South Africa has possibly just experienced the most significant two weeks in the some 20-year history of the AIDS epidemic. It all began on Monday, July 28 when Medicines Control Council registrar, Dr Precious Matsoso, made the sudden and shocking announcement that nevirapine might be deregistered for use to prevent the transmission of HIV from mother to child.

“Here we go again!” screamed the headline of one South African daily.

After more than four years of often acrimonious public bickering between Government and a variety of interested parties, high profile court cases, civil disobedience and seemingly endless delays around the rollout of a national ARV treatment plan, the exasperated, cynical tone was hardly surprising.

Then, almost unbelievably, twelve days later on the afternoon of Friday, August 8, long after many newsrooms had packed up for the pub, a cabinet press release was issued by the GCIS (Government Communication and Information System). No fanfare, no drum roll, whistles or bells. Just the usual press statement with GCIS head Joel Netshitenzhe’s name and cell number at the end of it.

About three quarters of the way into the officialese was the nugget: “Cabinet decided that the Department of Health should, as a matter of urgency, develop a detailed operational plan on an antiretroviral treatment programme..It is expected that this detailed work would be completed by the end of September 2003”.

Radio, television and print journalists had little time to pick up on or digest the meaning of it all that particular weekend. And while everyone was trying to come to terms with what it all meant, other significant developments seemed to slip by almost unnoticed.

A few days after Matsoso’s announcement, the first national AIDS conference, hosted in Durban, saw more than 2 000 scientists, researchers, activists, health professionals and government officials gathered under the same roof.

The networking that took place outside the main sessions was extraordinary with intense discussions and debates around tables or in the passages of the International Convention Centre.

Politicians were noticeably absent except for the host province’s health MEC, Zweli Mkhize, who kept a low profile until the last day of the conference when he offered a hint of things come.

He ended his speech with the statement that it was no longer a question of “whether” government would be providing anti-retrovirals, but rather “when”. He clearly had inside information but at that stage everyone was too battle-weary to really hear it.

Health minister Dr Manto Tshabalala-Msimang and Deputy President Jacob Zuma had both left after giving unremarkable speeches at the opening of the conference on the Sunday.

The conference ended with a sense of goodwill with Matsoso and the scientists making a commitment to finding further studies required to verify the efficacy of nevirapine so as to ensure that the drug continues to be registered for use in PMTCT.

In another significant development the MCC announced that it had registered several generic anti-retrovirals paving the way for local manufacturers to develop and produce cheaper versions locally.

SA Medical Association chairperson Kgosi Letlape received the loudest applause at the Durban conference when he appealed to President Thabo Mbeki to take the lead in fighting the epidemic.

Letlape’s words had hardly been uttered when the President, after months of dithering, added his signature to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria agreement, injecting a massive U$41-million over two years into the South African coffers for treatment and prevention of HIV/AIDS and TB.

Then came August 8 when a special Cabinet meeting confirmed it had seen the much debated task team report costing the rollout of anti-retrovirals.

Significantly the Treatment Action Campaign immediately suspended their civil disobedience campaign.

“There is cause for optimism and celebration,” they opined.

But judging from some of the debates and discussions that have taken place since the announcement, it is clear that many South Africans are still sceptical, preferring to “wait and see.”

The British journal, The Lancet, summed up the feeling: “many South Africans with HIV/AIDS have waited a long time while being repeatedly disappointed by their government leaders, many have died. South Africans are understandably impatient and sceptical. But now there is a real chance to leave the past behind and move swiftly forward to a better future for the people of South Africa. We urge the government to put the recommendations into practice.”

The real challenges and work begins now and it will no longer be appropriate to apportion all the blame and responsibility at government’s door. Those with skills will have to come to the party. Sitting on the sidelines and shouting the odds is no longer appropriate. But it is also important to acknowledge that much work has already been done – thousands have been treated for opportunistic infections, there is an attempt to address poverty by increasing access to grants, prevention efforts are being stepped up and government is elevating the critical importance of nutrition.

Civil society will have to step forward, playing a role in ensuring that the 40-million South Africans who are not infected are well informed and educated about the importance of preventing new infections. We need to stem the tide.

As Letlape said: “Time is not on our side.the fight against HIV/AIDS should become a 24 hour job, not an eight to four job.”