He Fixed South Africa's AIDS Policy, Now He's Out To Fight Salt

Dr. Aaron Motsoaledi had arrived in the U.S. for a two-week visit. "I'm here to meet influential people," he says energetically despite having just gotten off a transatlantic flight.

Motsoaledi became the South African Minister of Health in 2009. He took over a national health system attempting to deal with the worst HIV/AIDS epidemic in the world, with nearly 30 million cases. His highly controversial predecessor, Manto Tshabalala-Msimang, was possibly best-known for claiming that AIDS could be cured with a cocktail of garlic and beetroot.

Tshabalala-Msimang was forced out in September 2008 and briefly replaced by an interim minister. Then Motsoaledi took over. Here are excerpts from his conversation with NPR.

Motsoaledi oversaw the expansion of anti-retroviral drug treatment for HIV to public clinics across South Africa.

Motsoaledi: "One of the weaknesses in South Africa [in the past] was a wrong HIV/AIDS policy. I'm sure you know about that. It's legendary. So we started five years ago to put together huge programs on HIV/AIDS. That's why now our program is one of the biggest in world. Thirty percent of all the people who are in treatment for HIV in the world are in one program — the South Africa program. It's huge, but we're actually planning to double it in the next 24 months. Now it's got 2.4 million people on treatment. We want to raise it to 4.6 million people in the next 24 months."

Tuberculosis is the leading cause of death in South Africa, with 25,000 deaths in 2010 attributed to TB directly. (Death notifications cite 62,827 deaths in which the patient had both HIV and TB infections, but in those instances, the cause of death is given as HIV.) The health minister says his country is now making significant progress against the disease, crediting a diagnostic machine called the GeneXpert.

Motsoaledi: "Before the advent of GeneXpert it used to take us five days to a week to diagnose a person with TB. In other words if you're coughing, you have TB signs, you go to health facility, they'll take your sputum, then you wait a week before they give you the results. With GeneXpert you only wait two hours, you can be treated immediately. Before GeneXpert when you are in treatment for TB and you're not getting better, it took us three months to conclude that this must be drug-resistant TB. That decision was made after 3 months of you actually spreading [drug-resistant TB]. But with GeneXpert we are able to make that decision within two hours of the diagnosis. That is a game changer."

Motsoaledi says South Africa is also facing what he calls "exploding pandemics" of non-communicable diseases: high blood pressure, diabetes, cancer, chronic lung disease. "These ones are on the march in any part of the world," he says. "It no longer matters whether you are rich or poor."

Non-communicable diseases are now placing a huge burden on public hospitals and clinics in South Africa. Motsoaledi has started telling people they need to take more responsibility for their own health.

Motsoaledi: "Changing people's behavior is a very difficult thing. In South Africa people are already saying, 'You're becoming a nanny state. You must allow us to choose.' In simple language they're saying, 'Allow me to get as sick as I can, and you fix me as a state.' Which is a very wrong phenomena. It means people are starting to assume that for every illness, government or scientists have a ready-made solution to reverse it. That's not how the world is. It's just a dream of people. They don't want to say, 'Look I must also try my best not to get ill especially when it comes to lifestyle diseases.'"

In order to cut rates of high blood pressure Motsoaledi has been trying to force South African food companies to reduce the amount of salt in bread, soups, snacks and other processed foods. But he's met fierce resistance both from industry and ordinary people.

Motsoaledi: "Some [companies] are very uncomfortable. They're fighting and saying, 'Why can't the government provide dialysis and kidney transplant?' It's some form of mental retardation to think like that, really. We say, 'If you do this, you are going to keep your normal kidneys.' You say, 'No, I don't want to keep them. You must provide me with new kidneys.' It's very difficult to get a kidney transplant, yet that's what people seem to be fighting for and we want to reverse them from that."

South Africa is a long way from the epicenter of the Ebola outbreak and hasn't had any cases, but Motsoaledi says his nation is nonetheless affected by the crisis.

Motsoaledi: "Just two weeks ago somebody posted on the web [in China] that there is a case of Ebola in South Africa. [The post] lasted about 6 or 12 hours, and it caused us big damage. People started canceling trips to South Africa. So last week I had to travel to Hong Kong and Beijing to talk to tour operators. Because China had a big problem with [the flu virus] h1n1 five years ago, many of them thought Ebola spread like h1n1. I explained that it is not true. When I left South African [tourism officials] reported that about 194 bookings which had been canceled have been re-enacted."

Motsoaledi has dispatched a South African diagnostics lab to help in West Africa, but he says his country doesn't have large numbers of doctors or nurses available to help treat Ebola patients. He also noted that South Africa has put in place travel restrictions on people coming from Ebola-affected countries. Even though the South African media calls it a "ban" Motsoaledi says he doesn't like to use the word "ban."

Motsoaledi: "All we said is, people from that area when they travel, it shouldn't be just willy-nilly. It must be essential. People traveling for business, we don't stop them. All we wanted was to make them apply so we can screen them, and so I know who traveled from that area into South Africa."