AIDS the Scourge of South Africa
Death Rate Expected to Reach One in 76 by 2010
Vysiwiya is 8 years old and she's just come home from school. It's spring here and the weather is lovely. She's wearing a crisp blue school uniform.
When she sees Dr. Carolyn Bolton sitting in the lobby of Bethesda House, an orphanage run by the Salvation Army that Vysiwiya calls home, she gives out a happy cheer and runs into her lap.
They're old friends.
Vysiwiya is about the size of a 3-year-old. Bolton, who's close to 6 feet tall, has seen her in the hospital any number of times. That's why they're old friends.
Vysiwiya has chronic lung disease. She has chronic pneumonia and "lots" of meningitis, too. She has AIDS. Her mother died of it, and that's why Vysiwiya and another 30 or so young children are here. Many AIDS-orphaned and HIV-infected children are not so lucky.
Bolton, 29, who does research work in mother-to-child transmission of HIV at the huge Baragwanath Hospital nearby, is delighted by how well Vysiwiya is doing.
But the fact is that Visiwiya and 9-year-old Weilisle, who insists on writing his own name in a reporter's notebook so that the spelling's right, and 11-year-old Lesetgo, his friend, and 4-year-old Ayala, who's no bigger than a 2-year-old and has a terribly distended belly, aren't going to be doing well for long.
They're going to die of AIDS sometime soon.
Just like a lot of other people in South Africa.
In 2010, according to U.S. Ambassador Cameron Hume, some 550,000 South Africans, or one in 76 in a population of 40 million, are going to die from AIDS. That's 125,000 more than will die of normal causes.
AIDS will affect everything from the availability of teachers and skilled workers, needed to attract foreign investment, and the government's spending on health care to a huge growth in what's called "child-headed" families. The mining giant, Anglo-American, estimates that it alone has as many as 30,000 HIV-infected employees.
For now, though, South Africa has an HIV epidemic. Close to 25 percent of the population is infected with HIV - almost 5 million people. A dozen years ago, only 0.7 percent was infected.
Among those with HIV are an estimated 83,000 children. Unlike Vysiwiya and the other children in the Salvation Army home, most of them are not sick. Not yet.
"All of us know that it's just two or three years from now," said Dr. Ayand Ntsaluba, the national director general of health.
And even though President Thabo Mbeki once famously suggested that it hadn't been proved that HIV leads to AIDS, South Africa's AIDS policy is clearly based on the belief that it is, Ntsaluba said.
Condoms are handed out at government offices and clinics all over the country at a rate of some 350 million a year. In some places, they're set out in baskets like after-dinner mints. There are AIDS billboards and an AIDS television series under production.
Mbeki himself wears an AIDS ribbon on his lapel in the formal portrait that hangs in the presidential offices. And, at least in urban areas like Soweto, the sprawling collection of townships outside Joahnnesburg where 4 million to 5 million blacks live, it's hard not to be aware of the HIV/AIDS threat.
The mobilization efforts may have come a little late - "Not any one of us can claim that we have done everything we should," said Ntsaluba - but it's clear the government, prodded by AIDS activists, the world community and even its own highest court, is now pressing the HIV fight.
Condom use appears to be increasing, said Warren Parker, director of the Johannesburg-based Centre for AIDS Development Research and Evaluation. One indication is that syphillis rates are down.
The rate of infection appears to have leveled off and the government has tripled its budget for AIDS for next year to some $350 million.
It's what's next that seems so overwhelming and controversial. What will South Africa do with hundreds of thousands of gravely ill people? Already the number of tuberculosis cases is climbing fast.
The simple answer appears to anti-retroviral drugs. Find a way to buy them, find a way to distribute them and soon, South Africa, like Europe and the United States, will be able to bring the AIDS epidemic under control. Some big industrial companies, like BMW, provide anti-retroviral treatment for workers here. Private health care, which serves about 20 percent of the population, mostly in urban areas and mostly for whites, also makes anti retrovirals available.
The government, and many others, however, argue it's more complicated than buying drugs. Delivering the anti retrovirals in an effective way requires a much more sophisticated and more expensive health care infrastructure than South Africa could hope to create in the next few years.
The finance and health ministries are studying how much a program would cost and how it could be put together, but for now, the focus is on doing a better job dealing with the opportunistic diseases, like tuberculosis and meningitis, that come with AIDS, Ntsaluba said. South Africa also needs to focus on community and home health care - where so much of the work will be done.
One group for whom drugs are finally available is babies.
The Consitutional Court ruled that providing the drug Nevirapine only to mothers in a limited number of pilot projects was unconstitutional. So now the government is gearing up to provide the drug, which is given to a mother just before birth to temporarily decrease the virus "load" in her system, to every mother who wants it. This helps protect babies against infection.
One immediate trouble with Nevirapene is that it's only about 50 percent effective. Other things must be done as well. Mothers should use only formula, never breast milk, because the virus can spread that way; deliveries should be as clean as possible because it's the mother's fluids that hold the virus, with Caesarian delivery the ideal solution. That's not an option in Soweto.
Not all babies born to HIV mothers become infected with the virus - only about 18 percent pick it up, according to Bolton. Luck sometimes goes the right way.
But that still means about 200 HIV-infected babies are born every day here (compared with about 400 a year in the United States). Even with a 50 percent effective rate, Nevirapene could still save 100 children a day.
"We can't mess around," said Bolton, who admits she was frustrated the program took so long to get going and that it's now going so slowly. Clinics must be established, powdered milk delivered, Nevirapene administered, mothers trained and counseled.
In any case, it's too late for the babies who live at Bethesda House now. Bolton looked quickly at one little girl who was being cared for by an 18-year-old volunteer from Maine and said matter-of-factly, "She probably won't last long."
Copyright © 2005 International Reporting Project. All Rights Reserved.