On August 8th, 2007, South African President Thabo Mbeki fired his Deputy Minister of Health, Ms. Nozizwe Madlala-Routledge. The international community and the South African Treatment Action Campaign consider her to be the champion of progressive health policy in a country that officially sanctions garlic and beetroot as a HIV/AIDS treatment [1]. South Africa’s Ministry of Health is responsible for one of the largest HIV/AIDS populations in Africa. At least 5.5 million South Africans are HIV positive; the virus affects nearly 20% of the country’s adult population [2]. No exception to the global trend, young women (ages 25-45) are more commonly affected by the virus than any other demographic in the country. President Mbeki’s actions leave only doubts over the direction South Africa is taking: Will the country continue to be an enclave of stable and legitimate government, or will it backslide into the corruption and power-mongering of the Apartheid era?

The President’s dismissal of Madlala-Routledge directs unwanted attention to the corruption that plagues his government. Madlala-Routledge gained the reputation as whistleblower of government inefficiency and mismanagement in HIV/AIDS treatment and other health policy. Her progressive policy positions often conflicted with those of Health Minister Manto Tshabalala-Msimang, an ally of the President’s whom the public has called “Dr. Beetroot” for her dismissal of anti-retroviral medicines [3]. Therefore, as the President approaches party elections in December, the sacking appears as a move to consolidate loyalty for his leadership in the party.

In February, opposition member Mangosuthu Buthelezi called on President Mbeki’s government to “accept the HIV/AIDS pandemic for what it is: a national and even regional emergency and [to] do everything in its power to curb it” [4]. Madlala-Routledge, a trained medical laboratory technologist, did just that by spearheading the revised National Strategic Plan for HIV/AIDS 2007-2011 [5]. This plan set the ambitious but necessary guidelines for treating and preventing the pandemic in South Africa. Also, she was honoured by the Tanenbaum Center for Interreligious Understanding as Peacemaker in Action [6]. A pacifist and a practicing Quaker, Madlala-Routledge was committed to the democratic transformation of South Africa during the struggle to end Apartheid. The Freedom of Expression Institute’s Jane Duncan noted the apparent governmental irresponsibility in firing Madlala-Routledge, saying that it signals the “growing intolerance of dissent” at the top in South Africa [7]. Madlala-Routledge’s dismissal places the President in an apparently adversarial position against science and democracy.

Critics identify “denialism” as the major systemic problem in South Africa’s government [8]. Denialism, as opposed to realism, is the official practice of lying about the actual state of affairs in the country by denying the gravity of, or responsibility for, national problems. Health Minister Tshabalala-Msimang’s record is rife with denials – denials of the science of anti-retroviral medicine, denials of her alcoholism, and denials of discrediting a government official at the expense of national welfare. Unfortunately, her policy of denialism has led South Africa to fall drastically short of its goals for the treatment and prevention of HIV/AIDS set for National Strategic Plan 2000-2005 [9]. Dr. Abdoulaye Dieng Sarr, a Senior Research Scientist in the Department of Immunology and Infectious Diseases at the Harvard School of Public Health, decries the widespread denialism in South Africa as an impediment to eradicating the virus in the region: “Governments need to work on slow-down of transmission of HIV, and confront just how much the country is losing to AIDS” [10].

The President defends his decision saying that Madlala-Routledge had a non-cooperative attitude that impeded government work [11]. Her unauthorized address to the International AIDS Vaccine Initiative conference in Madrid at the government’s expense is given as evidence for her inability to work in a collective [12]. Against such allegations, Madlala-Routledge argues that she is the victim of a governmental smear campaign, a heavy-handed reaction to her scathing report of high infant mortality rates at the Frere Government Hospital’s maternity ward. In a surprise visit to the hospital, Madlala-Routledge found the maternity ward in a “state of national emergency” as she called it [13]. Although the Ministry of Health website purports to still host her official reports [14], this author was unable to find active links to Madlala-Routledge’s governmental reports.

Madlala-Routledge’s firing indicates a deep-running, but often cleanly covered up, corrupt and authoritarian quality to Thabo Mbeki’s government. The post-Apartheid South African government has achieved many successes in creating a democratic system of governance. It must not stop here; the President must reroute South Africa toward better governance in order maintain its good reputation for progress and integrity in the region and world. Dr. Dieng Sarr confirms that “if you don’t have the commitment of the governments, there is nothing we can do for Africa. Corruption slows everything down” [15].

In the eyes of many, Madlala-Routledge represented transparency, accountability, progressivism and realism in governance. Therefore, in her absence, the IIJD urges the South African government to maintain the standard that she set for the Ministry of Health. Only by meeting the goals of the HIV/AIDS National Strategic Plan 2007-2011 can the government clear itself from accusations of denialism. It is imperative that attention and action be taken to increase prevention efforts and awareness education for HIV/AIDS while strengthening the management of health structures and resources. The IIJD hopes President Mbeki will take steps to transforming his reputation of authoritarianism by increasing transparency and accountability in governmental affairs, and by using internal and external criticism as the basis of much-needed democratic reforms.