Leading article: Death and denial

In many ways, Thabo Mbeki has been a successful leader of South Africa since he took over from Nelson Mandela in 1999. The country has registered impressive economic growth in recent years. And President Mbeki has helped to heal some of the racial divisions left over from the apartheid era.

But there is one particular area in which President Mbeki has been a scandalous failure: in confronting the scourge of HIV/Aids. More than one in 10 of the population are infected. It has been estimated that 1,000 South Africans are dying of an Aids-related illness every day. Yet President Mbeki for a long time refused to put his weight behind a safe-sex awareness campaign and the rolling out of anti-retroviral drugs to prolong the lives of the infected.

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In the face of all credible scientific research, he has argued that Aids was a "disease of poverty" rather than a sexual infection. Even now, when the link between the HIV virus and Aids is beyond dispute, President Mbeki is begrudging of anti-retrovirals and criticises outside attempts to help to ease the problem as a manifestation of neo-colonialism.

And there are worrying signs that the situation is about to get worse. Yesterday, South Africa's deputy health minister, Nozizwe Madlala-Routledge, was fired by President Mbeki. This was supposedly because she attended an Aids conference abroad without the president's permission. But the likelihood is that she was the victim of a power struggle with her boss, the health minister Manto Tshabalala-Msimiang.

Ms Tshabalala-Msimiang is a close ally of President Mbeki and someone who shares his sceptical attitudes on Aids. Indeed, Ms Tshabalala-Msimiang's views are even more outlandish. At a conference in Toronto last year she extolled the virtues of garlic, lemons and beetroot as an alternative remedy for the disease.

Ms Tshabalala-Msimiang, who has recently returned to work after having a liver transplant, was known to be unhappy at what her deputy had done in her absence. Ms Madlala-Routledge was one of the driving forces behind a plan to extend anti-retroviral treatment to 80 per cent of those with Aids by 2011. This focus is exactly what South Africa's Aids programme had been lacking. But now Ms Madlala-Routledge has gone, there is a serious danger that the momentum towards this goal will be lost.

The social stigma and denial surrounding Aids in South Africa will only be eradicated through strong political leadership. The tragedy for South Africa is that such regressive attitudes seem as entrenched at the top as they are throughout wider society.