"South Africa is currently experiencing one of the most severe HIV epidemics in the world. By the end of 2005, there were five and a half million people living with HIV in South Africa, and almost 1,000 AIDS deaths occurring every day, according to UNAIDS estimates. A survey published in 2004 found that South Africans spent more time at funerals than they did having their hair cut, shopping or having barbecues. It also found that more than twice as many people had been to a funeral in the past month than had been to a wedding.

A number of factors have been blamed for the rapid rise in HIV prevalence in South Africa, and debate has raged about whether the Governments response to the epidemic has been sufficient. South Africa has had a turbulent past, and this history is relevant to the explosive spread of HIV in the country.

There has been some tension in South Africa between the methods used by different medical practices to treat HIV. Around 80% of people living in African countries consult traditional African healers and use traditional African remedies, even if they use conventional medicines as well, and some of these traditional methods of treatment are potentially harmful to people living with HIV. For instance, some people (such as the Health Minister, Manto Tshabalala-Msimang) claim that African potato boosts the immune system and thereby helps to fight off AIDS. Yet a recent study shows that people taking ARVs should not eat African potato, because it lowers the level of antiretroviral chemicals in the body and increases the likelihood of HIV developing resistance to the drugs.

At the same time, some traditional medicines and practices have been shown to be beneficial in the treatment of HIV. Traditional healers are treated with respect in South African society, and in 2004 the Traditional Health Practitioners Bill was passed to formally recognise and regulate their legitimacy. Many such practitioners recognise the benefits of ARVs, and counsel people living with HIV to continue with antiretroviral treatment. The TAC argues that traditional healers have an important role to play in the treatment of HIV:

Their cultural importance combined with their close involvement within communities puts traditional healers in a unique position to help fight HIV. - Zach Rosner, TAC.

Many people argue that the response to HIV/AIDS in South Africa has been hampered by AIDS denialism, a minority scientific movement that refutes the orthodox idea that HIV causes AIDS. Some leading figures in South Africa have flirted with this school of thought, much to the dismay of AIDS activists. President Mbeki has consistently refused to acknowledge that HIV is the cause of AIDS; he argues that HIV is just one factor among many that might contribute to deaths resulting from immunodeficiency, alongside others such as poverty and poor nutrition:

South African president Thabo Mbeki
Does HIV Cause AIDS? Can a virus cause a syndrome? How? It cant, because a syndrome is a group of diseases resulting from acquired immune deficiency. Indeed, HIV contributes, but other things contribute as well.

Although Mbeki has never declared outright that he rejects the link between HIV and AIDS, he has continually inferred as much through statements such as this. He has also failed to publicly state that he believes HIV to be the cause of AIDS.

While international scientific consensus holds that antiretroviral medication is an effective treatment for HIV, Mbeki has claimed that it is harmful and unsafe. Drug companies, he argues, have exaggerated the importance of ARV treatment in order to further their profits.

In 2000 Mbeki included a number of AIDS dissidents, such as the controversial American scientist Peter Duesberg, in a committee set up to advise the Government on tackling the AIDS crisis. In the same year, hundreds of delegates walked out of the International AIDS Conference in Durban in protest after Mbeki reiterated his view that HIV is not wholly responsible for AIDS.

In October 2000, Mbeki stated that he would withdraw from the public debate about whether HIV causes AIDS, after admitting that his stance had created confusion amongst the public. Since making this statement he has largely avoided the issue of what causes AIDS, but has repeatedly suggested that the impact of AIDS in South Africa may have been overstated.

In 2002 the Cabinet issued a statement on their latest AIDS campaign, declaring:

In conducting this campaign, Governments starting point is based on the premise that HIV causes AIDS

While this remains the official stance of the Government, there is evidence that certain politicians continue to question scientific consensus on AIDS. President Mbeki has repeatedly stressed the importance of a good diet in halting the progression of AIDS, as has the Health Minister Manto Tshabalala-Msimang, who famously urged people to eat lots of beetroot and garlic to fight off the illness. While it is true that a good diet is an important part of treatment, it is certainly no substitute for antiretroviral medication, as she has suggested. Her stance has angered many, including the revered South African cleric Desmond Tutu:

"We are playing with the lives of people, with the lives of mothers who would not have died if they had had drugs. If people want garlic and potatoes let them have them, but let's not play games. Stop all this discussion about garlic."

The Health Minister has also voiced support for the Dr Rath Health Foundation, an organisation that promotes vitamin supplements as a substitute for ARV drugs. The foundation has previously published adverts in South Africa claiming that antiretroviral drugs are toxic and cause AIDS. In August 2005, The Advertising Standards Authority ruled that such statements were a threat to public health, and that the organisation would not be allowed to make such claims in future adverts. Manto Tshabalala-Msimang later stated in newspapers that:

No reason exists to criticise Rath, his treatments and his foundation

The Dr Rath Health Foundation continues to promote its ineffective vitamin treatment in South Africa despite widespread international condemnation. The organisation has been banned from almost all other countries in which it has tried to operate. The TAC, which recently won a court case to prevent the Rath Foundation from wrongly labelling them a front for the pharmaceutical industry, has strongly criticised the Government for failing to condemn the organisation.

The Health Minister continues to make statements that play down the importance of ARVs, and it is likely that the attitude towards the drugs taken by her and other politicians has been central to the slow rate of progress in providing access to treatment. Amongst the scientific community there is little doubt about the benefits of ARVs; a recent study in South Africa reported that 93% of HIV positive people surveyed were alive after one year of treatment.

Alongside AIDS denialism and misinformation about AIDS treatment, false beliefs about how HIV can be transmitted are also a concern. In April 2006, on trial for the alleged rape of a HIV positive woman, South Africas former Deputy-President Jacob Zuma was found not-guilty but confessed that he had had consensual sex with the woman despite being aware that she was HIV positive. He stated his belief that HIV was not easily transmitted from women to men, and that he had showered after sex in the belief that this would minimise his chances of contracting HIV. There was widespread dismay amongst the AIDS prevention community that a politician (particularly one who had once been head of the National AIDS Council) could display such ignorance, and a fear that his statement would cause confusion amongst the public, undermining years of AIDS prevention campaigns. The National AIDS Helpline was subsequently inundated by callers querying the validity of his statement.

Many people believe that the widely publicised views of politicians such as Mbeki, Tshabalala-Msimang and Zuma have added to the climate of misinformation that surrounds the problem of AIDS in South Africa. Zackie Achmat, leader of the TAC, argues that the real hindrance to antriretroviral drug provision in the country is not lack of funding, but the attitude of the Government:

The biggest problem we have in South Africa is that we have a President who doesnt believe that HIV causes AIDS."