South African AIDS activists criticize firing of Madlala-Routledge

South Africa's deputy health minister was fired last week. Critics say it's political.

The firing of a government bureaucrat isn't usually the kind of story that newspaper editors put on page one.

But the sacking of Nozizwe Madlala-Routledge, South Africa's deputy health minister, has struck a chord in South African society, exposing deep differences over sensitive issues of AIDS, governance, and race.

Ms. Madlala-Routledge – a longtime member of the ruling African National Congress credited with hammering out the country's first strategic plan for the AIDS crisis – was fired last week after taking a trip to Spain to attend a conference on AIDS, a trip that was not approved by President Thabo Mbeki.

In a letter explaining his decision to fire her, Mr. Mbeki wrote that Madlala-Routledge's colleagues complained about her "inability to work as a collective."

Her firing has touched off a firestorm among AIDS activists, and political analysts say Mbeki's decision has undermined his credibility in a crucial year, when the ruling party will begin to choose its successor as president.

"It has sent all the wrong signals," says Steven Friedman, a political analyst for the Institute for Democracy in South Africa in Johannesburg. "It's not enough to say we're dealing with the [AIDS] problem. You have to show enough concern to win the trust of the people."

The anger and misunderstanding surrounding Madlala-Routledge's firing speak volumes about the growing importance of AIDS in South African society. No other nation in the world has more AIDS patients than South Africa. Out of the 40 million people in the world living with HIV, 5.41 million of them live in South Africa. Approximately 2 million South Africans have died since the epidemic began here in the 1980s, and nearly 500,000 South Africans with HIV have no access to antiretroviral treatment.

Roots of defensiveness

It's a crisis that took root during the apartheid era, when black men had to leave their families behind in townships to find work in the cities, a setup that weakened black families.

But it's the black-majority government that has been left to deal with the consequences, and the presidency of Thabo Mbeki in particular has dealt with criticism over its handling of AIDS almost as a racial slur.

"This situation is complicated by our racial history," says Friedman. "You have the negative cycle of bigotry and defensiveness. It affects everything, when you had white prejudice that assumes that HIV and AIDS are purely signs of promiscuity among blacks. The response of blacks is often a defensive one – that the issue of AIDS is exaggerated."

This defensiveness filters into most political discussion, says Aubrey Matshiqi, a political analyst at the Centre for Policy Studies in Johannesburg. adding that it hampers the spirit of compromise necessary for democratic government. "What I bemoan, and what I see in the media, are two extreme positions. It cannot be that one side represents 100 percent good, and the other side is 100 percent bad. The answer lies between the two."

Yet it was almost inevitable that Madlala-Routledge would cause a stir.

An outspoken government critic

From the outset, she was the one prominent black official who spoke publicly about the failings of government, and the need for drastic action.

This spring, she took an AIDS test and suggested that her fellow government officials should do so as well, since there is "denial at the highest level."

The final straw seemed to come this spring, when the deputy minister visited the public Frere Hospital to investigate newspaper reports of a high incidence of infant deaths, due to staffing shortages and lack of resources.

She called the quality of healthcare at Frere "a national emergency," the tip of the iceberg in a failing public hospital system.

In August, after taking a June 12 trip that she says she assumed had been approved, Madlala-Routledge was finally let go from her post.

She will continue to serve as an ANC parliamentarian on the back benches.

"The government wishes to reaffirm its commitment to the national policy and strategic plan on HIV and AIDS. The government's position will not be affected by any changes in leadership at any level," said Themba Maseko, SA government spokesman, in a statement to reporters.

Fired for slamming her bosses?

Supporters say Madlala-Routledge was set up after she launched a series of hard-hitting statements against both her boss and President Mbeki.

Soon after assuming office in 1999, Mbeki questioned the scientific link between the HIV virus and AIDS.

His statement caused an uproar among AIDS activists, who said that Mbeki's statement would confuse South Africans and undo years of careful public messages about the need to avoid unprotected sex.

Mbeki has never retracted his statement.

Nathan Geffen, spokesperson for Treatment Action Campaign in Cape Town, says that the dismissal of the deputy minister has "raised deep fears among us that this will undermine the strategic plan."

Many AIDS activists worry that, without Madlala-Routledge, AIDS policy will be undermined by her boss, Health Minister Manto Tshabalala-Msimang.

Ms. Tshabalala-Msimang is nicknamed Dr. Beetroot for her focus on nutrition in preventing AIDS rather than on treatment such as anti-retroviral drugs.

"Raw garlic and the skin of a lemon – not only do they give you a beautiful face and skin, but they also protect you from disease," the health minister once told a reporter.

Such statements have a negative effect, says Mr. Geffen, but the greater effect comes from actions the government has failed to take, rather than the misinformation they have spread.

"What you're not seeing is a massive information campaign by leaders, getting on radio, telling people to get tested if necessary, to get treatment, to use condoms to avoid unprotected sex," says Geffen. "That should be the message, but instead the message they are getting is confusing."