updated 8/24/2009 7:49:50 PM ET 2009-08-24T23:49:50

Researchers for a leading international medical journal say South Africa's health system is failing women and children in particular, but that new leadership could solve many of the problems.

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At a meeting in Johannesburg, South African Health Minister Dr. Aaron Motsoaledi listened attentively as The Lancet experts detailed the findings of an issue released Tuesday devoted to his country.

His willingness to engage with scientists — contrasting with a predecessor's insistence that AIDS should be treated with beets and garlic — was hailed as an important step forward.

It was unclear, though, when Motsoaledi's new leadership style would produce the new action South Africa so direly needs.

Still, "I sense a willingness to learn from the mistakes of the past," Dr. Bongani Mayosi, head of the University of Cape Town's Department of Medicine, said in an interview.

Mayosi was the main author of an article in The Lancet's South African issue on emerging epidemics of stroke, heart disease and other non-communicable diseases here. Other articles detailed indifferent and incompetent nurses and doctors, crumbling hospitals, the struggle against AIDS and the burden criminal violence places on the health system.

Researchers noted that South Africa is one of the few countries in which the rate at which children are dying has increased in recent years, in part due to AIDS.

"Failure of leadership in tackling the HIV epidemic is a fundamental reason for poor health outcomes," one article concluded.

"There has been a conspicuous absence of government-promoted stewardship and leadership," said another.

Richard Horton, editor of The Lancet, said the implications were far-reaching. If the country with Africa's most sophisticated health system can't build a workable health system, "that will be an extraordinary failure of leadership" not just for South Africa, but for the continent

Motsoaledi, in an interview with The Associated Press about The Lancet issue, said it was not the first time South Africa's wider responsibilities had been impressed upon him.

"We accept that," he said. "We must take the lead."

At one point during The Lancet presentation, Motsoaledi moved from the head table to the audience to get a better look at a researcher's slide presentation, beckoning to an aide to bring his glasses.

"I feel we need to work with anybody who is trying to find solutions," Motsoaledi said, adding The Lancet issue was also a chance to keep health on the agenda at a time when donors are watching spending more closely because of the global financial crisis.

South Africa, with a population of around 50 million, has an estimated 5.5 million people living with the HIV virus — the highest total of any country.

As the epidemic raged, former President Thabo Mbeki, who stepped down last year after nearly a decade in power, denied the link between HIV and AIDS, and his health minister Manto Tshabalala-Msimang, mistrusted conventional anti-AIDS drugs.

"Yes, we did adopt very wrong policies," said Motsoaledi, appointed to his post in May by new President Jacob Zuma. "It was wrong, and it set us back 10 years."

But Motsoaledi did not promise a quick turnaround. He said, for example, his government was just starting a review that would decide how strongly it would endorse circumcision as a means of preventing AIDS.

Studies have shown circumcision can cut the risk of HIV infection by as much as 60 percent, and some of South Africa's neighbors have made the procedure widely available. But Motsoaledi said some in South Africa have expressed fears that men who undergo the procedure might become complacent and more likely to have unprotected sex.

Motsoaledi said circumcision as a medical intervention also would have to be explained in a way that took into account differing traditions in South Africa, where some tribes routinely circumcise young men as a rite of adulthood and others do not.

The review involved government officials, health workers, AIDS activists and representatives of groups that promote and protect cultural traditions. Motsoaledi could not say when it might be completed.

"It is something that is frustrating," he said. "I can stand up and say, 'As many people as possible must go and circumcise.' What I can't say is it is government policy."

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