deputy health minister, the woman credited with ending a decade of Aids denialism at the heart of the South African political leadership.

Activists fear that the decision spells a disastrous political regression on Aids, which could cost the lives of hundreds of thousands of people. More than 1,000 people a day in South Africa die of Aids. One in 10 is HIV positive, which is significantly higher than anywhere else in the world. And 1,400 people are newly infected with HIV every day. But only a third of those who need life-saving Aids drugs receive them.

The sacked minister, Nozizwe Madlala-Routledge, is an outspoken critic of President Mbeki and his Health Minister, Manto Tshabalala-Msimang and the way they have handled the epidemic. She was the co-architect of an ambitious new five-year plan to accelerate the rollout of free, life-saving Aids drugs, tripling the numbers on treatment by 2011. That plan could now be in jeopardy.

For years Mr Mbeki was the world's most prominent Aids denier. His government only began making free Aids drugs available to sufferers in 2004, after an international outcry ­ and that was years after other, poorer, African countries. But by sacking his cabinet's most forceful advocate of an aggressive campaign to provide drug treatment, Mr Mbeki has reopened questions about his own acceptance of the science surrounding Aids.

"He has once again shown his contempt for those seeking scientific approaches to Aids," said Professor Nicoli Nattrass of the University of Cape Town. "This is a dreadful error of judgement. It indicates that the President still remains opposed to the science of HIV," the Treatment Action Campaign (TAC), South Africa's biggest Aids advocacy group, said yesterday.

His decision represents a victory for Mrs Tshabalala-Msimang, who has been discredited and derided as "Dr Beetroot" for telling HIV patients to eat more of the vegetable, and for her view that antiretroviral drugs are "poison".

Although she has been condemned as a representative of the lunatic fringe by the United Nations' special envoy for Aids in Africa, and by 60 of the world's HIV specialists as disastrous, Mr Mbeki has remained her loyal ally.

"It's an absolute disgrace," said Mike Waters, the opposition Democratic Alliance's health spokesman. "The fact is for the first time we had a deputy minister with a clear direction in the fight against Aids. Both the President and the Minister are denialists, while the deputy minister has her feet stuck in reality."

Mrs Madlala-Routledge, speaking to The Independent, said: "I can't say what the reasons are for the President's decision. But with the Health Minister back in the driving seat she wanted to reassert her ideas.

"We are dealing with an emergency where large numbers of people are dying."

Ostensibly the reason for firing Mrs Madlala-Routledge was that in June she travelled to Madrid to speak at an Aids conference without the President's written authorisation.

Her real crimes, say insiders, were to challenge the President's handling of the epidemic and help drive through the new treatment strategy. That happened earlier this year when liver transplant surgery forced Mrs Tshabalala-Msimang out of the picture. But "Dr Beetroot" came back. In the past few weeks she has, officials say, set about undermining the treatment plan.

She has also launched into a fresh defence of one of her favourite themes: traditional African remedies. "You can give your patients as many tablets as you want to, if the nutritional status is weak and is not up to the mark, those tablets will not do the trick," she told MPs on her return.

Health Department staff, under Mrs Tshabalala-Msimang's direction, have recently again begun drawing a distinction between "HIV and Aids" and "HIV/Aids". The semantics and the infighting, say doctors such as Ashraf Grimwood, who works on the HIV front line, is the equivalent of fiddling while Rome burns. "This is a complete distraction. We have people dying in the queues. It is obscene and it is unacceptable."

The long-term impact of the epidemic is almost incalculable. The country has 1.2 million Aids orphans. A generation of women is being lost. Teachers are dying at the rate of 14 a week; child mortality rates in some areas have trebled in the past 15 years. And life expectancy, because of Aids, has fallen to around 47 years. "This is medieval," said Dr Alan Whiteside of Kwa-Zulu Natal University in Durban. "Why are we not shouting it from the rooftops?"

Officially, Mr Mbeki's government is committed to the drugs rollout, but staff struggling to rush out the treatment, complain of constant delays. Anti-retrovirals can only be dispensed in accredited sites, but applications routinely get bogged down in red tape. "It's bureaucratic nonsense. All it means is people can't access treatment," Dr Grimwood said.

Campaigners said it was "unfathomable" that Mrs Madlala-Routledge had been given the boot. They challenged Mr Mbeki to pledge his public support for the treatment strategy. "Our country has waited, vacillated, hoped, pained and fought too long over HIV/Aids," said Nathan Geffen of the TAC.

This is about sick people who need care

It is one of the tragedies of our young democracy that a country that emerged from so much pain, and in the throes of establishing itself as a free democratic country, had to be confronted with a health catastrophe on this scale.

But how we respond to the Aids epidemic is not about me or anyone else in government, it's about sick people who need careand who need it yesterday. This is, after all, an emergency which is claiming the lives of a great many people.

In our struggle against apartheid, during my years of activism which included going to jail for my beliefs, I learned that to achieve anything, you need to get everyone talking around the table.

I can't say what reason the President had for dismissing me. But I know that the Health Minister, back in the driving seat, wanted to reassert her ideas. We have made progress recently, and I would be saddened and disappointed if we were now to be taken back to a time when people were confused about Aids treatment.

I am certain now, that if our Health Minister goes back to talking about garlic and beetroot, she will face only ridicule. I am not, I must stress, attacking the traditional African medicines that she is keen to champion. They have a place in health care.

But we are dealing with a modern disease. And as with any modern disease, we have to subject whatever we propose as a cure, to the most rigorous scientific testing.

I don't regret saying that our political leaders should show the way and undergo HIV testing, in public. We need at least 25 million people tested. When you are in charge of the country, you have to offer leadership.

It is also important for us to hear Mr Mbeki's voice, encouraging people, leading, and showing them that HIV/Aids, with treatment can be managed.

Nozizwe Madlala-Routledge is the former deputy health minister of South Africa