Health minister missed AIDS Day, but wasn't missed

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JOHANNESBURG -- World AIDS Day has come and gone, but there is still no sign of South Africa's health minister, Dr. Manto Tshabalala-Msimang, who has questioned the link between HIV and AIDS, and suggested that a potion of garlic, beet root and potato can keep the disease at bay.

In August, the contrarian minister, lampooned at home as "Dr. Beet Root," was verbally abused at an AIDS conference in Toronto when she set out the South African booth with vegetables and gave no space to life-saving anti-retroviral drugs, or ARVs.

However, when she entered a hospital to be treated for a lung infection last month, her deputy, Nozizwe Madlala-Routledge -- who previously had been forbidden from making statements on AIDS -- signaled a change in policy, pressing the need for ARVs and describing the Canadian protest as "embarrassing."

Dr. Tshabalala-Msimang is now back at the ministry, but the nation appears to have moved on without her. Last Friday saw huge rallies around South Africa to mark World AIDS Day, but in a change from previous years, government officials participated alongside representatives of the Red Cross and the U.N. program on AIDS, both of which have criticized the slow rate at which ARVs have been made available in South Africa.

Dr. Tshabalala-Msimang's office issued a statement saying the minister played no role in the events because she was still recuperating from her illness. Deputy President Phumzile Mlambo-Ngcuka, who filled in as keynote speaker, announced in the eastern city of Nelspruit that the government planned to cut the rate of new infections in half and that ARVs would be made available to all who need them.

The shift appears to have come from the highest level of government. Sources close to the Cabinet say that after the Toronto conference, President Thabo Mbeki and other ministers were concerned that the matter had gotten "out of hand."

Senior members of the ruling African National Congress have been speaking openly about the damage done to South Africa's image abroad by Dr. Tshabalala-Msimang's backing for alternative medicine.

Global health organizations, including the Red Cross and human rights groups, have argued that, in a country where adult mortality has increased more than 80 percent in the past decade and nearly two-thirds of state-hospital deaths are HIV related, it is irresponsible to promote untested treatments.

Five years of bungled health policies have turned the epidemic into a crisis:

• 5.4 million South Africans are HIV positive.

• 950 die from the illness every day.

• One-third of women giving birth in state hospitals test positive for HIV.

• 42 percent of deaths of children under 5 are AIDS-related.

The official number of orphaned children in South Africa is approaching 2.5 million, but efforts to reduce the rate of new infections, now standing at 1,400 per day, have made little progress.

One-fifth of girls have given birth at least once by age 18, and recent research funded by Baltimore's Johns Hopkins University shows a growing trend towards teenage sex.

Washington's ambassador to South Africa, Eric Bost, opened a U.S.-funded care and treatment facility in central Johannesburg last week where patients who cannot obtain or afford ARVs will be given the drugs at less than half the normal cost. The ambassador also volunteered to have the clinic's first HIV test and encouraged all South Africans to follow his example.

But while the supply of ARVs has been stepped up, there are complaints that at government outlets, they are only prescribed when the illness has reached a critical stage. Out of the 5.4 million recognized cases of HIV/AIDS, about 730,000 people are rated as seriously ill, yet only 230,000 are receiving ARVs.