Introduction

The inauguration of Nelson Mandela as the first democratically elected president of South Africa brought down the final curtain on decades of apartheid misrule, marking the beginning of a new chapter of hope for the ‘rainbow nation’. This was an achievement hailed by the international community as the political miracle of the 1990s. But to dampen the euphoria, it soon became evident that in the area of health care, the infant democracy had inherited an expensive, hospital-based, high-tech medicine that was not only inappropriate for the health needs of the majority of rural black South Africans, but also reflected a highly fragmented health system that would need more than just the defeat of apartheid to correct.

While it was generally anticipated that a major feature of South Africa's new challenge would revolve around issues of poverty eradication, job creation, crime prevention and new directions in historical writing, academic debate and public comment became increasingly dominated by the centrality of a new struggle of global proportions – the fight against HIV/AIDS. In the mid-twentieth century, cancer was the disease which carried the awe, symbolism and threat that tuberculosis possessed a hundred years before. Yet the arrival of HIV/AIDS in the second half of the century has since introduced a sinister new contestant for cancer's crown with an epidemic that poses an even greater demographic danger than tuberculosis and cancer combined.