South Africa intensifies war on AIDS

'Dr. Garlic'
But doctors often have to battle bureaucracy. A clinic in rural KwaZulu-Natal suspended two doctors for giving women dual therapy ahead of its local authorization and other "misdemeanors." The health chief in the province, which is also suffering sky-high rates of TB which feeds off AIDS, makes no secret of her dislike of conventional treatment.

Much of the blame for South Africa's AIDS disaster is laid at the door of its health minister, Tshabalala-Msimang, and President Thabo Mbeki, who gained notoriety after he came to office in 1999 by questioning the link between HIV and AIDS.

Mbeki for years supported Tshabalala-Msimang, dubbed "Dr. Garlic" for her mistrust of AIDS drugs and her espousal of garlic, olive oil and lemon. Instead, he axed her respected deputy, Nozizwe Madlala-Routledge, whom he accused of being insubordinate, but who was a driving force behind the new AIDS strategy launched last year.

Mbeki has said nothing to indicate he has reversed his position on the causes of AIDS, and Tshabalala-Msimang continues to advocate nutritional remedies, although she now extols the virtues of the new national campaign.

"The sustained and expanded national response to HIV and AIDS is beginning to pay some dividends," she wrote in the foreword of a report to the U.N. General Assembly.

Events may simply be overtaking the controversies. Mbeki has only one more year in office. His deputy heads the revamped South African National AIDS Council and has mended fences with activists, and the Treasury has announced a massive increase in spending on HIV.

Jacob Zuma, who is first in line to succeed Mbeki as president, says taming the epidemic is a top priority.

But there is a snag. Zuma was in 2006 acquitted of rape in a trial in which he confessed to having knowingly had unprotected sex with the woman, who had the AIDS virus. His defense: He showered afterward, believing it reduced the risk of infection. He has since apologized and AIDS activists hope he will try to silence his critics by getting tough on AIDS.

'Prevention is just a disaster zone'
Prevention is the weakest link in South Africa's shaky chain.

The Human Sciences Research Council estimated that there were 1,500 new infections per day in 2005.

"For every two people put on treatment, five get infected. It's just unbelievable. You are chasing the tail the whole time," exclaims Venter, the doctor. "Prevention is just a disaster zone."

South Africa is not alone. Major initiatives like the WHO's "3 by 5" campaign, which aimed to put 3 million people worldwide on AIDS drugs by 2005, and much of the Bush administration's AIDS funding, are criticized by experts for focusing on treatment rather than building up the health system, condom distribution or HIV testing.

Male circumcision is the only new tool in the prevention armory. But unlike other African health ministers, Tshabalala-Msimang is skeptical. She says there is not enough information available about its effect on AIDS infection — this despite its endorsement by WHO and UNAIDS, based on "extensive and convincing" evidence that the procedure cuts the risk for infection for men by about 60 percent.

The government says education campaigns among the young are beginning to pay off. The prevalence rate among girls aged 15 to 19 fell to 13.5 percent in 2006, down from 16 percent two years previously.

Witch accusations
South Africa still lacks extensive public anti-AIDS publicity, too many of its men still shun condoms, and the biggest obstacle remains the stigma associated with the virus. But Bonani believes that, too, is beginning to change, at least in his community.

When Bonani first took in AIDS orphans, his church congregation vanished. One of his workers was accused of being a witch. But now AIDS is discussed openly in the community, he said, and his congregation is back up to 70, of whom 17 have revealed they have the virus.

"It took them three years to come back and to rebuild the trust," Bonani says, smiling. "Now they apologize, and they accept us."

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