By Rick Westhead, Chiara Carter and Eleanor Momberg
South Africa's "salad stand" at the international HIV and Aids conference in Toronto, Canada, along with a damning indictment of the government by the United Nations envoy for Aids in Africa, have thrust South Africa's response to the pandemic back into the global spotlight.
Leading figures in the fight against HIV and Aids, headed by UN envoy Stephen Lewis, have lambasted the government's response to the crisis.
And locally, the Treatment Action Campaign (TAC) is taking its battle with the government over the provision of anti-retroviral drugs (ARVs) to the prisons, streets and courts this week and is demanding that President Thabo Mbeki explain why, in the face of the HIV and Aids crisis, he does not fire Manto Tshabalala-Msimang, the health minister.
The catalyst for the TAC going head to head with the government is the state's refusal to implement an interim high court order that the department of correctional services immediately supply ARVs to critically ill HIV-positive inmates at Durban's Westville Prison.
The government is appealing against the Durban high court's ruling, but the TAC is going back to the court on Wednesday to challenge, in turn, whether the government may ignore an interim order.
This follows the death earlier this month of one of 15 prisoners who, with the TAC, took the departments of correctional services and health to court on the issue.
Achmat said the TAC intended staging further protests this week: at the Cape Town magistrate's court on Tuesday, and countrywide on Thursday when the TAC intends calling on supporters and the public to demand that Mbeki fire his health minister or explain why he keeps her on.
"We need government to unambiguously state that people should take their medication and that while a healthy lifestyle is desirable it cannot be a substitute.
"We need moral leadership to challenge a situation where our maternal and infant mortality rates are higher than under apartheid and young adults are dying at an unprecedented rate," Achmat said.
At the Toronto conference this week the centrepiece of scorn poured on the South African government was the country's makeshift display at the city's downtown convention centre, which features glitzy exhibits built by pharmaceutical companies.
Tucked away in the bowels of the exhibition hall, South Africa's stand was stocked with several bowls of beetroot, garlic and lemons, alongside containers of anti-Aids medicines.
"It is a joke that South Africa still talks about the benefits of traditional medicine and puts out garlic and lemons like this when there is science that is so consistent about the benefits of anti-retroviral therapies," said Ed Mills, an Aids researcher and professor at Canada's McMaster University.
A steady stream of TV camera crews, Aids campaigners and journalists has scoured the sprawling convention centre in search of South Africa's booth.
Some wanted to see whether rumours about bowls of fruit and vegetables were true.
The controversy over the exhibit was covered by news organisations such as London's Daily Telegraph and the BBC, Canada's Globe and Mail and Toronto Star newspapers and ABC News in the United States.
The harshest words came from the UN's Lewis, who closed the conference on Friday with renewed criticism of Mbeki and Tshabalala-Msimang.
South Africa, Lewis said, "is the only country in Africa... whose government is still obtuse, dilatory and negligent about rolling out treatment.
It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state.
"I am of the opinion that they can never achieve redemption... it is not my job to be silenced by a government that knows what it is doing is wrong," Lewis said.
On Thursday, before leaving the conference early, Tshabalala-Msimang defended her support of traditional medicine and shrugged off her critics: "We have a saying in my country: If a truck is standing still, dogs will go under it and pee. If the truck is moving, the dogs will bark."
She said she was the truck spurring action in South Africa's medical system and her critics were running alongside, barking.
"I want anybody to challenge me that it's not important to eat nutritious food. If I have a cold, I know to eat lemon or ginger tea. That's the normal thing to do to improve your immune system."
Tshabalala-Msimang yesterday rejected "with contempt" Lewis's attack. In a statement titled "Lewis is not Africa's messiah", she said he had avoided the facts about HIV and Aids programmes in South Africa.
"Lewis should tell the world which other developing country has invested resources comparable to South Africa in implementing HIV and Aids prevention, care and treatment programmes."
The government had tripled the budget allocation for HIV and Aids over the past four years from just above R1 billion in 2002 to R3,5 billion in 2005, she said.
"Lewis should have the courage to whether there is any other country... that distributes more than 340 million male condoms and close to 3 million female condoms a year free. He should also know that more than 80 percent of people on the continent use traditional medicine to meet some of their health needs. Does he want them to stop?"
She said Lewis should name the country that had more people on ARV therapy than South Africa. By June more than 175 000 people were receiving free ARVs.
"If he wants to be regarded as a messiah of the modern-day Africa he should answer these questions with facts and figures, not empty rhetoric."