Nathan Geffen is Policy Co-coordinator for the Treatment Action Coaltion.

Editorial Note: Rewire often highlights the important linkages between HIV/AIDS and Reproductive Health. We publish this post today in coordination with TAC's global day of action to pressure the South African government to change its HIV policies. Read below to learn more.

Masizole (* name changed) died of AIDS in August. He was an inmate at Durban's Westville Prison in South Africa and one of over 100 prisoners at this facility who died of AIDS in the last year. Prisoners don't have much respect in South Africa. Public concern about high levels of crime and violence render them the most scorned class in our society.

Nevertheless, Masizole spent his last few months trying to assert his dignity. He was one of 15 prisoners who, together with the Treatment Action Campaign (TAC) and represented by the AIDS Law Project, applied to the country's court system to compel the Departments of Health and Correctional Services to provide life-saving antiretroviral treatment to prisoners with AIDS. Last month the court ruled in Masizole's favour, but not in time for him. He needed to be on treatment last year already.

In pitiful health, about three weeks before his death, he was finally put onto treatment. It was much too late. Since his death, the government has not only appealed the ruling, it has also appealed an order of the Durban High Court that it must provide treatment to prisoners while the appeal is being heard. No move to block access to essential medicines is too cynical for the South African government.

South Africa has over five million people living with HIV, probably more than any other country. A recent count of all available death certificates showed that since 2000 more adults have been dying in their 30s than in their 60s. This is a perverse situation for a modern country in the 21st century.

TOO FEW ON TREATMENT

Treatment with antiretrovirals has been available at selected clinics in most parts of the country since 2004. The Department of Health estimates that over 160,000 people are on treatment in the public health sector, making ours one of the biggest treatment programmes in the world. The programme was only implemented following immense pressure from civil society organisations, and in particular, a civil disobedience campaign run by the TAC in 2003.

Yet, half-a-million people who have now got AIDS cannot access treatment. Many sit on year long waiting lists and will be dead long before they get medicines. Many more simply get tested too late, when their bodies are riddled with opportunistic infections and the odds of survival are poor. Charlatans abound offering people quack remedies as alternatives to scientifically proven ones. There is no systematic competently implemented programme to encourage people to get tested for HIV nor any encouragement from government for people to take antiretrovirals via their local public health clinics when they develop AIDS.

FAILED PREVENTION EFFORTS

In 2002, a Constitutional court ruling compelled the government to implement a mother-to-chid transmission prevention programme. In 2006, the programme still only reaches half of HIV-positive women. And in most of the country a sub-optimal drug regimen is used with the consequence that we have a massive but entirely avoidable paediatric HIV epidemic.

Adult infections continue unabated. By the best estimates there are well over 1,000 new infections a day, among the highest in the world. HIV prevention efforts in South Africa have been sparse. The Minister of Health, Dr Manto Tshabalala-Msimang, talks a lot about prevention being the cornerstone of government's policy, but our prevention efforts have failed. The previous prevention plan expired in 2005 and there is no new plan. The contract of the country's major provider of HIV information in the media has not been renewed. Most schools remain without proper sex education programmes and condoms. Accessing post-exposure prophylaxis (medicines to prevent infection) is still extremely difficult for most women who have been raped.

HEALTH WORKER SHORTAGE

Nurse and doctor patient ratios in the public sector are extremely high and appear to be getting worse. A survey of four provinces published in

2002 found a nearly 16% HIV infection rate among nurses. The same survey found that morale was low among health workers and that this was due in part to the HIV epidemic with the consequent effects of increased numbers of patients and increased mortality among them. After much campaigning by TAC and others, the Department of Health has finally developed a human resources plan, but it is devoid of concrete targets and actions.

CHARLATANS EVERYWHERE

The most galling aspect of government's response is the Minister of Health's support, both implicit and explicit, of charlatans selling unproven remedies as alternatives to scientifically proven medicines.

The Minister has embraced pseudo-science at the expense of people's lives. At the recent International AIDS Conference in Toronto, the South African exhibit featured the Minister's favourite AIDS treatments: garlic cloves and lemons.

There is much to criticise about pharmaceutical companies. Indeed, the TAC has been one of the most outspoken critics of the industry and has litigated successfully on several occasions against drug companies. But the Minister's attitude to modern medicine is absurd. The scientific evidence demonstrating that antiretrovirals work is overwhelming and her continued scepticism of them is due to her failure to understand science.

She's also inconsistent. She has openly supported Matthias Rath, a pharmaceutical entrepreneur who sells unproven mega-dose vitamin products and claims they treat everything from heart-disease to cancer to AIDS. He makes the bad guys in The Constant Gardener look like angels. The fact that he's been condemned or reprimanded by the WHO, UNAIDS, the FDA, Harvard University nutrition researchers, various advertising authorities and found guilty of making false claims in a German court has not deterred the Minister's support for him.

Underlying the South African health crisis is poor political leadership.

The Minister of Health, appointed and supported by President Mbeki, promotes pseudo-science and has failed in every critical aspect of her job. The consequences of this is sickness and death on an unprecedented scale in South Africa's modern history. We in TAC have tried to negotiate with government on numerous occasions. Our efforts are usually spurned or we are simply lied to. But we cannot continue to allow the Minister's gross negligence to kill ever larger numbers of people. We have therefore embarked on mass non-violent protests and will continue them until government policy changes.

On the TAC website:

Why TAC is protesting.
Westville Prison Fact Sheet.
Global Day of Action: Support our five demands.

Also see www.aidstruth.org for debunking of AIDS denialist myths.