The big question
Why are we asking this now?
The South African leader has just announced a barrage of new HIV and Aids commitments that he bills as "the opening of a new era" in the fight against the disease.
Jacob Zuma used World Aids day on Tuesday to make a rhetorical break with the denialism of his predecessor Thabo Mbeki and meet what most health experts agree are the major policy commitments needed to arrest the crisis and start to diminish the impact of the pandemic in the country it hits harder than any other.
What did he say, and how can we be sure he meant it?
While it is obviously important what he said and the detail of the policies, it matters politically how he said it and what he chose to emphasise. The new policies call for earlier treatment for all patients diagnosed with Aids or tuberculosis, the biggest killer of HIV positive people; a huge expansion of HIV testing; for pregnant women to receive anti-retroviral drugs (ARVs) to reduce the number of infected babies being born; and for all babies who test positive to receive drug therapy.
In rhetorical terms the normally macho Mr Zuma made moves to remove the stigma which still clings to the country's biggest killer of young adults. In the audience for the address was the daughter of Gugu Dlamini, a woman stoned and stabbed to death in 1998 after revealing on a radio show that she had HIV. "To families looking after sick relatives, we wish you strength," Mr Zuma told a live television audience.
"We understand what you are going through. To those who have lost their loved ones to the epidemic, we share your pain and extend our deepest condolences." The showman president's very public embrace of those living with the disease may be as powerful as policy changes.
How bad is the HIV/Aids crisis in South Africa?
So bad the statistics are almost impossible to digest. The country of 50 million has some 5.3 million people infected with HIV, by far the highest number of any country in the world. There have been an estimated 413,000 new infections this year alone. Someone dies of HIV-related illness every two minutes in South Africa.
There are still nearly 1.5 million people with HIV not getting ARVs, of whom more than 100,000 are children. This despite the fact that South Africa has more patients on AR drug therapy than any other country, a massive burden on a developing country with a chronically stressed national health system.
If you spotlight almost any demographic, horrifying figures emerge: one third of all South African women between ages 25-29 are HIV positive; there are 1.4 million Aids orphans and experts believe that one third of all children in the country will have lost one or both parents to the disease by 2015. Practically the only bright spot is that the rate of new infections has plateaued. But the number of HIV-related deaths will continue to soar for the next five years.
How does this change things?
Hugely. At present life-prolonging anti-retro viral drugs that have transformed the life expectancy of HIV sufferers in the industrialised world are only available to HIV positive South Africans whose immunity levels have already fallen dangerously low. The latest accepted diagnosis for identifying the point where HIV becomes full blown Aids is with a count of white blood cells. When the CD4 or T-cell counts are lower than 200 or 14 perent of total white blood cells, it's Aids.
Currently, this is the mark public hospitals wait for before they will dispense ARVs. From April 2010, pregnant women and patients with both tuberculosis and AIDS will receive treatment if their CD4 or T-cell counts are 350 or less.
This is in line with WHO guidelines for reducing the number …