TOPICS > Health

AIDS in South Africa

May 22, 2000 at 12:00 AM EST
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FRED DE SAM LAZARO: Across South Africa, hospital wards have gone from near full to overflowing, thanks largely to the AIDS virus. It’s not unusual for two infants to share a cot at the Chris Hanney Hospital in Soweto where Dr. Glenda Gray heads the Perinatal HIV Clinic.

DR. GLENDA GRAY, Perinatal HIV Clinic: HIV’s prevalence amongst children in 1992 was 6 percent. And recently we did a survey, and we found that up to 40 percent of kids admitted to our hospital every day are HIV-infected. And last year, 75 percent of all our guests in these wards were HIV-related. So almost half of the children admitted to our wards in any one day are HIV-infected.

FRED DE SAM LAZARO: Adult figures are equally staggering. Almost one in four pregnant mothers are believed to be infected with HIV, infected by heterosexual contact. Some 10 percent to 12 percent of all South Africans are HIV positive. (Singing) At the same time, both government and non-government organizations have pushed extensive awareness campaigns. AIDS is the subject of this Zulu school chorus. (Singing)

And the whistle-stopping love train. In broadcasts, billboards and posters, South Africans are warned about the dangers of HIV And AIDS. There’s plenty of evidence that the awareness campaign is working. 98 percent of South Africans say they’re aware of HIV, AIDS, and how it’s transmitted.

However, there’s little evidence that that awareness is translating into changed behavior. For example, fewer than one in ten women report using a condom during their last sexual encounter. Mary Crewe is the director of the study of AIDS at the University of Pretoria.

MARY CREWE, Director, Study of AIDS: We don’t understand why the prevention campaigns have failed. We don’t understand why we can’t change behavior. We don’t understand whey there’s such a refusal to acknowledge what the epidemic is doing. We don’t understand the denial. And until we start really becoming a very critical society — critical of our own practice, critical of our own thoughts, critical of what we’re doing — I don’t think we’re going to really find the answer to this, the epidemic.

FRED DE SAM LAZARO: South Africa’s epidemic is proving most devastating in impoverished rural areas, in households like Rose Mthembu’s. Women like Rose Mthembu spend most of their lives alone with their children; their husbands took jobs in distant cities as part of a migrant labor system. The former white minority government did not allow men to take their families along.

Today, migrant workers, HIV- positive in large numbers from exposure to commercial sex and alcohol, are returning home to spend their last days, ill with AIDS or related diseases like tuberculosis and pneumonia. Once they sent money home. Today their health care is likely to deplete the family savings. Rose’s husband, a mine worker, was buried behind their tiny home in March. He left a wife who is also HIV-positive, as are two of their five young children.

ROSE MTHEMBU (Translated): We had decided to refrain from sexual intercourse after we knew he was HIV-positive, but sex is a natural thing and we were tempted. Women are not socialized to say no. Even if she knows that her husband is sleeping around, our culture does not make it easy for her to say, “No, we cannot have sex today.” There has not been any support by people in the community. They used to keep saying, “Why are you spending money to take him to the hospital when you know he’s going to die anyway?”

FRED DE SAM LAZARO: With all the epidemic’s complexities, scientists say President Thabo Mbeki added a new complication when he recently opened a debate that appeared to call into question whether AIDS is, in fact, the result of an HIV Infection. Mbeki cited work he personally came across while surfing the Internet — articles by dissident scientists, including American Peter Duesberg, who assert that AIDS is not caused by the HIV virus.

They say AIDS may instead be the result of recreational drug use, that AIDS drugs may in fact be the cause of death. It’s a view widely discredited by scientists worldwide, but in a letter to several world leaders, Mbeki defended his right to consult the dissidents. “It is obvious that whatever lessons we have to and may draw from the West about the grave issues of HIV-AIDS, a simple superimposition of western experience on African reality would be absurd and illogical. We will not, ourselves, condemn our own people to death by giving up the search for specific and targeted responses to the specific African incidents of HIV-AIDS.”

WOMAN: Thank you. Thank you very much to all of you for a most successful meeting.

FRED DE SAM LAZARO: The South African government, led by its health minister, called a conference early this month, allowing leading scientists and dissidents to discuss the HIV-AIDS link, along with other issues. It’s a debate Mary Crewe says is both unnecessary and dangerous.

MARY CREWE: It allows people to think that HIV is not sexually transmitted and, therefore, there is no need to change behavior, there’s no need to look at any of the cultural, racial, patriarchal issues that are driving the epidemic.

FRED DE SAM LAZARO: Anecdotally, doctor’s offices report that patients have begun to ask questions. Glenda Gray’s clinic, for example, offers anti-HIV drugs free to pregnant women if they volunteer for research trials funded entirely by international grants, not the South African government.

DR. GLENDA GRAY: We do have patients who are on anti-retroviral therapy, who phone us and say, “well, the President’s a very clever man, he’s an intellectual man, and if he says he doesn’t think HIV causes AIDS, then I believe him. And I’m going to stop taking these drugs because they’re toxic and they’re probably giving me HIV.”

FRED DE SAM LAZARO: The government has indeed alleged that drugs, like the widely used AZT are toxic. And it has refused to provide AZT or another drug, called Nevirapine, to HIV-positive women during pregnancy, even though studies show this lowers the risk of passing the virus onto their babies.

DR. GLENDA GRAY: It could half the amount of vertical transmission, and maybe even get it down to a third of what you see at the moment. And we know that Nevirapine given in labor at a cost of 4 U.S. dollars will half the transmission. And using good obstetrical care and good labor care, we could probably decrease their transmission even further.

FRED DE SAM LAZARO: South Africa’s health minister, Mantu Tsabalala Msimong, trained as an obstetrician herself, defends the government approach, precisely she said, because of the lack of good obstetrical and other care for mothers in rural areas.

MANTU TSABALALA MSIMONG, Minister of Health; I don’t quite ascribe to the theory of just giving medicine and not looking at a woman… her whole health status because the last thing that I’d like to see is for medical person to give a particular woman an injection and you never see that woman again. You don’t know what complications are there. You don’t know what the side effects are.

FRED DE SAM LAZARO: Meanwhile, Bongani Kumalo, recently appointed to head the presidential response to the epidemic, said Mbeki has been misunderstood, that he merely wanted a broader approach to dealing with the epidemic.

BONGANI KUMALO, Presidential Adviser/AIDS: We believe we face a catastrophe. And when you face a catastrophe, you don’t go on with that which is routine. You begin to look at other things that you may not have been looking at. You begin to wonder if you are actually addressing all the questions. I will listen very carefully to what the people are saying in response. If it suggested that it is a behavior change, that is attitude change, we will look for that because it will be very important that we correct any change in attitude and behavior. We must be… we must stand firm, we must be strong in our resolve to beat AIDS.

FRED DE SAM LAZARO: The controversy surrounding Mbeki’s statements has helped step up the debate among South Africans, facing a health crisis of scope rarely witnessed in human history. An estimated 1,700 South Africans are becoming infected with HIV each day.

GWEN IFILL: We will have a Newsmaker interview with South African President Mbeki tomorrow night.