When little Tsidiso (4) goes to sleep at night, his mouth and throat covered in thrush, he doesn’€™t wonder whether HIV causes AIDS. All he knows is that six months ago he had parents. His life was uncomplicated, but he lost both his parents within the space of two weeks.

Now Tsidiso, orphaned and HIV positive, and his five siblings have to rely on the mercy of others to feed them.

While tragedies such as these are played out daily, South Africans are trying to come to grips with an epidemic that is threatening to wipe out any development gains made by the fledgling democracy.

In South Africa, the epidemic is projected to reduce the economic growth rate by between 0,3% and 0,4% annually, resulting by the year 2010 in a gross domestic product (GDP) 17% lower than it would have been without AIDS and wiping U$22-billion off the country’€™s economy (UNAIDS report).

The question now is, will South Africa be able to stem the tide before it is too late? Will the country show a commitment towards finding innovative ways to treat the already more than four million people living with HIV/AIDS or providing a sanctuary for the millions of orphans that will result from the epidemic?

Or will our response continue to be questions related to the link between HIV and AIDS, the toxicity of drugs such as AZT or the vested interests of the drug companies.

There is no doubt that President Thabo Mbeki’€™s debates centred around the causes of AIDS have caused damage, whether intentional on his part or not.

Rather than people talking about abstaining, being faithful or condomising, the question, “Why should I use a condom when my president says AIDS does not exist” is still heard.

Mary Crewe, Director at the Centre for the Study of AIDS at the University of Pretoria, said Mbeki’€™s questioning had allowed a space for denial and a refusal to think about behaviour and behaviour change and had stifled debate. But it has also has raised the profile of AIDS in the country to a level where it has never been before, Crewe said.

“It has got more people talking about AIDS and debating the issues, but the effectiveness of this is stifled by the first two points,” Crewe said.

Morna Cornell of the AIDS Consortium, an umbrealla body for AIDS non-governmental organisations, has no doubt that Mbeki’€™s impact has been massive.

“It has been extremely damaging and we continue to feel the impact,” she said.

Cornell said the fact that Mbeki had withdrawn completely was also not appropriate as the president should be driving a “very strong and concerted” AIDS campaign.

She said the fact that AIDS had become a political playball held no benefits and that political parties should show a commitment to all South Africans and not only those in those wards they control after the December 5 elections.

But Crewe pointed out that everyone had complained previously that AIDS was being ignored by political parties. “Now they do have policies and plans and everyone complains that they are making AIDS political.

“People living with AIDS who vote should hold the parties accountable if they make promises,” Crewe said.

Professor Olive Shisana, head of the Department of Health Systems Management and Policy at the Medical University of Southern Africa, said the positives were that when political parties debated the issues and made promises, it forced others to rethink their own AIDS strategy.

Shisana, a former director-general in the national health department, said the disadvantages were that the party promising services ran the risk of creating expectations it might not fulfil.

What is becoming increasingly clear is that the treatment of those people living with HIV/AIDS is becoming central to all responses to the epidemic.

“We are trying to control an epidemic and if your prevention programme is not linked to treatment there is no benefit,” said Cornell.

She said the mother to child transmission programme in the Western Cape had led to much higher levels of awareness and risk in the community.

“Unless you are able to offer people treatment, there is no incentive for them to be tested,” said Cornell.

While central government appears to be seriously pursuing the phased implementation of mother-to-child (MTC) transmission programmes using nevirapine, the Western Cape is rolling out an MTC prevention programme using the drug, AZT.

For the past 22 months, the province’€™s health department has been running an MTC programme in Khayelitsha in partnership with Medicines Sans Frontieres.

This will now be extended to Gugulethu, Langa, Bonteheuwel, Paarl, Worcester and George between January and April next year.

“In Khayelitsha they had an 88% take-up of HIV testing since the implementation of the prgramme. The spin-off is incredible,” Cornell said.

Shisana cautioned that programmes should not only focus on prevention and care, but also on social development.

“Poverty increases vulnerability to HIV infection and AIDS. This has been known for many years, but not adequately addressed by many countries. But at the same time AIDS may cause poverty.”

Shisana said the fact that South Africa had the highest number of HIV infected people in the world, meant “we are not doing enough”.

“And here I do not mean Government, I mean all of us.”

But at the end of the day the buck does stop with Government to provide firm leadership, feeding all the responses through and around it.

Government’€™s strategic plan for the next five years centres around the priority areas of prevention; treatment, care and support; legal and human rights; and monitoring, research and evaluation.

To implement these plans costs money and Government is yet to match its public announcements with budgeting commitment as reflected in its failure to increase health spending in the next three years.

Shisana said if all sectors were doing enough, the country would not be where it was now, with 1 600 people infected daily.

“We have a national crisis that demands an emergency response. We need billions of rands to deal with HIV/AIDS in a comprehensive fashion. A nation is dying in front of us, yet our response is not commensurate with the magnitude of this problem.”