“Pound, pound, pound,” laughs Dr Nono Simelela, describing how she deals with her frustrations by going jogging as often as she can.

As head of government’s national HIV/AIDS Directorate, she has plenty of frustrations to vent on the Midrand pavements around her home – not least of all the fact that she is often blamed for political decisions over which she has no control.

Given the intense emotion associated with HIV/AIDS, being the top public official in charge of dealing with the crisis is a terrifying responsibility.

“As a mother and an obstetrician, I have the love and the drive to do this job and I am passionate about it,” says Simelela. “But the worst part of my job is that we are continually misunderstood. It is very hurtful to always be criticised. People don’t seem to accept how far we have moved as a country, and this constant criticism can get me down.”

She is particularly stung by criticism from those who “sit smugly outside government and judge”.

“The struggle seems to have achieved the freedom for the previously advantaged to be free from taking responsibility for the disadvantaged,” says Simelela.

She acknowledges that her job involves enormously painful decisions. The budgeting process, says Simelela, is “a calculus of misery” as she and her officials try to juggle demands for home-based care, palliative care and anti-retroviral drugs.

“There is no simple way to compare degrees of suffering,” she says of the tough choices she has to make.  

Another serious stumbling block is the fact that almost the entire health budget is distributed to provinces who decide how to spend the money – and many lack the capacity to run an efficient HIV/AIDS programme.

It is a difficult task, yet Simelela is obviously well liked and respected by her staff. The Health Department’s head of communications, Jo-Anne Collinge, describes her as being “much loved”.

One of her deputy directors, Celicia Serenata, praises her for “being able to delegate and not breathing down your neck. She just expects the job to get done”.

“The qualities I most admire about her,” says Serenata, “are her focus and commitment. She has an incredible memory. She can remember the details of something that happened at a meeting two years ago. She also has so much energy and pays great attention to detail. She is under unbelievable pressure. I don’t know how she stands it. But somehow she manages to remain focused.”

When Simelela applied for her current job – after getting a little bored of being a consultant in the Department of Obstetrics and Gynaecology at the Medical University of SA (Medunsa) – she could not have anticipated the pressures that lay ahead.

Since she took over the directorate in December 1998, HIV/AIDS has become one of the most important and controversial issues in South African – and global — politics.

Her appointment came shortly after a string of disastrous state interventions into HIV/AIDS. In 1996, there was Sarafina 2, in which R14-million was wasted on AIDS awareness play that reached no one. In 1997, government tried to force through human trials on the “AIDS cure” Virodene, which turned out to be an industrial solvent. In 1997, it tried to make HIV a “notifiable disease” despite massive opposition. In 1998, President Thabo Mbeki declared the anti-retroviral drug, AZT to be toxic.

After her appointment, things got even tougher. Last year, President Mbeki lent his ear to discredited scientists who claimed there was no link between HIV and AIDS and faced virtually unanimous condemnation in the world media.

Frequently under attack for its political blunders, the embattled government has often taken a confrontational stance against critics of it’s HIV/AIDS policies.

Yet confrontation seems to be the very antipathy of the soft-spoken, warm and dignified Simelela.

David McCoy of the Health Systems Trust, a non-governmental organisation that works closely with the Department of Health, believes that Simelela is a successful official precisely because she’s not dictatorial or of the “little grey man” school.

“Simelela is battling within a very unfriendly bureaucratic environment,” says McCoy. “For every one Nono Simelela, there are four or five officials who reflect a degree of incompetence and an arrogant refusal to acknowledge that they don’t know what they are doing. We need to support her and keep her in public health.”  

However, while there is general respect for Simelela’s intellect and intentions, some in the NGO world say that the directorate lacks the management capacity to implement government’s HIV/AIDS policy in a forceful and efficient manner.

Born in Sophiatown 40 years ago, her schoolteacher father and midwife mother sent the young Nothemba Princess off to Catholic boarding schools which offered a better education than the Bantu education being shovelled out in township schools.

“The first school I went to was run by Irish nuns in the middle of a forest in the North West, past where Sun City is today. We had no distractions so we just had to study.”

 By Standard Eight, it was clear that Simelela excelled in studying, particularly in the sciences. “I had already decided to pursue a career in the sciences and as the school didn’t offer matric mathematics, I moved to a school in Vryburg [Northern Cape].”

Her decision to become a doctor, however, was prompted by witnessing the indifference of white doctors to their black patients.  

“I was once taken to a rural hospital in the Northern Cape run by nuns. There I saw a doctor consulting with patients under a tree. He was making them breathe deeply but the stethoscope wasn’t even in his ears. He was just playing with them. Then I became convinced that I should become a doctor.”

Excellent matric results secured Simelela an Anglo American merit award and a scholarship to study medicine at Medunsa in 1978. She later became the first black woman gynaecologist to qualify in South Africa.

Of this brilliant achievement, Simelela says modestly: “I am happy that I finished. It was hard work. But it is fulfilling to know that I may have influenced other young women to qualify as gynaecologists.”

After spending some time in private practice and lecturing at Medunsa, Simelela was ready for “new challenges” and decided to move into HIV/AIDS management.

“I had already seen and managed a number of HIV positive patients. These were people with pelvic infections and women who had had caesareans but became very ill because their wounds were not healing. So I was aware of the impact the disease was having on people.”

Despite the unbearable public pressure that comes with her job, Simelela says she is pleased that “there is now an awareness and a vibe [about HIV/AIDS] in South Africa. We are being forever challenged as government, but that is OK because people are now talking about it and asking questions on the streets.”

Although her work is all-consuming, Simelela describes her three children “probably the best thing in my life.”  

But her voice quietens as she explains: “They have had to grow up so quickly and they are suffering because I don’t see them as much as I would like to. Their father passed away three years ago, and so they have nothing but me. I wish I could be there more for them.”

Having witnessed the “craziness” of their mother’s life, Simelela laughingly says that her three children are unlikely to follow in her footsteps.  

“Thabang, 18, has just completed his matric. He’s into the arts and has a part-time job at K-TV. Noni, 16, is the studious one. She tells me she wants to be an astronaut. Rudzi, my baby, is 12. She’s sings and dances all the time.”  

Simelela describes her mother as her “strength”, who often comes from her Soweto home to stay with the children when work takes Simelela away – as it so frequently does.

Sadly for the children, Simelela’s priorities for the next year are going to take her away from them even more.  

“I want to help the provinces to consolidate and build their structures to deal with mother-to-child transmission [of HIV], voluntary counselling and testing and home-based care. If they don’t have enough staff, I must ensure they get the staff.

“We need to train healthcare providers to deal with opportunistic diseases. Ensure that the necessary drugs are supplied.”  

The list is endless in a country that is home to more HIV positive people than any other in the world.

And so too are the demands on one small, intelligent, compassionate woman who is trying to do her best to combat a pandemic characterised by pain, fear and political manoeuvring.