World AIDS Day is today, and the usual analysis of how the world is coping with reducing the global epidemic of HIV and AIDS is enhanced by a story by Celia Dugger in the New York Times last week:  A report by Harvard University estimates that 330,000 lives were lost in South Africa between 2000 and 2005 by the country’s failure to implement a timely distribution of anti-retroviral medication. The study, “Estimating the Lost Benefits of AntiretroviralDrug Use in South Africa,” also says 30,000 babies were born with HIV due to lack of access to proper medication for pregnant women. “there is no evidence yet of major changes in HIV-related behaviour.” Disturbing trends continue: Women are still disproportionately affected, legal reforms that would help protect the rights of women are slow in coming, and the ambitious National Strategic AIDS Plan finished in 2007 is sluggish in producing meaningful results.

This is the cost of denialism in South Africa. President Thabo Mbeki, who was recently ousted by his party, the African National Congress, and his controversial health minister Manto Tshabalala-Msimang were both well known for questioning that HIV causes AIDS. They are both now gone, but the new leader likely to assume the presidency next year, Jacob Zuma, testified in court that he had unprotected sex with an HIV+ woman, adding that he took a shower afterwards. One must wonder how he will lead the fight against AIDS in South Africa.

This is a country where the UN estimates 5.7 million people are living with HIV/AIDS, the highest number of people in any country on the planet. The latest figures from UNAIDS for 2007 show the epidemic may be leveling off, but also that

Every one of the 330,000 people who died because they could not get the medication they needed represents a violation of the right to basic health care. This is why good policy matters and why we need to support the citizens and their organizations that are pushing government to deliver the kinds of wide-ranging measures that will end this HIV and AIDS crisis once and for all. This should include programs for prevention, treatment, care, and support for orphans– all essential. I have visited some of the local community organizations struggling to deliver these services, and they are working day and night to meet the needs of their neighbors because the government can’t do it for them. But these programs must be matched with laws and policies that will reduce the vulnerability of women, and end the stigma, superstition, and conspiracy theories that impede the durable solutions to the crisis.

If the change in administration could end the climate of denial in South Africa, then this is a big step forward. But it is only one step.