One of the greatest challenges facing post-apartheid South Africa is the control of
the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly,
and tuberculosis has been declared a national emergency. In 2007, South Africa, with
0.7% of the world's population, had 17% of the global burden of HIV infection, and
one of the world's worst tuberculosis epidemics, compounded by rising drug resistance
and HIV co-infection. Until recently, the South African Government's response to these
diseases has been marked by denial, lack of political will, and poor implementation
of policies and programmes. Nonetheless, there have been notable achievements in disease
management, including substantial improvements in access to condoms, expansion of
tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care
for acutely ill AIDS patients and long-term provision of ART are two issues that dominate
medical practice and the health-care system. Decisive action is needed to implement
evidence-based priorities for the control of the HIV and tuberculosis epidemics. By
use of the framework of the Strategic Plans for South Africa for tuberculosis and
HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV
prevention, and HIV treatment. Strong leadership, political will, social mobilisation,
adequate human and financial resources, and sustainable development of health-care
services are needed for successful implementation of these approaches.