Men missing in HIV fight, says SANAC CEO

Written by Kerry Cullinan

Unless men start to behave responsibly, South Africa is facing a “runaway epidemic”, according Dr Sandile Buthelezi, new CEO of SA National AIDS Council (SANAC).

“Research shows us that adolescent girls are being infected by men aged 25 to 40 years. They hardly use condoms, some abuse alcohol and are perpetrators of gender-based violence. They don’t know their HIV status,” says Buthelezi.

Every week, around 2000 young South African women under the age of 25 are infected HIV, and while Buthelezi says the country is doing well with treatment “we have to stop new infections because there is going to come a time when the fiscus simply cannot afford to pay for treatment”.

An estimated 7,1 million South Africans are living with HIV – and about 4,2 million are on ARVs.

“This World AIDS Day I would like to call on men to start playing an active role in preventing HIV and for all South Africans to start taking personal responsibility,” says Buthelezi, who took on the position of steering the country’s HIV programme three months ago.


SANAC’s public image has taken a beating over the past year. The Treatment Action Campaign (TAC) has threatened to withdraw from its civil society forum. It accuses the forum’s head, Steve Letsike, of manipulating the elections of the forum’s 18 sectors to secure her position and enable her clique to profit from SANAC work.

In addition, the previous CEO, Dr Fareed Abdullah, was unexpectedly told that he would not be reappointed two weeks before his five-year contract came to an end late last year. There was speculation that the health department had a preferred candidate – but this rumour did not manifest when months went by with no appointmen.

The council had been without a CEO for nine months when Buthelezi took office in September. He denies emphatically that he was asked to apply for the CEO position and says that it took SANAC three months to call him for an interview so “I had even forgotten about it”.

Buthelezi knows that the CEO hot seat might well burn him – and he has already faced hostility with TAC’s general secretary, Anele Yawa, describing him as an “AIDS denialist”.

“But it felt like the right time to work in the public sector again. [Health Minister] Dr Aaron Motsoaledi has built a very good basis for addressing HIV, and to undo things that went seriously wrong,” said Buthelezi, who was the General Manager of KwaZulu-Natal’s HIV programme from 2006 until 2010.


While never an AIDS denialist, Buthelezi has some skeletons in his past – and he says that he “quite definitely has regrets”.

He worked under Peggy Nkonyeni, the controversial former health MEC for KwaZulu-Natal, for five years. During that time, he joined the pack that bayed for the blood of a group of Christian doctors at Manguzi Hospital who had raised their own funds to give pregnant mothers with HIV a second antiretroviral, AZT, to try to protect their babies from infection.

At the time, the national policy was to give pregnant women only one ARV – nevirapine – although the World Health Organisation (WHO) had declared that a combination of two ARVs was much more effective. The Western Cape was already offering this dual therapy and had slashed the infection rate of newborns to around five percent, while KwaZulu’s infection rate was sitting at around 30 percent.

Buthelezi publicly declared that the doctors were violating national policy.

“I was a junior official and I could not go against national policy,” Buthelezi defends himself. But he denies that he worked with local health officials to persecute the doctors, Colin Pfaff and Victor Fredlund, who faced insubordination charges that were vigorously pursued by Nkonyeni, a close associate of Manto Tshabalala-Msimang, the former health minister who presided over the country’s AIDS denialist phase.

[quote float = right]“This epidemic will never be defeated in the board room but in communities. Civil society is very important.”

Buthelezi was eventually shafted himself, accused of giving a relative of his wife a R30,000 catering contract in one of the province’s sub-districts.

“I had no control over tenders in the districts. I had already resigned, and the disciplinary hearing was set for my last day,” says Buthelezi. “Imagine someone in my position risking my job for R30,000!”

All he will say is that “politics” was to blame for him for the allegation and that the province has since withdrawn all charges and that the current provincial MEC, Dr Sibongiseni Dhlomo, provided him with a reference for the SANAC position.

Buthelezi worked as a consultant for a number of years, and for the past four years he was the Country Director for Icap, a project linked to Columbia University that works to strengthen government responses to HIV in various countries.

Buthelezi is extremely concerned to mend relations in SANAC’s civil society forum.

“This epidemic will never be defeated in the board room but in communities. Civil society is very important.”

He says that he has looked into the forum’s elections, which were conducted by the Independent Electoral Commission (IEC), and could find nothing wrong with the process.

But he has been tightening up governance procedures – developing a code of conduct and conflict of interest guidelines – to go to the February plenary.

“The problems [in the civil society forum] are symptoms of the non-finalisation of procedural guidelines,” says Buthelezi.

However, Abdullah, the previous CEO, had already developed a conflict of interest document. The problem was that SANAC board members hadn’t bothered to sign them.

“We had a very cordial meeting with the Deputy President [Cyril Ramaphosa, who chairs SANAC) and TAC after my appointment in September. They promised to give us their concerns in writing. I have followed up with Anele Yawa and he says they are still busy with that,” says Buthelezi.

Treatment adherence

About half of South Africa’s 450,000 new TB cases annually are among people living with HIV (File photo)

He has also been trying to raise donor money for civil society organisations, because these are the organisations that ensure the people adhere to ARV treatment.

“There is no point spending a lot of money on ARV treatment if people don’t take their medicine and disappear. That will be wasted money and we will get resistance,” said Buthelezi, adding that Lotto has allocated some money for civil society work.

But how Buthelezi dishes out the Lotto money will be a key test of his strength and leadership. One of the main reasons for the fight in the civil society sector hinges on access to resources, which are getting more and more scarce for civil society.

Letsike has openly admitted to trying to do business with government and has her own NGO, Access Chapter Two. TAC’s resources have been dwindling year by year and it will certainly want a stake.

Both Buthelezi and his predecessor have the technical expertise to led SANAC. But Abdullah was renowned for being unafraid to take unpopular decisions, which is said to have led him into conflict with some of the powerful forces at SANAC. SANAC needs strong and decisive leadership, and the country needs Buthelezi to be up to the task to steer the country’s HIV response. – Health-e News.

About the author

Kerry Cullinan

Kerry Cullinan is the Managing Editor at Health-e News Service. Follow her on Twitter @kerrycullinan11