Fergal Keane: The spirit of resistance that has found a new voice in the struggle against Aids

You could watch coffin follow coffin into the earth. Death was knocking on doors everywhere

I can't exactly recall when I became aware of HIV/Aids in South Africa. I think it was at the start of the 1990s, when we began to get calls from women's groups in the townships. "Come to our demonstration. We are handing out leaflets and condoms," they would say. I went to one demonstration in Alexandra township down the road from where I used to live in Johannesburg. I remember enthusiastic women in a small procession and a bemused local populace.

And that was really the extent of it. I did go to Zimbabwe in those years and visited an AIDS hospice run by Irish nuns. There were about seven or eight people there being cared for with great gentleness. And I remember one of the nuns saying one of the worst problems was the stigma. People just didn't want to face up to the problem.

But like most of the other journalists covering the region back then, I was preoccupied with the epic story in South Africa. Mandela had been released from prison. There was terrible violence in the townships. It was an exciting and often frightening time. In those days I used the phrase " the heave of history" to describe the tumultuous transition. What I and so many others missed, however, was the insistent march of HIV. Go back now and read, listen or watch the coverage of South Africa in those years and you will really struggle to find any sense of HIV/Aids as a devastating crisis.

That was largely because the political imperative was finding a solution to a conflict which could have pitched South Africa into a civil war. There were other factors: the white regime never seemed overly concerned about a disease which largely affected the black population; the older ANC leaders such as Mandela betrayed a deep reluctance to confront sexual matters. But these were secondary to the main problem of preventing a racial bloodbath.

And then came 1994. The transcendent moment when a democratic South Africa was born, and along with it came a whole new list of reasons for not making Aids a priority. I deliberately use the word "reasons" and not "excuses". There were houses and schools to build, water and electricity and jobs to provide. Yes Aids was a growing problem, and one that the politicians were by now well aware of. Journalists were highlighting the issue as were the increasingly concerned health professionals.

Others can disagree but I think it's reasonable to cut the politicians some slack in those early years. They can make a plausible defence for failing to push Aids to the top of their priority list. Where the excuses run out is after two or three years of the new government, when political and economic stability had been achieved and there was time to reflect on the bigger picture.

By the late 1990s, that picture was very bleak indeed. You could go into hospitals all over the country and see the gaunt figures of Aids victims and hear their rasping, tubercular coughs. You could travel to Soweto's main cemetery at the weekend and watch coffin follow coffin into the newly turned earth. Death was knocking on doors in every part of the country.

Enter a new president. I remember writing in this paper in fairly hopeful terms about Thabo Mbeki when he was first elected back at the end the 1990s. He was a technocrat, a politician who had proved wise in the long negotiations to end white rule, and who had come to power promising to improve the daily lives of the poor. In beginning the work of creating equality, Mbeki has done well. To anybody who knew the old South Africa, that land of oppression and humiliation, the modern country is by far a happier and better place.

But with one huge exception. For Mbeki's record on Aids is bleak: a refusal to recognise the scale of the problem, flirting with the science of the HIV/Aids deniers and verbal attacks on those who were bold enough to contradict him. Three years ago, he caused outrage by saying in New York that he personally did not know anybody who had been diagnosed with HIV. This from the leader of a country where one in 10 of the population was estimated to be HIV positive, and whose own spokesman had died after a lengthy illness after being diagnosed with HIV.

Yet the official confusion has continued. Just when it seemed the government was taking a more enlightened approach the health minister, Dr Manto Tshabalala-Msimang, told an international conference last August that garlic, beetroot and African potatoes were effective in managing the disease. According to one report, the South African government stand in the conference hall featured a display of vegetables but no antiretroviral drugs.

Of course they are not a cure for Aids. Nor will they rid South Africa of the poverty, the lack of power among rural women and the attitudes towards sex which have allowed HIV/Aids to thrive. But they do make a real difference to the lives of those for whom they are properly proscribed and who are carefully monitored.

During that last trip to South Africa, I went to a small house in the Eastern Cape that serves as an Aids clinic. Inside I was confronted immediately with those iconic images of Aids in Africa: the figures prostrate beneath thick woollen blankets, the look in the eyes that is halfway between despair and resignation. I was taken back to that other house in Zimbabwe a decade earlier.

And yet it was here among the dying and the severely ill that a little glimmer of hope appeared. It came, as so often in my experience of Africa, from a woman. Lulu Boxosa runs the Aids charity Temba and campaigns not only for funds but to open eyes and ears to the catastrophe that has attacked so many homes. Lulu is not bitter about the official failures. She doesn't have time for that. Everybody woke up too late, she told me. But her presence, the bustling good humour she brings into the rooms of the dying, speaks of one of South Africa's greater advantages, the power of civil society. Apartheid bequeathed a terrible legacy of poverty, but it also created a tradition of resistance which has found a new voice in the fight against Aids.

Those like Lulu - and there are so many like her across Africa - know that speaking out unambiguously about what causes Aids and what can manage the crisis is where any successful campaign must begin. She is not so naïve as to think that a well-managed roll-out of drugs or a campaign to change sexual behaviour will bring this tragedy to an end. But she knows these are the vital first steps.

If the fight against apartheid taught us anything it is that South Africa's grassroots campaigners don't give up. There are already signs that senior ANC figures will respond to the pressure. On World Aids day, amid the plentiful images of sorrow, that spirit is a small, good thing to remember.

Fergal Keane is a BBC Special Correspondent. His series 'Taking A Stand' is broadcast on Radio 4 on Tuesdays at 9am