In South Africa, a Dramatic Shift on AIDS

After years of international criticism over its handling of the AIDS epidemic, the South African government is taking steps to turn its HIV/AIDS program around by expanding prevention, treatment and testing, observers say. Driving the change is the government's growing realization of the severity of the problem, an estimated 5.4 million of its 47 million citizens have HIV, and concern that the controversy surrounding its efforts is harming South Africa's international image. Among recent developments:

• The appointment of Deputy President Phumzile Mlambo-Ngcuka to lead an urgent review of South Africa's AIDS response. In public comments and private meetings over the past six weeks, she has emphasized that the government now believes unequivocally that HIV causes AIDS, a connection President Thabo Mbeki once publicly questioned. She has also acknowledged "shortcomings" in the government's response to HIV/AIDS thus far.
• After years of hostility and legal clashes, AIDS groups like Treatment Action Campaign say government officials are reaching out to them to meet activists' long-standing demands, such as setting targets for expanding the country's free antiretroviral (ARV) program to reach 1 million South Africans. "There's clearly a shift taking place," said TAC leader Zackie Achmat.
• Government officials privately acknowledge that Health Minister Manto Tshabalala-Msimang, who has long supported a diet of lemons, beets, and garlic while downplaying the effectiveness of ARVs in HIV treatment, has become an embarrassment. Activists say they are confident she has been effectively marginalized by Mlambo-Ngcuka's appointment. "The beetroot and all that lemon stuff is out the window," said an adviser who spoke on the condition of anonymity. "These guys are now serious about getting it right."

"[The government] has lost at least five years," said Mark Heywood, director of the AIDS Law Project at Witwaterstrand University in Johannesburg. "They're behind on prevention. They're behind on treatment. They're behind on planning for the social impact of HIV. But it's not too late to prevent a whole other generation of people from getting HIV."

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