By JONATHAN MUNDELL

September saw what has been described as the biggest political crisis in South Africa since Apartheid. On 21 September 2008, Thabo Mbeki resigned as President of South Africa, after the ruling African National Congress (ANC) publicly withdrew its backing of the President a day before. This move followed a ruling earlier in the month by Judge Chris Nicholson, which declared the corruption and racketeering charges against ANC president Jacob Zuma invalid, on the basis of political interference. It was then announced soon after Mbeki’s resignation that former trade unionist and Zuma ally, Kgalema Motlanthe, would be taking over Mbeki’s position, at a time that South Africans fear possible political and economic breakdown. According to the ANC National Executive Committee (NEC), Motlanthe will act as caretaker president until the upcoming elections in 2009, where it is expected that Zuma will then take over. This, however, is dependent on whether the case against Zuma remains dormant.

These recent events have been viewed by many with a great deal of pessimism and scepticism, particularly following the resignation of a widely respected president, the subsequent resignation of almost a third of the Cabinet, and obvious divisions within the country and the ANC itself. The past few weeks have, however, been perceived from a quite different perspective by those living and working in the HIV & AIDS sphere. These South Africans, and in fact the international HIV & AIDS community, have welcomed the recent reshuffle in cabinet with enthusiastic optimism. This month’s newsletter briefly explores the recent political shifts in South Africa from an HIV & AIDS perspective.

MBEKI’S TAINTED PRESIDENCY TERMINATED

For many years, AIDS activists, civil society and many others have argued that good leadership and commitment by government are critical to the success of national attempts to address HIV & AIDS. A perfect example of this can be seen in a country such as Uganda, where HIV prevalence has declined dramatically since leaders put HIV & AIDS at the top of their priority list. This is something that Thabo Mbeki definitely did not accomplish during his time as president of South Africa, and something that he was widely criticised for. In sharp contrast, in fact, Mbeki’s ‘AIDS denialism’ greatly hampered the country’s attempts to stem an epidemic that had become quite clearly out of control.

While Mbeki deservedly received a great deal of respect and support during his time in office for various contributions to the country, the continent and the global community, his reign was severely tainted by his views relating to HIV & AIDS. These included doubts as to the cause of AIDS, refusal to accept the scale of the epidemic in the country, and resistance to introducing antiretroviral (ARV) drug treatments. According to Zackie Achmat, head of the Treatment Action Campaign (TAC), Mbeki’s removal from office “is long overdue”. Achmat stated that he “would have liked to see [Mbeki] impeached for causing the deaths of many hundreds of thousands of people living with HIV ".

Taking Mbeki’s place as President of South Africa is ANC Deputy President Kgalema Motlanthe. Motlanthe has been described as “a quiet, firm and principled leader” and “one who seeks to unite rather than divide” by former president Nelson Mandela. Helen Zille, leader of the opposition Democratic Alliance (DA), stated soon after Motlanthe’s arrival in office, that “he is perhaps the most level-headed and reasonable of all the politicians in the Zuma camp", and that he would offer hope to the country. Motlanthe won the hearts of all South Africans involved in the HIV & AIDS fight, when he very promptly removed widely criticised health minister Manto Tshabalala-Msimang, signalling his intent to more adequately address the issue of HIV & AIDS in the country.

AN END TO POLITICALLY SUPPORTED AIDS DENIALISM

Thabo Mbeki was not only criticised for his personal views on HIV & AIDS during his time in office, but also for his consistent willingness to support a rather questionable, and many would say incompetent Health Minister, Dr. Manto Tshabalala-Msimang. Tshabalala-Msimang became known internationally as Dr Beetroot, related to her advocacy of vegetables, lemon skin and garlic to fight the disease, in place of ARV treatment, which she described as poisons to the people of South Africa. In 2005, while promoting the use of raw garlic and lemon skin in place of conventional HIV treatment, Tshabalala-Msimang stated: “All I am bombarded about is antiretrovirals, antiretrovirals…There are other things we can be assisted in doing to respond to HIV & AIDS in this country".

The TAC has been one of Tshabalala-Msimang’s biggest critics, and has fought her in numerous legal battles. A recent statement released by the TAC states that "Mbeki and his health minister pursued a policy of politically supported AIDS denialism and undermined the scientific governance of medicine". It was not surprising then that shortly following the decision by the new South African President, Kgalema Motlanthe, to remove the health minister from her position, the TAC celebrated with an impromptu party in Cape Town, stating that, "The period of politically supported AIDS denialism has ended". The TAC certainly was not on its own in celebrating the removal of the health minister. Among many others were the DA who stated this month, "Tens of thousands of South Africans have lost their lives because of her ridiculous policies on HIV & AIDS, and she should have been fired nine years ago".

If history is anything to go by, the South African health sector is in for some substantial improvements. The last time Tshabalala-Msimang was absent from her position as Health Minister, back in 2006 when she was hospitalised with lung problems and a liver transplant, a tremendous amount of progress was made, as her respected Deputy Health Minister, Nozizwe Madlala-Routledge took over her responsibilities. During this period, Madlala-Routledge restored confidence in AIDS activists, and assisted tremendously in the drafting of the current National HIV & AIDS Strategic Plan (NSP). Sadly, however, Madlala-Routledge was ‘conveniently’ sacked by Mbeki shortly after Tshabalala-Msimang’s return to office. In a turn of events though, and amid rapturous applause, President Motlanthe named Nozizwe Madlala-Routledge Deputy Parliamentary Speaker soon after being sworn in as the new head of state.

Tshabalala-Msimang has not been removed completely from government, and will now be responsible for government communications as the Minister of the Presidency. While she will be a close advisor to the president, she will not hold any specific responsibilities, adding further to reasons for celebration for her many critics. Tshabalala-Msimang rejected criticism on her move, however, stating: "The only critics were the media, and the media had lost perception…I am very excited about the new challenge". Tshabalala-Msimang loses her position to former finance committee chair, and political prisoner, Barbara Hogan.

A NEW CHAPTER FOR THE SOUTH AFRICAN HEALTH SECTOR

South Africa can now look forward to what is expected to be a hugely competent new Health Minister. Barbara Hogan, who has been one of few outspoken members of the ANC on HIV & AIDS issues and has been openly critical of the HIV & AIDS policies and governance provided by Mbeki and Tshabalala-Msimang, and the related ‘AIDS denialism’. While Hogan does not come from a health background, she has definitely played her part in the country’s fight against HIV & AIDS. Hogan is an anti-apartheid veteran, and was imprisoned and tortured for treason by the Apartheid government. Following her release, almost 10 years later, she again became intensively involved with the ANC, and worked with Mbeki as his Finance Portfolio Chairperson, before being dismissed, reportedly for her stance on HIV & AIDS. She continued her work in the fight against HIV & AIDS, however, and will now have the opportunity to make a significant difference in the lives of all HIV-infected South Africans.

It is clear that President Motlanthe, and his new Health Minister, intend to approach health care, and specifically HIV & AIDS care and treatment, from a far more scientific angle than in the past. In a recent interview, Hogan endorsed the rollout of ARVs, stating that the biggest challenge for the Department of Health “is HIV & AIDS and all the strains that it places on the health system. I would thoroughly endorse the roll-out of antiretrovirals and any way we can accelerate that, the better”. The TAC has sung the praises of Hogan, who has welcomed the opportunity to work in partnership with them. “I've always had a good relationship with the TAC and NGOs involved in that sector and I think you need to mobilise every possible sector of society at the moment, from the private sector to the NGO sector to the government sector, to improve our health services”, she said.

Hogan will be assisted in a long list of tasks as Health Minister by her newly elected deputy, Dr Molefi Sefularo. Sefularo was previously the MEC of the Northwest Province, where he was critical in the rollout of prevention of mother-to-child transmission (PMTCT) services, and ARV treatment. He also played a significant role in the development of the NSP, which was released last year. Hogan is confident that she will be able to meet the mandate given to her by the ANC of significantly improving health delivery, and will certainly go a long way in assisting in eliminating the AIDS denialism that has haunted the country for so long.

THE NEW HANDS OF GOVERNMENT

The coming months will prove to be very interesting, both in terms of the changing political situation, and also the expected shifts in the health sector. It should be noted that although the movements within the South African Government has left the Health Department in far more competent hands, the country has also lost many important players, most significant to the HIV & AIDS fight being pushed by Phumzile Mlambo-Ngcuka, who resigned as Deputy President. According to Helen Zille, “unlike other members of the Cabinet, Phumzile Mlambo-Ngcuka gave vital leadership in the fight against HIV & AIDS”, and assisted in the revival of the South African National AIDS Council. Despite her departure, however, the country’s health sector is in far safer hands than before. Zuma himself, who may very well take over the presidency from Motlanthe next year, has expressed his intentions to step up the fight against HIV & AIDS. Only time will tell whether the new hands of Government will be the hands of significantly positive change in the realm of HIV & AIDS.

Notes