Contribution to Open Democracy Blog by Dean Peacock, Sonke Gender Justice, South Africa

Late last year the AIDS activist community breathed a collective sigh of relief when Manto Tshabalala-Msimang was shifted from her position as Minister of Health into the far lower-profile Minister in the Presidency.

During her long tenure she obfuscated about whether HIV caused AIDS, insisted that anti-retroviral treatment was toxic and that AIDS treatment advocacy organisations were dupes of international pharmaceutical associations. She made repeated pronouncements that garlic, beetroot and olive oil were the best way to strengthen the immune system despite abundant evidence that anti-retroviral treatment is safe and effective and that alternative remedies are not sufficient to halt the spread of the virus. To add insult to injury, she collaborated frequently with peddlers of unproven and often expensive “alternative remedies” and granted them national prominence and legitimacy. The Journal of AIDS recently argued that her department’s failures to implement effective treatment strategies cost 330,000 people their lives.

At the end of eight years Tshabalala Msimang had become reviled internationally and her obstructionist positions and bizarre rants a source of enduring embarrassment for many within the ruling party, her long tenure emblematic of then President Mbeki’s willingness to reward loyalty over delivery.  Late last year, when President Mbeki was outmanoeuvred in intra-party power struggles and forced to resign, Tshabalala Msimang was put out to pasture in the Office of the President. Despite the fact that she would now oversee the Office on the Status of Women, civil society, including the “gender sector” kept quiet, grateful.

This year, the 53rd session of the annual United Nations Commission on the Status of Women focused on “the equal sharing of responsibilities between women and men, including caregiving in the context of HIV and AIDS”.

Tshabalala-Msimang’s statements as the head of the South African Delegation to the CSW have brought into stark relief just how shortsighted we were in quietly accepting her appointment as the Minister in charge of the Office on the Status of Women.

The South African delegation arrived in New York with its work cut out for it. The 2007-2011 National Strategic Plan on HIV and AIDS (which civil society and allies within the Department of Health were able to push through while the Minister was in hospital receiving a liver transplant), sets clear and ambitious prevention and treatment goals aimed at reducing the care burden. The NSP commits government to 1) “reducing the number of new HIV infections by 50% and 2) reducing “HIV and AIDS morbidity and mortality as well as its socioeconomic impacts by providing appropriate packages of treatment, care and support to 80% of HIV positive people and their families by 2011”. The NSP also resolves to “recruit and train new community care givers, with emphasis on men”, and sets a numeric target of increasing men’s involvement by 20% by 2011.

Despite the ambitious targets set in the NSP, both the treatment backlog and the burden of AIDS care continue to grow. According to a report released in October of 2008 by the South African National AIDS Council “there has been an 87% rise in the number of deaths reported between 1997 and 2005 and deaths among those aged 25-49 has risen by 169%, surging from contributing 30% of all deaths in 1997 to 42% by 2005.  This can only be explained by the HIV epidemic.” The document also reports that only 28 percent of people who need access to treatment currently have it and this, the report points out, is “below the global average for low- and middle-income countries”. The report also argues that “from a national perspective, South Africa has largely failed in the prevention of mother to child transmission (PMTCT) of HIV due to the very uneven access women enjoy to both HIV testing and to the PMTCT services that should follow.” At the end of February 2009, the province of the Free State had stopped enrolling new patients on treatment due to a stock-out of ARVs with predictable consequences on those providing AIDS related care and support.

Instead of using the CSW as an opportunity to find solutions to these problems, Minister Tshabalala-Msimang has instead used every opportunity she has had to resurrect her now thoroughly discredited positions on treatment toxicity, “pharmacovigilance” and “alternative remedies”.

In response to this, Sonke has issued a press release calling on the South African government to clarify its position on treatment roll-out and explain why a senior representative of the government continues to distract from the real issues at hand. In the press statement we have also urged government to negotiate for CSW conclusions and recommendations that make clear its commitment to the goals articulated in the NSP and that focus on three priority areas: 1) strengthening the capacity of the health sector; 2) implementing effective HIV prevention and treatment strategies and 3) implementing the various strategies South Africa has committed to increase the involvement of men and boys in achieving gender equality, including full participation in AIDS related home and community based care.