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South Africa: AIDS Action Relapse

AfricaFocus Bulletin
Aug 14, 2007 (070814)
(Reposted from sources cited below)

Editor's Note

"Unlike other African countries, South Africa has the financial resources and the medical talent to successfully take on its H.I.V./AIDS epidemic. What it lacks is a president who cares enough about his people's suffering to provide serious leadership. .. Unless he finally starts listening to sensible advice on AIDS, he will leave a tragic legacy of junk science and unnecessary death." - New York Times, August 14, 2007

This New York Times editorial reflects a loud chorus of condemnation coming from South African AIDS activists and medical professionals, joined by supporters around the world, in response to the dismissal of Deputy Health Minister Nozizwe MadlalaRoutledge. She is widely credited with energizing South Africa's response to AIDS over the last two years. While President Mbeki's government is unlikely to reverse its decision, it faces virtually unanimous condemnation for this signal of reversion to previous erratic policy on the AIDS crisis.

Madlala-Routledge garnered strong expressions of support not only from AIDS activists, but also from medical professionals. Health Minister Manto Tshabala-Msimang, who often clashed with her deputy, has been repeatedly criticized for failure to act on AIDS and for her unscientific views on treatment. Madlala-Routledge, noted for speaking her mind and approaching her work from a human rights perspective, is an active member of the South African Communist Party and of the Religious Society of Friends (Quakers).

This AfricaFocus Bulletin contains a statement by the former deputy minister, an appeal from the Treatment Action Campaign, just prior to the decision, asking President Mbeki not to dismiss the minister, the official dismissal statement, and an additional background article from the UN's Integrated Regional Information Networks.

Another AfricaFocus Bulletin sent out today is on a more positive note, providing a posting from Journalists against AIDS in Nigeria with a newspaper advice columnist's response to a man fearful of revealing his HIV-status to friends and family.

For previous AfricaFocus Bulletins on health issues, visit

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

This is about sick people who need care

Statement by Nozizwe Madlala-Routledge, former deputy health minister of South Africa

The Independent

It is one of the tragedies of our young democracy that a country that emerged from so much pain, and in the throes of establishing itself as a free democratic country, had to be confronted with a health catastrophe on this scale.

But how we respond to the Aids epidemic is not about me or anyone else in government, it's about sick people who need care and who need it yesterday. This is, after all, an emergency which is claiming the lives of a great many people.

In our struggle against apartheid, during my years of activism which included going to jail for my beliefs, I learned that to achieve anything, you need to get everyone talking around the table.

I can't say what reason the President had for dismissing me. But I know that the Health Minister, back in the driving seat, wanted to reassert her ideas. We have made progress recently, and I would be saddened and disappointed if we were now to be taken back to a time when people were confused about Aids treatment.

I am certain now, that if our Health Minister goes back to talking about garlic and beetroot, she will face only ridicule. I am not, I must stress, attacking the traditional African medicines that she is keen to champion. They have a place in health care.

But we are dealing with a modern disease. And as with any modern disease, we have to subject whatever we propose as a cure, to the most rigorous scientific testing.

I don't regret saying that our political leaders should show the way and undergo HIV testing, in public. We need at least 25 million people tested. When you are in charge of the country, you have to offer leadership.

It is also important for us to hear Mr Mbeki's voice, encouraging people, leading, and showing them that HIV/Aids, with treatment can be managed.

Action Options

(1) On-line Petition from Friends of Nozizwe Madlala Routledge

(1) Appeal from Healthgap listserv and AIDS and Rights Alliance for Southern Africa, Cape Town

Fax numbers for the SA President's Office are below. Please pick one number and SEND A FAX TODAY.

The faxes should be addressed to President Mbeki. The text of the fax should be individualized but need not be long. You should say you are writing to protest the dismissal of Deputy-Minister of Health Nozizwe Madlala-Routledge.

Some points to include in your own words:

  • Nozizwe Madlala-Routledge was a driving force in the creation of the new South African national AIDS plan and helped to forge bonds of trust and respect between civil society and the government
  • Given Madlala-Routledge's dismissal, your own support for AIDS denialism and Health Minister Manto Tshabalala-Msimang's promotion of unproven remedies for the treatment of AIDS, the world now questions the South African government's commitment to a vigorous, evidence based approached to HIV/AIDS.
  • South Africa needs real leadership on AIDS from the Presidency down to the local level and you must lead by example. You must come out personally in word and deed and show the world that South Africa has moved on from denialism and delays.
  • Literally millions of lives are at stake.

Fax numbers to use (select one):

+27 21 461 2838
+27 12 323 8246
+27 12 323 3231
+27 12 323 6080
+27 12 464 2171

As background here are some statements from South African advocacy organizations:

TAC (Treatment Action Campaign)

President Mbeki dismissed Deputy-Minister of Health Nozizwe Madlala-Routledge on 8 August 2007. This is a dreadful error of judgment that will harm public health-care and especially the response to the HIV epidemic. It indicates that the President still remains opposed to the science of HIV and to appropriately responding to the epidemic. We call on him to reverse his decision.

ARASA (AIDS and Rights Alliance for Southern Africa)

"The dismissal is clearly a political reprisal for the Deputy Minister's outspokenness and truthfulness on South Africa's AIDS epidemic and other health issues, including infant mortality," said Michaela Clayton, ARASA's Director.

While ARASA understands President Mbeki has the right to appoint and dismiss his ministers, the signal he has sent to his own people and to people around the region is that AIDS denialism is alive and well in his administration.

Madlala-Routledge's work had stood in profound contrast to that of South African Health Minister Manto Tshabalala-Msimang, who since her return from medical leave, has continued to promote untested and unproven remedies for HIV/AIDS and has fought court orders to provide essential medical services to people living with HIV/AIDS.

Treatment Action Campaign

President Mbeki: Do not dismiss Deputy-Minister Nozizwe Madlala-Routledge. Can our people trust you on HIV/AIDS?

NB: At about the same time this statement was released (a few minutes before the 9th of August), the presidency released a statement announcing that Nozizwe Madlala-Routledge had been dismissed.

9 August 2007

Deputy-Minister of Health Nozizwe Madlala-Routledge has demonstrated unparalleled political leadership and competence in the struggle for better health-care in South Africa. As Deputy-Minister of Defence, she introduced antiretroviral treatment into the military. She has consistently supported the scientific governance of health policy and denounced AIDS denialism. She has helped improve the image of the South African government both at home and internationally because she has counter-balanced the President's support of denialism.

She, together with Deputy-President Phumzile Mlambo-Ngcuka, led the development of the HIV/AIDS National Strategic Plan. She has unequivocally called for people to get tested and, if necessary, treated with antiretroviral treatment. She has also helped mend the relationship between civil society organisations like TAC and the AIDS Law Project with government. She has begun rebuilding relationships between the Department of Health and the country's HIV clinicians and scientists. On TB, HIV treatment and prevention, the human resources crisis in the health system and women's health, the Deputy-Minister has led and been a voice of common sense. In a ministry that has become synonymous with pseudo-science, incompetence, embarrassment and the cause of suffering, anguish and anger, she has offered honesty, integrity, leadership and hope.

For her excellent leadership, the Mail & Guardian rightly gave the Deputy-Minister the highest score on its annual ministers' report card of 2006.

President Mbeki's response has been to ask Deputy-Minister Madlala-Routledge to resign. This is a dreadful error of judgment that will harm public health-care and especially the response to the HIV epidemic. It indicates that the President still remains opposed to the science of HIV and to appropriately responding to the epidemic. We call on him to reverse his request and instead to give his full support to the Deputy-Minister. The TAC supports the Deputy-Minister's decision to refuse to resign. We urge President Mbeki to meet with all the independent civil society organizations that work in HIV/AIDS, health and human rights to discuss the following issues:

  1. Does the President support the work done by the Deputy-President, Cabinet, SANAC and the country on HIV/AIDS?
  2. Why does the President obfuscate the real crisis in public health management?
  3. Is the President above all our people, the Constitution and only accountable to Health Minister Manto Tshabalala-Msimang?

President Mbeki gave Deputy-Minister Madlala-Routledge two reasons for his unreasonable and arbitrary demand: (1) Madlala-Routledge's handling of the Frere Hospital scandal and (2) her recent trip to Spain. Both reasons are unfathomable. She visited Frere Hospital after the Daily Dispatch exposed the hospital's dreadful conditions. Instead of reacting defensively, she acknowledged the crisis and spoke of the national emergency of our high child mortality rates. This is how accountable political leaders should act when the media or civil society exposes governance problems. President Mbeki, on the other hand, as well as the Minister of Health, have acted defensively and attacked the integrity of the Daily Dispatch.

(See these webpages for more on the Frere Hospital incident: )

The Spanish trip

On Tuesday 7 August, several newspapers reported that the Deputy-Minister flew to Spain at the state's expense of R160,000 on business class accompanied by her advisor and her son. The trip was apparently taken without the President's permission. The TAC has investigated the facts of this incident and determined the following:

  • The Deputy-Minister travelled to Spain to participate in a meeting of the International AIDS Vaccine Initiative (IAVI). The trip therefore involved her carrying out valid business duties.
  • Government policy allows ministers and deputy-ministers to be accompanied by one member of family when travelling internationally. This is common practice and allowed by government policy. There was therefore nothing improper about the Deputy-Minister's son accompanying her. It is telling that this fact went unmentioned in, for example, the Business Day article that reported this incident.
  • It is standard for ministers and their accompanying entourage to fly business class. We have learnt that only two of the three tickets were in business class.
  • The Deputy-Minister applied for permission from the President to travel to Spain, as is required by protocol. This should have been a formality. Apparently there was some administrative confusion and the Deputy-Minister believed that permission had been or would be granted when she embarked on the trip. There was no good reason for the President to refuse permission, as the Deputy-Minister was carrying out her duties. Yet the President did refuse permission. The Deputy-Minister, immediately upon learning this, returned to South Africa, without attending the IAVI meeting. She has also apologised for the breach of protocol.

This is where this trivial incident should have been left. Instead, it was leaked to the media in a distorted manner aimed at discrediting the Deputy-Minister. This raises the concern that the Deputy-Minister's trip to Spain was refused in order to discredit her and that this is an orchestrated attempt to justify dismissing her. This is the second time President Mbeki has attempted to dismiss her and resorted to unfounded allegations of misconduct to justify it.

The President's legally irrational, unreasonable and arbitrary demand is an abuse of a constitutionally mandated power. The Treatment Action Campaign calls on all our allies to join in asking the President to show a degree of courage by meeting all of us to answer the questions:

Can our country trust you on HIV/AIDS as more than 900 people a day continue to die? Can our Deputy-President Phumzile Mlambo-Ngcuka continue to lead us with your support?

Our country has waited, vacillated, hoped, pained and fought too long over HIV/AIDS. This weekend TAC will consult with our allies across the country to prepare joint protest action including possible legal action on all the delays related to the agreed National Strategic Plan on HIV/AIDS. Our best defence of the Deputy-Minister is to end HIV/AIDS denialism.

She is the best person currently to restore the credibility and competence of the National Department of Health. We urge President Mbeki to revoke his decision and to unequivocally voice his support for her. This is the only sensible course of action that he could take if he is truly concerned about the health of millions of poor people in South Africa. Women's Day 9 August 2007 will be remembered as the day when a heroic woman took a principled stand in defence of life, dignity and health. We salute the Deputy-Minister Nozizwe Madlala-Routledge.

Deputy Health Minister 'Sacked for Doing Her Job'

UN Integrated Regional Information Networks

10 August 2007


South African deputy health minister, Nozizwe Madlala-Routledge, told a media briefing in Cape Town on Friday that President Thabo Mbeki sacked her for "just doing my job."

Madlala-Routledge was appointed deputy minister in 2004, but it soon became apparent that her views on HIV/AIDS were at odds with both Mbeki and his health minister, Manto Tshabalala-Msimang, who promotes garlic and lemon juice as a panacea for symptoms of the the disease, which according to the latest government survey has infected 5.41 million South Africans.

During her tenure as deputy minister Madlala-Routledge sought to mend fences between the government and AIDS activists, shepherding through a comprehensive five-year HIV/AIDS plan that was seen as instrumental in changing perceptions about South Africa' poor response to the pandemic.

Former UN secretary-general's special envoy for AIDS in Africa, Stephen Lewis, told the South African financial newspaper, Business Day, that Madlala-Routledge's firing "was a dreadful setback in the struggle against the pandemic, a blow to those fighting it internally and a blow to those outside watching developments in South Africa. The government of South Africa seems determined to discredit itself in the eyes of the world.

"Everyone will be shocked by what has happened. We assumed that the turnaround experienced in 2006 signified a real change in heart but obviously with the reemergence of the health minister [Tshabalala-Msimang] it means we are going in reverse again."

In February this year, Tshabalala-Msimang took a medical leave of absence to undergo a liver transplant, but rather than appoint Madlala-Routledge to the post of acting health minister, transport minister Jeff Radebe was asked to oversee the health ministry.

Tshabalala-Msimang returned to her post shortly before the third South African AIDS Conference in June, and then withdrew from the conference because she believed her deputy was given a more prominent role, an allegation disputed by the organisers who said they had invited the minister to speak at the conference's opening session.

Reasons for sacking

Although the presidency has refused to disclose the reasons for Madlala-Routledge's sacking, the former deputy health minister told the media briefing she was "fired for paying an unannounced visit to Frere Hospital [in East London] on the 13th of July 2007 and for my response to the shocking situation I found in the maternity ward."

Madlala-Routledge's visit to the hospital was prompted by an investigation by the local paper, the Daily Dispatch, that found an alarmingly high infant mortality rate, with at least 2,000 still births in the past 14 years. Following her visit to the hospital the deputy health minister declared the overburdened maternity ward a "national emergency". Within days there was a fierce rebuttal from first Tshabalala-Msimang, who said her deputy was not speaking the truth, and then from Mbeki in his weekly newsletter published on the ANC website.

"My comments that the situation constituted a national emergency were informed by the shocking realisation that some of the deaths were avoidable, and that the situation I observed was not unique to Frere Hospital," Madlala-Routledge told the press briefing.

Another reason given by Madlala-Routledge for her dismissal was "the much publicised trip I undertook to Madrid to address a conference hosted by... the International AIDS Vaccine Initiative."

"What is at issue here is that I went to Madrid without permission from the president," Madlala-Routledge told the press briefing. "When I realised the trip had not been approved by the president, I had a huge dilemma because besides the huge cost to the department, I could not be seen to defy the president by attending the meeting. So I did not attend... I took the first available flight back home."

Uproar over Madlala-Routledge's firing

Her dismissal, on the eve of Women's Day, has led to an uproar in South Africa and the belief that the real reason behind her sacking, was her views on HIV/AIDS were out of sync with Mbeki and Tshabalala-Msimang's.

The Treatment Action Campaign (TAC), which has spearheaded the fight for universal access to antiretroviral treatment in South Africa, said in a statement: "This [the sacking of Madlala-Routledge] is a dreadful error of judgment that will harm public health-care and especially the response to the HIV epidemic. It indicates that the president still remains opposed to the science of HIV and to appropriately responding to the epidemic. We call on him to reverse his decision."

TAC chairman, Zackie Achmat, told Business Day, "There is no question the minister of health and her director general [Thami Mseleku] are the strongest movers behind this sacking."

The general secretary of the Congress of South African Trade Unions, Zwelinzima Vavi, told the weekly newspaper, the Mail & Guardian, "In the absence of any other convincing explanation, we then conclude that she was fired because of her views on HIV/AIDS, which were not shared by the president and Minister Tshabalala-Msimang. It is very sad because this means the sheep mentality of following the leader will persist. It will deepen the culture of sycophancy among government ministers and officials."

IRIN/PlusNews was unable to get any official comment. Mbeki has yet to name a successor to Madlala-Routledge.

Mbeki Releases Letter Dismissing Minister

South African Government (Pretoria)

12 August 2007

Following media reports regarding the dismissal of Ms Nozizwe Madlala-Routledge, the former Deputy Minister of Health, the President has decided to publish the contents of the letter he wrote to her, in an effort to prevent further speculation and misrepresentations of facts.

Dear Deputy Minister,

This letter serves to inform you that, acting in terms of the provisions of clause 93 of the Constitution of the Republic of South Africa, I have decided to relieve you of your duties as Deputy Minister of Health with effect from today.

All of us who serve our people through the national government took an oath or made a solemn affirmation to respect and uphold the Constitution. This same Constitution calls upon us to, among other things, work collectively to develop and implement national policies.

I have, during the period you served as Deputy Minister of Defence, consistently drawn your attention to the concerns raised by your colleagues about your inability to work as part of a collective, as the Constitution enjoins us to.

For the same reason, I have also discussed this matter with you as Deputy Minister of Health.

You traveled to Madrid despite the fact that I had declined your request to undertake this trip. It is clear to me that you have no intention to abide by the constitutional prescriptions that bind all of us. For this reason I suggested to you that you should resign.

It is clear that you do not accept my advice. This leaves me no choice but to relieve you of your duties.

I thank you for your participation in government over the past years.

Yours sincerely,

Thabo Mbeki

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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