The former South African president Thabo Mbeki was accused of having blood on his hands as the human cost of a decade of Aids “denialism” was revealed by a study that claimed 365,000 people had died as a result of misguided government policies.

Zachie Achmat, South Africa’s leading Aids activist, called for Mr Mbeki and his former health minister, Dr Manto Tshabalala-Msimang, to answer questions before a special commission of inquiry into the deaths of hundreds of thousands of people who were denied access to antiretroviral drugs.

The Government – which has altered its position on Aids dramatically since Mr Mbeki fell victim to a bitter split within the ruling African National Congress (ANC) in September – is certain not to allow the creation of such an inquiry, which would be modelled on the Truth and Reconciliation Commission that investigated apartheid-era crimes. “There are too many other people in government today who were part of Mbeki’s overall denialist Government and kept quiet. Such an action would set a precedent no government would accept,” said one activist.

However, lawyers say Aids activists and bereaved relatives could bring civil actions against the former president, who no longer enjoys the immunities of office, and his loyal lieutenant, who was ridiculed as “Dr Garlic” and “Dr Beetroot” for her assertions that diet was as important as drugs in fighting the killer disease.

The Treatment Action Campaign (TAC), which was co-founded by Mr Achmat, has distanced itself from his latest remarks, emphasising that he is no longer the organisation’s leader. It said Mr Achmat’s comments were made in a personal capacity after the recent publication of a study by Harvard researchers that estimated the Mbeki Government’s deliberately slow “roll-out” of drugs between 2000-2005 led to the premature deaths of thousands of people.

Rebecca Hodes, TAC head of policy, communication and research, said: “Mbeki and Manto were not operating in a vacuum. Their health policies percolated through the network of government health institutes and were either opposed or supported by other political actors and healthcare workers. Where would responsibility for deaths from Aids and delays in treatment begin and end?”

The Harvard study concluded that policies that grew out of Mr Mbeki’s rejection of the scientific consensus that the HIV virus alone causes Aids resulted in the needlessly early deaths of 330,000 HIV-positive sufferers and about 35,000 babies born with HIV in the same period.

South Africa has the largest caseload of HIV sufferers anywhere in the world. About 1,000 people a day die of Aids; a fact that Mr Mbeki – who once claimed he did not know a single person who had died of the disease – resolutely refused to accept. A scholarly man whose “denialism” appeared at odds with his much vaunted intellectualism, Mr Mbeki is also accused of having tolerated a host of charlatans touting bogus Aids cures under the guise of “traditional” African medicines.

One of the first actions of his successor, Kgalema Motlanthe, was to replace the controversial health minister with one of her most vocal ANC critics, Barbara Hogan.

The Government now plans to use World Aids Day next Monday to break with the past. Several top politicians will agree to be tested in an attempt to bolster a “Know Your Status” campaign and help to end the stigma still attached to the disease.

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