AIDS killing South Africa’s people, prospects

by Charles W. Holmes, 2002 Pew Gatekeeper Editor
Reprinted with permission of The Atlanta Journal-Constitution

Soweto, South Africa — Their mothers are already buried and the children at the Bethesda House orphanage are under death sentence as well.

The AIDS virus is ravaging this nation, hampering South Africa’s efforts at stability and prosperity in the post-apartheid era.

An estimated one in four South Africans between the ages of 18 and 50 carries the AIDS virus, making it the most infected country on earth. By 2015, 9 million South Africans may be dead from the disease, leaving behind 2 million orphans.

Vuysiwiya, an 8-year-old schoolgirl, is one such orphan. She lives with about 30 others in the Bethesda orphanage, a tidy, one-story building run by the Salvation Army in the sprawling township of Soweto.

Wearing a smart blue uniform and a broad smile, Vuysiwiya dashes to the orphanage from her nearby school. She is eager to show visitors how she can write her own name, but her enthusiasm is interrupted by a death-rattle cough.

”We’re worried about her,” said Dr. Carolyn Bolton, 29, who runs a mother-child AIDS clinic at Soweto’s Baragwanath Hospital. ”She was very sick recently with respiratory problems brought on by her condition. I’m afraid we’ll be seeing her again.”

Outside the AIDS orphanage, beneath a flourishing shade tree, is a memorial stone listing the names of 24 children who lived and died at the facility. There’s ample room on the granite marker for additions.

”It is really tough sometimes. It matters when you see a kid get sick here. We have to admit kids to the hospital and you have to get yourself ready that they may not come back,” said Haylee Freeman, 19, a volunteer worker from Maine, busy feeding a motherless 14-month-old girl named Nomcebo.

About 40 million people are infected with HIV around the world — three-quarters of them in sub-Saharan Africa. Another 3.5 million new infections are estimated for the region by year’s end. In 2002, the disease will claim 2.4 million Africans.

In South Africa, government spending on HIV/AIDS has tripled since President Thabo Mbeki came to power in 1999. Government programs look good on paper but are reaching relatively few people, health care providers complain.

Critics continue to question Mbeki’s political will to confront the problem. In the face of overwhelming evidence to the contrary, Mbeki and his health minister suggested that HIV does not cause AIDS and that the drugs used to fight the disease could serve only to poison South Africans.

This year, a court battle forced the government to distribute the drug Nevirapine, which helps to reduce the transmission of HIV from mothers to their babies. Previously, the government denied the drugs to pregnant women, despite an infection rate of 70,000 to 100,000 babies born HIV-positive each year.

”More children will be infected with HIV in the next two days in South Africa than will be infected in all of 2002 in the United States,” said Bolton.

Cameron Hume, the U.S. ambassador to South Africa, routinely gives visitors to the embassy in Pretoria a presentation on the challenges facing South Africa. The biggest is AIDS.

The country is only beginning to see massive deaths from the disease. An estimated 5 million South Africans are infected with HIV. Over the next decade the full-blown effects will begin and the bodies will begin piling up.

Unusually blunt for a diplomat, Hume says the South African government is in denial about AIDS. Children can’t go to school if their parents are dead, he says. There will be fewer educators to teach since teachers are dying of the disease, too. Who will work the gold and diamond mines — central to the South African economy — as the workers fall ill? Life expectancy will drop from 59 years to 42 before the end of this decade, according to one estimate cited by Hume.

A bad bet for potential investors

The problem is sure to be on the agenda when President Bush visits South Africa and other African nations in a trip scheduled for mid-January.

Beyond the human cost, foreign investors view the AIDS crisis with the bottom line in mind. A German financial company estimated two years ago that, by 2015, AIDS will have killed 18 percent of South Africa’s work force.

Factoring things like productivity, insurance costs and death benefits, South Africa’s AIDS problem makes it a bad bet for potential investors. According to a 2000 financial analysis by ING-Barings, South Africa’s gross domestic product by 2006 was expected to be 3.1 percent lower annually than it would have been without AIDS. By 2011, it will be 4.7 percent lower.

”There is a very big gap from where we would like to be and reality,” conceded Ayanda Ntsaluba, director-general of the government health department.

Government officials and health care advocates acknowledge that South Africa’s public health system cannot cope with the crisis. The expensive antiretroviral drugs that prolong the lives of AIDS sufferers are being administered in a small pilot project to several hundred patients. But such treatment on a wide scale would consume most if not all of the government’s budget for health and social services, Ntsaluba said.

”I think none of us can with a clear conscience say that we’ve done everything that we could, everything that we should,” he said. ”The problem is bigger than just the government can deal with.”

Social stigma a huge obstacle

Some 350 million condoms will be distributed free this year by the government and private health care providers. Condoms are readily available almost everywhere, at gas station toilets, the U.S. embassy, the national parks. Safe-sex messages blare from highway billboards in Johannesburg and graffiti murals on the walls of the country’s poorest slums.

But perhaps the biggest obstacle facing the government and health care workers is the social stigma of AIDS. In the country’s teeming streets and busy graveyards, AIDS is spoken of in whispers, if at all.

Near Cape Town, in the huge black township of Khayelitsha, AIDS counselor Matthew Damane, 26, is a rare survivor. He was diagnosed with HIV in 1997, and like many with weakened immune systems he contracted tuberculosis a year later. He recovered and was able to join a pilot project run by the international relief group Doctors Without Borders to get on a regimen of the famed ”triple cocktail” of medicines that has proved effective in treating the virus.

Damane contracted the disease after unsafe sex and now counsels young people to abstain, or use condoms if they decide to have sex. But they do not listen.

Men say they don’t enjoy sex with condoms, says Damane, and if someone insists on using one, his partner may worry about his fidelity or whether he is already infected. Young women are at greatest risk of contracting HIV, but cultural norms prevent them from demanding condom use, aid workers say.

Zanele Rini, 49, a social worker in the impoverished Driftsands neighborhood of Khayelitsha, says programs are held with young people to encourage condom use. ”After the program, outside the clinic, you see them unopened on the ground. They blow them up as balloons, they play with them, but they don’t wear them,” she said.

Nosisa Dyasi, 37, a mother of four, lives in a one-room shack of plywood and canvas in the Driftsands slum known as L.A. She lives on about $2 a day in government subsidies, eats cornbread at most meals and is slowly dying of AIDS. Her 16-year-old son, Kahnyiso, breaks into tears as his mother tells her story of abandonment by her husband and the infection that is killing her.

But at least she talks openly of her plight.

”Most of the people who are sick,” said Adelaide Ngokomashe, a nurse who cares for Dyasi and other AIDS patients in Driftsands, ”they are still hiding it.”