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South Africa: AIDS Action Relapse
Aug 14, 2007 (070814)
(Reposted from sources cited below)
"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
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
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
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
It is also important for us to hear Mr Mbeki's voice, encouraging
people, leading, and showing them that HIV/Aids, with treatment can
(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
- 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
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
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
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
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:
- Does the President support the work done by the
Deputy-President, Cabinet, SANAC and the country on HIV/AIDS?
- Why does the President obfuscate the real crisis in public
- 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 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
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
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
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
"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
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
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
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
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
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