Aids activists and opposition politicians reacted with fury yesterday to the sacking of South Africa’s high-profile Deputy Health Minister after she spoke candidly about the country’s HIV-Aids crisis and the appalling conditions in some public hospitals.

Nozizwe Madlala-Routledge, who won plaudits across the political spectrum for her work, was dismissed by President Mbeki after she refused to resign for allegedly attending a conference on Aids in Spain without presidential approval.

She had previously fallen out publicly with her boss, Manto Tshabalala-Msimang, the controversial Health Minister — dubbed Dr Beetroot for advocating a diet of garlic and beetroot to fight HIV infection. The clash followed an unannounced visit to a public hospital last month where she described the conditions as a national emergency, a view later disavowed by Mr Mbeki in his weekly online newsletter. “This is a dreadful error of judgment that will harm public healthcare,” said the Treatment Action Campaign (TAC), the country’s leading organisation of Aids activists.

South Africa has about 5.5 million HIV-positive people, one of the highest caseloads in the world. An estimated 1,000 people die each day of Aids-related illnesses.

The TAC said that the sacking of Ms Madlala-Routledge would further harm South Africa’s fight against Aids. “It indicates that the President still remains opposed to the science of HIV and to appropriately responding to the epidemic,” it added.

Mr Mbeki’s office confirmed that he had “relieved the Deputy Minister of Health of her duties”, but said that it was under no obligation to give any reasons for the decision.

South African media reports said that the deputy minister was dismissed because she defied the President’s orders and attended the Aids conference in Spain, with her son and a consultant, at a cost to the taxpayer of 16,000 rands (£1,100).

However, ministers frequently travel to meetings and receive approval retrospectively.

Mr Mbeki, who fled apartheid South Africa in 1962 with a group of activists which included Ms Tshabalala-Msimang, has shown her unswerving loyalty in the face of much derision at home and abroad.

After years of foot-dragging the Government has brought forward plans to roll out antiretroviral drugs for HIV-positive sufferers. The deputy minister, who had criticised Mr Mbeki and Ms Tshabalala-Msimang publicly for their approach to the crisis, was at the forefront of a new pro-active government anti-Aids strategy.

“The President has finally found the courage to fire someone, but he has fired the wrong person,” said Patricia de Lille, leader of the Independent Democrats opposition group. “This will have a direct and deadly impact on the lives of our millions of poor.”

Critics said that the dismissal showed how the African National Congress (ANC) placed loyalty above all else. Mr Mbeki has only previously fired his Deputy President, Jacob Zuma, after he was embroiled in a corruption scandal, and a former head of the intelligence services. He has never before dismissed a government minister.

“Ms Madlala-Routledge brought hard work, a love for freedom of expression and the ability to admit mistakes to the ANC Government and she has been rewarded in an outrageous way,” added Ms de Lille.

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