Johannesburg - South Africa's newly appointed health minister, Barbara Hogan, has inherited an unenviable to-do list from outgoing minister Manto Tshabalala-Msimang, but AIDS activists are optimistic that she is up to the job.

Indeed, in her first media briefing as health minister - on Thursday, 2 October, in Pretoria - Hogan said the co-existence of the tuberculosis and HIV epidemics, and improving the quality of services, were two of the many challenges facing the health department.

However, she could not give a concrete plan on how to deal with these challenges as she did not believe in "quick fixes and sound bytes".

Some days earlier, Lesley Odendal, a researcher at the Treatment Action Campaign (TAC), said that among the many challenges facing Hogan was addressing the bottlenecks hindering the scale-up of South Africa's public sector ARV treatment programme. "Although we do have a large number of people on treatment now, we still have about half a million people who need ARVs," she told IRIN/PlusNews on 26 September. "We still have a long way to go."

Odendal identified tuberculosis (TB), the leading cause of natural death in South Africa and a common opportunistic infection in people living with HIV, as one of Hogan's most urgent priorities. "We need to address infection control measures in hospitals and communities ... We need a multi-sectoral approach, but the Department of Health needs to provide leadership."

Dr Warren Parker, the executive director of the Centre for AIDS Development Research and Evaluation (Cadre), a non-profit organisation, urged the new health minister to prioritise HIV prevention strategies beyond condom promotion and distribution.

"The focus on condoms hasn't worked," he told IRIN/PlusNews. "It's so apparent that people don't understand the real risks of HIV infection. The campaigns haven't focused on the specifics enough."

Parker recommended campaigns addressing the HIV risks of concurrent sexual partnerships and early sexual debut among teenagers.

Both Parker and Odendal agreed on the urgent need for the Health Department to scale up prevention of mother to child HIV transmission (PMTCT) services. The strategy of using dual ARV therapy to reduce infections from mother to child was approved by the department in January 2008, but had yet to replace less effective mono-therapy in many parts of the country, Odendal noted.

Hopes for new leadership style

"The sad thing has been so many lives lost as a product of poor strategic emphasis, including very directly through many thousands of babies becoming infected," said Parker. "The leadership orientation of the previous ministry and presidency has been to defer issues rather than leading on them, and it has cost lives."

Parker added that many of the shortcomings in the current government response to HIV/AIDS could be "turned around" with more effective leadership.

While acknowledging that more than leadership was needed to address South Africa's AIDS epidemic, the largest in the world, Odendal agreed that with a widely lauded National Strategic Framework already in place, there was plenty of room for hoping that Hogan's appointment could mark the beginning of a more positive chapter in the country's AIDS fight. - IRIN/PlusNews

Related articles

New health minister means end of state AIDS 'denialism'

Solving treatment bottlenecks

Government under pressure to introduce new PMTCT regimen

ARV and TB drugs taken together halve deaths