AT THE TIME THAT this chapter was first written in early 2005, South Africa was still deeply enmeshed in government-endorsed AIDS denialism. Access to antiretroviral treatment was being resisted and delayed by the government; voluntary HIV testing was not encouraged; and HIV and TB were talked about as unconnected. All hard to believe! At that time this author speculated that South African President Thabo Mbeki's response to the HIV and AIDS epidemic would become the Achilles heel of his government.

However, Mbeki was still in the ascendency. In 2004 he had led the anc to another convincing general election victory and was secure in his leadership within the party and the country. Mbeki's ‘denialist’ position on hiv had been the subject of fierce criticism from trade unions, churches and the Treatment Action Campaign (tac), but the anc itself seemed largely unmoved. Although there had been cracks indicative of some unhappiness with the President's position, these cracks were mere fault-lines for what would later become deep divisions. Indeed, Mbeki's self-confidence and his blindness to public opinion on hiv/aids internationally and in South Africa were evident in his decision to re-appoint Dr Manto Tshabalala-Msimang as Minister of Health after the 2004 general election.

Writing in late 2009 therefore, it seems surprising how quickly predictions that hiv would be the Achilles heel of the Mbeki presidency came true. In a few short years, it has become received wisdom that Mbeki erred seriously on hiv.