Official's Firing Revives S. African Battles Over AIDS

By Craig Timberg
Washington Post Foreign Service
Friday, August 17, 2007

JOHANNESBURG, Aug. 16 -- South African President Thabo Mbeki's firing of a top health official with strong ties to AIDS activists has undermined a fragile, year-old truce over how to combat the epidemic, an issue crucial to the future of Africa's most prosperous nation.

Mbeki has said he fired Deputy Health Minister Nozizwe Madlala-Routledge on Aug. 8 for attending an AIDS conference in Spain against his wishes. But activists say Madlala-Routledge initially fell out of favor because of her outspoken advocacy for more ambitious action against the HIV virus, which has infected an estimated 5.5 million people here, more than in any other nation.

The episode has reignited old battles over Mbeki's controversial views about AIDS and the fitness of Health Minister Manto Tshabalala-Msimang -- long vilified as "Dr. No" because of her reluctance to embrace lifesaving antiretroviral drugs -- to lead the nation's battle against the epidemic.

Above all, activists and experts say, the incident and the uproar it caused, including renewed calls for Mbeki to fire Tshabalala-Msimang, has been a huge distraction after a year of steady progress toward a unified national approach to AIDS.

"It's quite clear that internal politicking takes precedence over the nation's health," said Francois Venter, president of the Southern African HIV Clinicians Society. "The one person who actually gave people hope and led from the front is now gone."

Madlala-Routledge was not in charge of AIDS policy within the health department but was vocal about the urgency of the epidemic, publicly taking an HIV test even though Mbeki has declined to. She often sounded like an AIDS activist herself despite serving in a government that has frequently engaged in legal and political battles with the nation's most prominent activist group, the Treatment Action Campaign.

Her firing outraged activists who were just beginning to trust Mbeki's government. Early in his administration, he was widely denounced for appearing to question the scientific consensus that the HIV virus causes AIDS and that the disease's symptoms can be safely treated with antiretroviral drugs. That controversy had died down, but "now he's right back in it," said Karima Brown, political editor of the Business Day newspaper. "All the goodwill is gone."

Even before recent incidents, Madlala-Routledge was an unusual figure in a government where, analysts say, loyalty to Mbeki's policies is paramount and many insiders keep a low profile. Her first senior job was as deputy defense minister, though she was a Quaker and an avowed pacifist. As deputy health minister, Madlala-Routledge repeatedly clashed with Tshabalala-Msimang.

In a publicly released dismissal letter, Mbeki questioned her ability to work with others and chastised her for attending the conference in Spain without his permission. She has said that Mbeki scolded her for an unannounced visit in July to the troubled maternity ward at a government hospital -- whose conditions she said amounted to "a national emergency."

The firing of Madlala-Routledge has marked a dramatic return to prominence for Tshabalala-Msimang.

Top government officials, weary of repeated controversies surrounding her, effectively removed Tshabalala-Msimang from overseeing AIDS policy last year. Deputy President Phumzile Mlambo-Ngcuka took control of the issue, and Madlala-Routledge gained a more prominent role as well.

A series of personal health problems further sidelined Tshabalala-Msimang, raising hopes among activists that her influence over AIDS policy was coming to an end. But after a liver transplant, Tshabalala-Msimang has gradually regained authority in recent months. Activists suspect that she engineered the firing of Madlala-Routledge.

Calls for the removal of Tshabalala-Msimang, once common but rarely heard for nearly a year, have returned. They have grown louder since South Africa's Sunday Times newspaper reported last weekend on allegations of heavy alcohol use by Tshabalala-Msimang, including alleged smuggling of whisky and red wine into her hospital room during a 2005 stay for shoulder surgery.

Activists and government officials have made back-channel efforts to keep these controversies from undermining the nation's newly adopted national AIDS policy, which includes ambitious targets for treating the disease and preventing new HIV infections, said Mark Heywood, a founding official for the Treatment Action Campaign and a member of the South African National AIDS Commission.

"TAC is not going to say, 'Okay, all the bridges are burned. Let's go back to war,' " Heywood said. "And I don't think the government is either."

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