbornly refused to change her message.

“I know I get attacked if I say it's nutrition or micronutrients or ARVs because you want me to say ‘and, and, and’ but I think we need to give South Africans options,” she told the National AIDS Conference in June.

But by elevating complementary treatments such as diet and vitamins to the same level as scientifically proven medicine, the Minister is essentially distorting information and undermining the ARV option.

A report released by the International Treatment Preparedness Coalition (ITPC) this week listed “lack of effective national political leadership, coupled with denialism and a flirtation with pseudo-science,” as some of the major barriers to effective AIDS management.

The report urged international organisations and agencies to “consider the minister’s inaction to be not only scandalous, but deadly - and to directly confront her and the government as part of an effort to cease discouraging patients from taking antiretroviral therapy”.

South Africa's proposals to all three of the most recent Global Fund rounds have been rejected, primarily due to the “substandard performance of SA National AIDS Council and the health minister’s lack of leadership”, costing the country up to R2-billion in lost funding, said the report.

South Africa has abundant expertise in HIV/AIDS. Some of our scientists are involved in world-class research into the disease.

Some researchers have developed a candidate vaccine for HIV which will begin phase II (large safety) trials next year. Others are helping to develop microbicides – vaginal gels that it is hoped will form a barrier that prevents HIV from entering women.

Doctors and nurses are fast becoming world experts in ARV treatment as South Africa rolls out what is potentially the world’s biggest treatment programme.

But instead of drawing on these experts and helping to promote scientific knowledge about HIV/AIDS, Tshabalala-Msimang has painted herself into a corner.

Her support for Rath has caused the Treatment Action Campaign and SA Medical Association to resort to the courts in a bid to force her to stop Rath’s “illegal activities”.

As belligerent as a cornered animal, Tshabalala-Msimang has become more strident and provocative in her support for Rath, rather than trying to bring all stakeholders together and avoid yet another money-wasting court case.

Cosatu, the SA Council of Churches and the SA Communist Party have since joined TAC to stop the Rath Foundation.

It seems politically suicidal for her to continue to support the man who, aside from having incurred the wrath of the ANC’s alliance partners also contested the German election against the ANC’s traditional allies in the country.

But last week, Tshabalala-Msimang told Parliament that the health department’s law enforcement agency had found nothing wrong with what the Rath Foundation had been doing.

Perhaps she is blinded by her hatred of the TAC, which the Rath Foundation has been very quick to try to undermine.

Perhaps it is because one of the Minister’s close allies, Professor Sam Mhlongo, is working with the Rath Foundation.

Whatever the case, her alliance with the Rath Foundation has turned into a time-consuming waste that is distracting South Africa from ensuring that people with HIV get the care, support and treatment they need.

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