On August 8, 2007, South African President Thabo Mbeki fired Deputy Health Minister Nozizwe Madlala-Routledge because she attended an AIDS conference in Spain without his permission.  Activists, however, allege that Ms. Madlala-Routledge had lost support from President Mbeki before this incident because of her advocacy for stronger action to combat the AIDS epidemic in South Africa.¹

South Africa has one of the highest HIV-infection rates in the world, with nearly 5.5 million people infected.  Until recently, South Africa’s efforts to provide HIV counseling, testing, and treatment have been largely inadequate, even compared to many poorer nations. According to AIDS workers, part of this failure was due to “government indecision and occasional denial of the scope of the epidemic.”²   President Mbeki received criticism early in his term for questioning whether HIV causes AIDS and whether the disease’s symptoms can be safely treated with anti-retroviral drugs.  The administration’s Health Minister, Dr. Manto Tshabalala-Msimang, has also received international criticism for her reluctance to advocate the efficacy of anti-retroviral drugs (earning her the nickname “Dr. No) and for recommending instead the use of garlic and beet root to prevent the advance of AIDS. ³ 

Ms. Madlala-Routledge’s aggressive stance on the AIDS epidemic and other key public health issues often clashed with the president’s administration.⁴  The deputy health minister was publicly tested for HIV to show her support for HIV testing and counseling while President Mbeki declined to participate.⁵  In July 2007, Ms. Madlala-Routledge paid an unannounced visit to a maternity ward because of allegations of an unusually high infant mortality rate.  She was reportedly appalled by the conditions, “saying [they] reflected a national emergency in health care.” After an investigation, however, Health Minister Tshabalala-Msimang disagreed with Madlala-Routledge’s assessment and insisted that the infant mortality rate was comparable to other hospitals.  This position was later supported by President Mbeki.⁶  Ms. Madlala-Routledge says she was subsequently reprimanded by the president for her unannounced visit and outspoken criticism, and activists suggest that this incident may have been a contributing factor in her dismissal.

Many AIDS activists are outraged over the dismissal of the deputy health minister and consider the incident a major setback when they were just beginning to trust the Mbeki administration.⁷ 

“This is a dreadful error of judgment that will harm public health care and especially the response to the H.I.V. epidemic,” said the Treatment Action Campaign. “It indicates that the president still remains opposed to the science of H.I.V. and to appropriately responding to the epidemic.”⁸

The incident has revived calls to remove Dr. Tshabalala-Mismang and has been a detour from the steady progress South Africa has made against AIDS in the last year.  Activists and government officials are now working to ensure that Ms. Madlala-Routledge’s firing does not undermine the national AIDS policy.⁹

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