With the South African government’s robust new policy on curbing the HIV/Aids pandemic, the long-dormant South African National Aids Council (Sanac) is flexing its not inconsiderable muscle.
In early August the council made groundbreaking recommendations on combating Aids to the government, including a tighter focus on HIV-tuberculosis co-infection and the possible decriminalisation of sex work.
In September, Sanac is to get another boost as Aids expert Dr Nono Simelela assumes her post as the organisation’s new CEO.
Appointed by Deputy President Kgalema Motlanthe at the Sanac plenary in May, Simelela says she was drawn to the position because it would give her a chance to work in a sector she feels passionately about, in what she calls the “conscious environment” of the new political leadership.
Simelela was the first South African black woman to qualify as a specialist obstetrician and gynaecologist, which led to a 20-year career in the Department of Health. From 1998 to 2004 she worked as chief director of the National HIV, Aids and TB programme. It was a time when HIV treatment was largely unavailable and the fight against HIV/Aids under the country’s then health minister, Dr Manto Tshabalala-Msimang, was heavily politicised.
“I think everyone knows it was a very challenging time in South Africa … in many ways. The magnitude of the epidemic was really brought to the fore, and the need to move quickly, in terms of treatment and care, was evident.” Simelela says from London, where she heads the technical knowledge and support division of the International Planned Parenthood Federation.
“It was tough and you had to hang in there; I think that it was necessary. The fact that we did get a plan and have people accessing treatment has been a huge positive outcome.”
She says South Africa’s antiretroviral programme – one of the world’s largest – remains one of its biggest achievements. But problems remain, such as recurring drug shortages, poor monitoring and evaluation, and the need to slow new infections.
“We haven't really established a robust monitoring and evaluation system across all sectors, including government,” she says. “We’ve got the National Strategic Framework, and targets that have been set, but we need a robust tool to monitor progress so we know what needs to be done.”
“The fact is that we have an epidemic that is raging, and new infections are still occurring. We need to go back to the prevention side of things to look at what we’re not doing well enough.”
Simelela says she hopes the mix of local and international experience of the HIV epidemic would help her and Sanac make much needed changes. At the forefront is strengthening provincial and district Aids councils, which both serve the community and collect crucial data.
“We have a lot of good policies, but when it comes to implementation they falter,” she says. “We need to be sure provincial and district councils are able to implement their HIV/Aids plans. It should almost be a bottom-up approach - issues would come up at the district level and the national council would then look at ways of resolving them.”
Although long inactive, Sanac still provides a crucial interface between the government and civil society, ensuring that the people implementing policies at whatever level are held accountable. Simelela says the reawakened giant now has a renewed opportunity to make a difference in people’s lives.
“For me, it’s almost more about an agenda for social justice, not only to provide people with treatment but to raise issues around HIV, such as the economic issues that, I think, South Africa is grappling with now,” she says.
“There’s a way to respond but at the moment we need to coordinate that response – I get the sense that if we work collaboratively across all sectors, there is a chance we can turn things around.”