"Antiretroviral Treatment and the Problem of Political Will in South Africa"

South African AIDS policy has long been characterised by suspicion on the part of President Mbeki and his Health Ministers towards antiretroviral therapy.1,2 The Minister of Health, Manto Tshabalala-Msimang, resisted the introduction of antiretrovirals for mother-to-child transmission prevention (MTCTP) until forced to do by a Constitutional Court ruling – and she resisted the introduction of highly active antiretroviral therapy (HAART) for AIDS-sick people until a cabinet revolt in late 2003 forced her to back down on this too. Since then, the public sector rollout of HAART has gained momentum, but it has been uneven across the provinces and continues to be constrained by a marked absence of political will at high levels.