S. African credited with fighting AIDS is ousted from post

JOHANNESBURG -- President Thabo Mbeki has fired his deputy health minister, Nozizwe Madlala-Routledge, who was widely credited for an aggressive assault on the devastating AIDS epidemic this year.

Madlala-Routledge's efforts came after her superior, Health Minister Manto Tshabalala-Msimang, became the target of international criticism for her position on HIV treatment.

South African AIDS activists called Madlala-Routledge's ouster a setback to efforts to curb AIDS by expanding prevention and treatment.

South Africa has one of the world's largest HIV-positive populations, but until recently, its programs to provide drugs and counseling to AIDS patients have lagged behind those of some poorer countries.

"This is a dreadful error of judgment that will harm public healthcare and especially the response to the HIV epidemic," the Treatment Action Campaign, the main South African AIDS lobby group, said in a statement. "It indicates that the president still remains opposed to the science of HIV and to appropriately responding to the epidemic."

Mbeki's office confirmed the firing yesterday, but gave no reason for Madlala-Routledge's removal. Her supporters say the president told her that she was being dismissed for her role in a controversy over infant mortality at a government hospital in London and an official trip she took to Spain at government expense but without Mbeki's authorization.

For nearly a year, Madlala-Routledge has been leading the Health Ministry's campaign against AIDS while the health minister was sidelined by illness. AIDS workers say that Madlala-Routledge was partly responsible for ending five years or more of government indecision and, on occasion, denial of the scope of the epidemic. During her interim leadership of the health ministry, control of national AIDS policy was removed from Tshabalala-Msimang, a close ally of Mbeki, and placed under a government-wide council headed by Vice President Phumzile Mlambo-Ngucka.

Up to 5.4 million of the 47 million people in South Africa are HIV-positive, a figure that is among the highest in the world. Madlala-Routledge acknowledged that the criticism of the government response to the epidemic was at least partly justified. She has said that the government had bred confusion over the need for antiretroviral treatment and urged leaders to encourage HIV testing by getting tested themselves. She and the vice president together unveiled a new government plan to attack AIDS.

Her position was jeopardized, however, once the health minister returned to work in June after a liver transplant.

Within weeks, Tshabalala-Msimang withdrew from a health conference after organizers asked Madlala-Routledge to speak at a key session and relegated Tshabalala-Msimang to a less important gathering.

Then in July, the officials clashed over allegations of high infant mortality at a government hospital in East London.

Madlala-Routledge paid a surprise visit to the hospital and condemned the standard of care, saying it reflected a national emergency in healthcare. Tshabalala-Msimang, who sent her own team to investigate a few days later, insisted that the infant death rate was comparable with that of other hospitals.

In his weekly newsletter, Mbeki sided with the health minister, saying the allegations of poor care were exaggerated.