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For People With AIDS, a Government With Two Faces

August 30, 2006
The New York Times

At the AIDS conference in Toronto this month, South Africa's booth included lemons, garlic and beets as part of its recommended treatment for H.I.V. South Africa's health minister has long touted salad, vitamins and assorted quack cures over antiretroviral drugs, which she has called toxic.

Such embarrassments are normal for the government of President Thabo Mbeki, who said not too long ago that he knew no one with AIDS. This in a country with the world's biggest AIDS epidemic. At the Toronto conference, Stephen Lewis, the United Nations special envoy for AIDS in Africa, broke all diplomatic conventions, saying South Africa's views were more worthy of a lunatic fringe than of a compassionate state.

And yet, more than a quarter million South Africans - more people than in any other nation - are now taking antiretroviral drugs. Most of them get the medicines free through the government health system. The AIDS budget has soared over the last two and half years. Among people being treated, deaths and hospitalizations have dropped tremendously. Can this lunatic government be compassionate as well?

South Africa is doing AIDS treatment on a mass scale even though the health system is close to nonexistent in some areas, clinics often have few nurses and no doctors, and rich countries are luring English-speaking health workers away.

But top officials can take little credit. They delayed the antiretroviral rollout, threw up obstacle after obstacle and have left large pots of money unspent. The program's progress so far is really a lesson in the power of balanced government and citizens' groups.

The courts have forced the government into action. This week an appeals court ordered officials to begin antiretroviral treatment for prisoners with AIDS and held the government in contempt for ignoring a June ruling to start doing so. Some regional governments, especially in the provinces containing Johannesburg, Cape Town and Durban, have leapt at the chance to provide antiretrovirals, and that is mainly where people are being saved.

The most important factor, however, is the Treatment Action Campaign, probably the world's most effective AIDS group. It was founded by Zackie Achmat, who chose not to take the antiretrovirals he needed until the government had agreed to make them available to all.

The group, financed largely by international and local foundations and European governments, became famous for distributing its "H.I.V. Positive" T-shirts - Nelson Mandela wore one - and organizing mass protests like its 2003 civil disobedience campaign, which pushed the government into the antiretroviral rollout.

Mr. Mbeki and his health minister, Manto Tshabalala-Msimang, have now largely gone silent about AIDS - undoubtedly an improvement. It would be a further improvement if Mr. Mbeki fired her, as many in South Africa have long demanded. The government should also be pushing the provinces that lag behind and encouraging South Africans to get tested and take their drugs.

What the government says and doesn't say still matters, unfortunately. I met some South Africans who can get antiretrovirals free at their local clinic but still prefer herbal medicines. They could live, thanks to the government's highly reluctant actions. Instead, they will die because of its words.