Every morning at 8:00 am, after his mobile phone alarm goes off, Thabo Moloi reaches for his pill box and swallows two small life-saving tablets.

"As long as I have my medication in my pocket, I don't worry," said the 30-year-old South African, about the twice daily ritual he has followed since starting anti-Aids treatment three years ago.

"My health is perfect," said Moloi. "I attribute it to the ARVs (anti-retro virals). They are my petrol: if I'm not taking my ARVs, then I won't move."

Moloi is part of the world's largest Aids treatment programme which the South African government now boasts after years of refusing to use ARVs at the peak of the epidemic.

The failure to act came right from the top: while the disease cut through South Africa, former president Thabo Mbeki questioned the link between HIV and Aids, then saying he did not know a single person who was HIV-positive.

At the same time, his health minister and loyalist Manto Tshabala-Msimang was dubbed "Dr Beetroot" for proposing lemon juice, olive oil, garlic and beetroot over ARVs to treat the disease.

Premature deaths

The lack of the critical drugs led to the premature deaths of 330 000 people and 35 000 babies being born HIV-positive between 2000-2005, a recent Harvard study found.

"Those people are dead because of the previous health minister and the previous president. It's that simple," said Dr Francois Venter, head of the Southern African HIV Clinicians Society.

"We had the chance to lead the response to the epidemic but instead we were the poster-child for 10 years of failed opportunity."

Today, some 550 000 South Africans have enrolled for Aids treatment — up from a mere 12 000 in September 2004, the year the drugs were made available.

But while welcoming the progress, experts say the country still faces a huge treatment gap which means that people are still dying unnecessarily.

"At the moment, we're meeting about 40 percent of need," said Venter, who says the government does not deserve any congratulation after years of dithering and that Mbeki and Tshabalala-Msimang should be held accountable.

The largest HIV population

"We have the largest programme but we also have the largest HIV population, so it's nothing to be proud of."

The South African government has radically shifted its stance on Aids since the former health minister was shuffled to a low-profile post by Mbeki's successor in September.

New Health Minister Barbara Hogan quickly set the tone for how her department will tackle the scourge that affects some 5.5 million South Africans: "We know that HIV causes Aids," she affirmed.

Hogan's appointment has been widely welcomed, with the advocacy group, the Treatment Action Campaign's Andrew Warlick calling her a person of "highest moral integrity".

"We've also seen the compassionate tone that one would expect from a health minister whose country is in the grips of a major public health epidemic like HIV," he added.

South Africa will hold an unprecedented national minute of silence for World Aids Day on Monday, with government, activists and business joining in.

Hogan the "new Obama" for health

Venter describes Hogan as "new Obama", pointing to her inheritance of a "system from hell" which she has shaken up in short time.

"You don't have that terrible defensiveness anymore," he said. "Now people are saying yes it's true, what can we do?"

But the task of lowering new infections, widening treatment and getting people to voluntarily test their status is no small matter and is compounded by years of inaction.

The disease has killed two million people since it first arrived in the country in the 1980s and 70 000 HIV-positive babies are still born annually, Warlick said.

"The legacy left by the former minister of health doesn't just extend to the HIV, it extends to the health system as a whole," he said.

"She left behind a woefully dysfunctional health system and the treatment gap that we see in terms of ARV coverage is one of the myriad of symptoms."

The 2004 roll-out of drugs at state hospitals was too late for Moloi's sister who died aged 32 as her family could not afford the R1200 ($120) per month needed for treatment in the private sector.

The family literally watched her die.

"If they made the drugs accessible long ago, my sister would still be alive," said Moloi, who remains angry at the government's failure to act timeously.

"You can live a normal life by taking ARVs," he told AFP. "I'm talking from my experience — there is nothing I can't do."

AFP