JOHANNESBURG, 20 August 2009 (PlusNews) - The South African National AIDS Council (SANAC), long perceived by activists as largely dormant, awakened to make groundbreaking recommendations to government earlier this month. Dr Nono Simelela, who takes over as the new CEO on 1 September, spoke to IRIN/PlusNews about where she would like to take the council.

Despite the challenges, Simelela said she was drawn to her new post at SANAC primarily because it would offer her a chance to work in a sector she feels passionately about, and in what she called a "conscious environment" - given current political leadership - which the country desperately needed.

Simelela was the first South African black woman to qualify as a specialist obstetrician and gynaecologist, which led to a 20-year career in the Department of Health, culminating as chief director of the National HIV, AIDS and TB programme in 1998 until she left in 2004. It was a time when HIV treatment was largely unavailable and the fight against HIV/AIDS under the country's then health minister, Dr Manto Tshabalala-Msimang, was heavily politicized.

"I think everyone knows it was a very challenging time in South Africa ... in many ways. The magnitude of the epidemic was really brought to the fore, and the need to move quickly, in terms of treatment and care, was evident," Simelela told IRIN/PlusNews on the phone from London, where she heads the technical knowledge and support division of the International Planned Parenthood Federation (IPPF).

"It was tough and you had to hang in there, [but] I think that it was necessary. The fact that we did get a plan and have people accessing treatment has been a huge positive outcome."

She said South Africa's antiretroviral programme - one of the world's largest - remained one of its biggest achievements, but also noted the recurring drug shortages, poor monitoring and evaluation, and the need to slow new infections.

"We haven't really established a robust monitoring and evaluation system across all sectors, including government. We've got the National Strategic Framework, and targets that have been set, but we need a robust tool to monitor progress so we know what needs to be done," she said.

"The fact is that we have an epidemic that is raging, and new infections are still occurring. We need to go back to the prevention side of things to look at what we're not doing well enough."

The road ahead

Simelela said she hoped the mix of local and international experience of the HIV epidemic would help her and SANAC make much needed changes. At the forefront would be strengthening provincial and district AIDS councils, which are not only points of service delivery but also collect crucial data.

"We have a lot of good policies, but when it comes to implementation they falter," she said. "We need to be sure provincial and district councils are able to implement their HIV/AIDS plans. It should almost be a bottom-up approach - issues would come up at the district level and the national council would then look at ways of resolving them."

Although long inactive, SANAC still provides a crucial interface between government and civil society, ensuring that the people implementing policies at whatever level are held accountable. Simelela told IRIN/PlusNews that the reawakened giant meant a renewed opportunity to make a difference in people's lives.

"For me, it's almost more about an agenda for social justice, not only to provide people with treatment but to raise issues around HIV, such as the economic issues that, I think, South Africa is grappling with now," she said.

"There's a way to respond but at the moment we need to coordinate that response - I get the sense that if we work collaboratively across all sectors, there is a chance we can turn things around."