South Africa’s Health Minister, Dr. Mantombazana Edmie Tshabalala-Msimang kept controversy to a minimum during her welcoming address at the World Health Organization’s technical consultation on Nutrition & HIV/AIDS in Africa, which began in Durban on Sunday night.
However, in high spirits at a cocktail party afterwards, she told the crowd that she felt “vindicated” that the world was finally acknowledging the importance of poverty and malnutrition to AIDS in Africa. “Our president was right all along,” she shouted joyfully.
Background
In 2000, South African President Thabo Mbeki addressed the World AIDS Conference in Durban, South Africa, about the correlations between AIDS, poverty and poor nutrition. While there was no disputing much of what he said — including that poverty and poor nutrition needed to be tackled in any response to AIDS in Africa — many in the crowd were angered when he made allusions to AIDS denialist theories and refused to acknowledge that HIV is the cause of AIDS.
While President Mbeki now dodges questions about the link between HIV and AIDS, former US President Bill Clinton told the press in 2003 that Mbeki was no longer in denial.
Since that time, the South African Government has come a long way, beginning the launch of a comprehensive HIV management programme that includes antiretroviral treatment of people with less than 200 CD4 cells.
Although the programme was slow to start and there continue to be gaps in some aspects of its implementation, it is one of the most ambitious, best-designed and holistic public health programmes ever launched by a country.
Addressing nutrition in South Africa
In her opening comments to the meeting, Dr. Tshabalala-Msimang described the country’s current approach to nutrition and food security issues.
“The majority of our population live [in areas with] high levels of unemployment, lack of access to basic services like proper housing, water and sanitation, health, education, electricity and so on. The people in these areas understand the realities of not having food on the table and of having no clinic or school close by.”
The government has been dealing with the issue of food security by providing food relief, and social support, creating employment opportunities, community-based income generating activities and food gardens. The country has built or upgraded more than 1300 clinics over the last ten years and extended access to safe water, sanitation, housing, electricity and education.
“Our approach…, has been to ensure that the food that can be easily accessed by the poor is nutritious and people are informed of the health benefits of certain products.”
So the government has launched a food fortification programme. All millers are now required to add specified amounts of vitamins and minerals to all corn meal and wheat flour produced in the country. The country also provides vitamin A supplements for children and offers feeding programmes for primary school children.
“Good nutrition is a critical component of a comprehensive response to diseases. Of course, good nutrition is not a substitute for appropriate treatment. It serves as a solid foundation that often determines the success of other interventions.
“As we give people medications to be taken before, with or after a meal, it is also our duty to ensure that people have a nutritious meal to take with their medication.”
Nutrition in the Comprehensive HIV and AIDS Care Plan
South Africa’s HIV management plan has a strong nutritional component. For example, patients are provided with a supplementary meal and a multivitamin syrup or tablet. The number of patients with HIV accessing this service was estimated to be 153,000 by the end of February 2005.
South Africa has also developed national nutrition guidelines for people living with HIV and AIDS and TB that has been implemented in all the provinces.
“We were right all along”
To close, she borrowed a line from President Mbeki’s speech at the opening of the World AIDS conference five years earlier “We should remember that the survival of millions of our people is dependent on the outcome of these processes aimed at shaping the world’s responses to diseases.”
“The mere fact that we are gathering here and now as a continent means that we have finally come to admit that a fundamental aspect of health has been omitted in the approach we have taken to curb the spread of HIV infection and mitigate the impact of AIDS in our society."
At the cocktail party following the opening ceremony, attended by such local dignitaries as the Queen of the Zulus, the Health Minister confessed: “You don’t know how gratifying it is for us to have this meeting here. The World AIDS conference held in Durban five years ago was a very painful time for us.”
In fact, she found the experience so gratifying that she burst into song. About half of the audience, South Africans mostly, joined in, singing in Zulu and dancing along.
The song's words translated:
"You got to work, work, work at staying healthy. Drink less alcohol… do more exercises... You got to work, work, work at staying healthy."