JOHANNESBURG, 26 September 2008 (IRIN) - South Africa's newly appointed health minister, Barbara Hogan, has inherited an unenviable to-do list from outgoing minister Manto Tshabalala-Msimang, but AIDS activists are optimistic that she is up to the job.

Hogan has no background in health, but has been a member of the ruling African National Congress (ANC) since 1977 and a member of parliament since 1994. She is known for being outspoken on sensitive issues, including HIV and AIDS.

According to Zackie Achmat, a prominent AIDS activist and former chairperson of AIDS lobby group, the Treatment Action Campaign (TAC), Hogan was one of the few members of parliament to speak out against "AIDS denialism" - the controversial view that HIV is not the cause of AIDS, allegedly held by former President Thabo Mbeki.

"She was removed as Finance Portfolio Chairperson by Mbeki, in part for her stand on HIV/AIDS," Achmat said in a statement. "She has a reputation for being hard-working, competent and principled."

Hogan's deputy, Dr Molefi Seflaro, is a medical doctor with qualifications in tropical medicine, public health and health service management.

The TAC clashed with Mbeki and Tshabalala-Msimang on numerous occasions during their nine-year tenure, most notably during a Constitutional Court battle that eventually compelled the health department to provide antiretroviral (ARV) drugs to HIV-positive pregnant women to prevent mother-to-child transmission.

Claiming that over two million South Africans died of AIDS during Mbeki's presidency, Achmat said that "at least 300,000 deaths could have been avoided had the President merely met the most basic constitutional requirements".

Among many challenges now facing Hogan, according to Lesley Odendal, a researcher at the TAC, is to address the bottlenecks hindering the scale-up of South Africa's public sector ARV treatment programme. "Although we do have a large number of people on treatment now, we still have about half a million people who need ARVs," she told IRIN/PlusNews. "We still have a long way to go."

She identified tuberculosis (TB), the leading cause of natural death in South Africa and a common opportunistic infection in people living with HIV, as one of Hogan's most urgent priorities. "We need to address infection control measures in hospitals and communities," said Odendal. "We need a multi-sectoral approach, but the department of health needs to provide leadership."

Dr Warren Parker, executive director of the Centre for AIDS Development Research and Evaluation (CADRE), a non-profit organisation, urged the new health minister to prioritise HIV prevention strategies beyond condom promotion and distribution. "The focus on condoms hasn't worked," he told IRIN/PlusNews. "It's so apparent that people don't understand the real risks of HIV infection. The campaigns haven't focused on the specifics enough."

Parker recommended campaigns addressing the HIV risks of concurrent sexual partnerships and early sexual debut among teenagers.

Both Parker and Odendal agreed on the urgent need for the health department to scale up prevention of mother-to-child HIV transmission (PMTCT) services. The strategy of using dual ARV therapy to reduce infections from mother to child was approved by the health department in January but has yet to replace less effective mono-therapy in many parts of the country, Odendal noted.

"The sad thing has been so many lives lost as a product of poor strategic emphasis, including very directly through many thousands of babies becoming infected," said Parker. "The leadership orientation of the previous ministry and presidency has been to defer issues rather than leading on them, and it has cost lives."

Parker added that many of the shortcomings in the current government response to HIV/AIDS could be "turned around" with more effective leadership.

While acknowledging that more than leadership was needed to address South Africa's AIDS epidemic, the largest in the world, Odendal agreed that with a widely lauded National Strategic Framework already in place, there was plenty of room for hoping that Hogan's appointment could mark the beginning of a more positive chapter in the country's AIDS fight.

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