Activists and health workers in South Africa celebrated outside the Cape Town parliament building last night after the news that Dr Manto Tshabalala-Msimang has been replaced as South Africa’s Minister of Health by Barbara Hogan, one of the few African National Congress (ANC) Members of Parliament who spoke out openly against AIDS denialism in former president Thabo Mbeki’s government.
Barbara Hogan supported the Treatment Action Campaign’s (TAC) early efforts to get the government to provide antiretroviral therapy (ART) in the public health system.
In addition, Dr Molefi Sefularo was appointed as the Deputy Minister of Health. As MEC of the Northwest Province, Dr Sefularo supported the roll-out of PMTCT and ART and helped write the National HIV and AIDS and STI Strategic Plan for South Africa, 2007-2011.
“We believe that the period of politically supported AIDS denialism has ended with the appointment of the Minister of Health,” a TAC press release declared.
The change of government in South Africa
The cabinet changes were announced yesterday, after the newly appointed South African President Kgalema Motlanthe was sworn in to replace Thabo Mbeki, who was recalled by the ANC last weekend after a prolonged power struggle with ANC party President, and former Deputy President Jacob Zuma.
President Motlanthe, is a well-respected veteran of the anti-apartheid struggle who until recently has kept out of the spot light. Seen as belonging to neither camp within the divided ANC, he was selected as a consensus candidate to lead the country, at least until elections next year, when Zuma is expected to run for President.
Already being seen as a bridge builder, President Motlanthe appointed a mix of Zuma and Mbeki supporters into government, as well as other respected politicians who have remained above the fray. Dr Tshabalala-Msimang, a staunch Mbeki ally, will actually remain in government, occupying President Motlanthe’s former position as Minister in the Presidency. Though this is something of a promotion, it may not be a long-lasting one.
What is important is that Dr Tshabalala-Msimang has effectively been transitioned out of the Health Department.
The inglorious career of Dr Tshabalala-Msimang
During Dr Tshabalala-Msimang’s tenure as Minister of Health over two million South Africans died of HIV.
Sometimes called Dr Beetroot, for promoting a diet of beets, African potatoes, garlic and lemon as a remedy for people with HIV, she initially resisted the roll-out of treatment to prevent mother-to-child transmission (PMTCT) and of ART in the country. Instead, she supported the right of AIDS denialists such as Dr Matthias Rath’s to sell high-dose vitamin ‘cures’ without scientific evidence of benefit.
Even after the government moved to begin introducing appropriate HIV care through the public sector (partly as the result of legal action by the AIDS Law Project and TAC), she has been accused of trying to stall it.
South Africa’s current HIV programme got underway in earnest while she was on a leave of absence to have a liver transplant. It was during this period, while the Deputy Minister of Health Nozizwe Madlala-Routledge was in charge of the Department, that the National Strategic Plan was drafted. When the Minister came back to duty, they are reported to have clashed, and Dr Tshabalala-Msimang declined to deliver an invited address at a national AIDS conference because she reportedly felt that the Deputy Minister had a more prominent position in the conference programme. Shortly afterward, Mbeki fired the Deputy Minister. Yesterday, however, in an interesting turn of fortune, Madlala-Routledge was elected the new Deputy Speaker of the National Assembly.
Infighting within the department has been typical of the former administration’s management style and there are many reports that morale in the department of health is extremely low.
Treatment activists have long called for the Minister’s removal. At the first South African TB conference in July this year, activists conducted a silent protest during a plenary talk by Dr Tshabalala-Msimang, holding up signs saying that “South Africa needs real leadership in the fight against TB and HIV.”
The new Minister
Minister Hogan does not come from a health background. She too is a veteran of the anti-apartheid struggle, joining the ANC after the 1976 riots. She was arrested for treason by the apartheid government, tortured and imprisoned for eight years (with one year in solitary confinement).
Since release, she has been deeply involved in the ANC, and served for a time in Mbeki’s government as Finance Portfolio Chairperson, until she was dismissed by Mbeki in part for her stand on HIV/AIDS (according to the TAC press release).
But she has continued to play a role in the fight against HIV, serving on the board of the Amandla AIDS Fund (AAF) established in 2003 with a $2.5 million donation from Carlos and Deborah Santana. AAF provides ART, care, treatment and prevention services to people and children with HIV. Serving with her on the board are Archbishop Desmond Tutu, TAC’s Zachie Achmat and Luyanda Ngonyama, Head of the AIDS Law Project Mark Heywood, Dr Jerry Coovadia, and Dr Fareed Abdullah.
In an interview with News24.com, she said 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.”
Minister Hogan said she welcome’s the opportunity to work with TAC. “I'm not saying we will always agree but 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.”
For their part, TAC is clearly eager to work with Minister Hogan. In fact, about 50 of the activists serenaded her outside her flat in Cape Town’s City Bowl last night.
According to an report in the Star, she came down to greet the activists. Fatima Hassan of the AIDS Law Project hugged her and announced that it was “the happiest day of her life.” (Also see this report).
But TAC acknowledges there will be tremendous challenges ahead.
“Hogan's biggest challenges will be to meet the treatment and prevention targets of the HIV/AIDS National Strategic Plan, integrate TB and HIV treatment, develop a feasible human resources plan for health workers and undo the considerable legacy of AIDS denialism left by her predecessor. The TAC will do all that it can to assist her and the Department of Health to meet these challenges.”