The announcement at the weekend of a targeted roll-out of HIV treatment in South Africa is considered a triumph against government policy. Joe Humphreys reports from Johannesburg
Campaigners against HIV/Aids in South Africa are celebrating a major U-turn by the government on how best to tackle one of the world's worst public health crises.
Zackie Achmat, founder and national chairman of the influential Treatment Action Campaign (Tac), says the government's long-standing policy of "denialism has been defeated" with the announcement at the weekend of plans for a targeted roll-out of treatment for HIV.
The policy shift comes amid growing domestic and international pressure for South Africa - a country which ranks a close second in the world after India for the number of people living with HIV - to embrace the use of anti-retrovirals (ARVs) in tackling the crisis.
For the past six years, the government's anti-Aids strategy has been characterised by scepticism over the efficacy of such drugs.
President Thabo Mbeki has publicly questioned whether HIV causes Aids, and his controversial health minister, Manto Tshabalala-Msimang, has been advocating an "alternative" treatment for the disease comprising native potatoes, beetroot and garlic.
The government first signalled a change of heart in September when it appointed deputy president Phumzile Mlambo-Ngcuka to head up its national Aids strategy.
At the weekend, she held a ground-breaking meeting with non-governmental organisations expressing support for their efforts and unequivocally stating that the government - in accordance with international norms - believed HIV caused Aids.
"We have to make sure that our energy is dedicated to the fight against HIV/Aids and not against each other," the deputy-president, who visits Ireland next month, told a gathering of church leaders, trade unionists and other activists in Johannesburg.
Achmat says lobbyists have been greatly impressed both with Mlambo-Ngcuka and deputy health minister Nozizwe Madlala-Routledge. "For them, this change in policy is not a calculation; it's about saving lives," he says.
The weekend conference was "the first time since 2000 that two cabinet members have addressed a meeting hosted by the Tac. That was more than symbolic, it was really an attempt to heal the divisions.
"Moreover," says Achmat, "both the deputy president and the deputy minister are committed to setting clear targets on decreasing infections, treatment and the roll-out of ARVs. That has never happened before.
"They said the targets would be bold and achievable and that is what we are seeking too."
Mlambo-Ngcuka has agreed to reconvene the country's co-ordinating committee on Aids, which has not met in a year because of the conflict between the government and civil society groups.
She has also signalled the government's intent to make ARVs more accessible to the poor, and has acknowledged the need for improved education and prevention measures.
Achmat says: "We should have been here eight years ago but I prefer not to look back."
A recent nominee for the Nobel Peace Prize, the Tac leader has been subjected to frequent attacks from government quarters, and just three months ago was arrested with fellow activists for holding a protest in Cape Town.
"It's going to take a lot of time to re-establish trust on both sides," he says.
"There is a lot of pain particularly on the side of campaigners. But we want to unite under the leadership of the government because we cannot do it without the government."
Since the weekend, the Tac has deliberately toned down its criticism of Tshabalala-Msimang, having recently called for her to be sacked.
The health minister dubbed by her critics "Dr Beetroot" has been in hospital for much of the past two months from a reported lung infection - and rumours are rife that she may be "retired" on health grounds.
"We find it difficult to work with the health minister but we will do it if it means we are going to save lives," Achmat told The Irish Times. "Our job is to save lives not dismiss ministers."
As for President Thabo Mbeki, whose election in 1999 signalled a shift in South Africa's policy away from international norms, Achmat says: "I don't know whether [ the] president has changed. I hope he has.
"But for him, it's difficult to have us on the streets against him because he has serious issues about elections coming up, and immediate questions of investment in South Africa to deal with. Also, in four years' time the whole world will be looking here for the World Cup.
"I hate to use the word 'expediency' but . . . there may be a calculation involved."
He says were Mbeki to publicly revoke his previous stance, "there is no question but our country would welcome it, and so too the whole world. But I have learned from politics never to ask for the impossible".
HIV/AIDS timeline in South Africa
1995: South African deputy president Thabo Mbeki acknowledges the seriousness of the HIV/Aids crisis with about 850,000 people - 2.1 per cent of the total population - believed to be infected.
The HIV prevalence rate among pregnant women stands at about 12 per cent.
1997: South Africa pushes for legislation to facilitate the importation of cheaper generic drugs for the treatment of Aids. Some 39 pharmaceutical companies sue for damages, leading to a four-year legal impasse.
Eventually, the drugs firms yield to domestic and international pressure, agreeing an out-of-court compromise.
1998: The Treatment Action Campaign (Tac) is formed by Zackie Achmat, a HIV-positive former anti-apartheid activist. The group initiates a series of legal actions against the state over the lack of availability of ARVs.
2000: Newly elected president Mbeki questions conventional thinking on Aids, describing it as a "disease of poverty". Following an internet search, he begins championing the cause of a small group of dissident scientists who claim that HIV is not the cause of Aids.
2002: The Constitutional Court orders that pregnant women should start receiving ARVs immediately. Achmat refuses to take Aids medications until the government makes them freely available to all. Former president Nelson Mandela pleads with the ailing campaigner at his home to resume treatment but Achmat continues to decline for another year.
2003: On the eve of the general election, and amid growing criticism from trade unions, the government announces a plan to distribute ARVs to the public. It subsequently blames "capacity constraints" for its failure to effectively roll out treatment.
2005: All 53 districts boast at least one service point for Aids-related care and treatment. But the number of people with HIV has now risen to about 5 million, and the HIV prevalence rate among pregnant women is 30.2 per cent.
2006: Health minister Manto Tshabalala-Msimang continues to defend "traditional cures" for HIV/Aids, drawing scorn for setting up a garlic and beetroot exhibition at an international Aids conference in Canada in August. Last week, deputy president Phumzile Mlambo-Ngcuka says the government unequivocally believes HIV causes Aids and will plan a new treatment strategy centred on the use of ARVs.