South Africa Steps Up Fight Against AIDS
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CHARLAYNE HUNTER-GAULT, NewsHour Special Correspondent: Overcrowded waiting rooms in an AIDS clinic at Helen Joseph Hospital, a public facility in Johannesburg, catering to the poorest of the poor, the sickest of the sick.
Men, women, old and young, with some 5.5 million people infected, about 18 percent of the population, South Africa leads the world in infection rates. Here AIDS patients who’ve been close to death are saved only by the anti-retroviral drugs the government — under pressure — began providing free at public clinics three years ago.
Half a million need them; only half are getting them. And even though this is a light day, there isn’t an empty seat in the place. Some have waited hours to be seen, some days.
SISTER SUE ROBERTS, Helen Joseph Hospital: We’ll get her right if we can put her onto the medicine.
CHARLAYNE HUNTER-GAULT: Nursing sister Sue Roberts is in charge.
SISTER SUE ROBERTS: Your number is number 130, somewhere up there.
CHARLAYNE HUNTER-GAULT: Sister Sue has seen the worst of times, times, she said, that led to the crunch in her clinic. Here and around the country, some 60 percent of patients in pediatric and adult medical wards are HIV-related cases.
Sister Sue remembers when the president of this country, Thabo Mbeki, questioned the link between HIV and AIDS in 2000, though in recent years he’s remained silent on the issue, and when the health minister derided anti-retrovirals as “toxic.” Critics call her Doctor Beetroot because she offered as an alternative traditional remedies, like the African potato, beetroot, and garlic.
SISTER SUE ROBERTS: The mixed messages have been a bit of a problem for the patients, because the patients don’t understand. And if they got sick because they were sometimes in denial about the HIV and sometimes, you know, worried about the treatment, because they saw so much negative publicity about the treatment.
The government sends new message
CHARLAYNE HUNTER-GAULT: Patients who come from the often mean streets of overcrowded and underserved townships, like this one, in communities like these, where the majority are poor and without jobs or decent food, the AIDS epidemic is raging, especially among young women 15 to 24 years old.
Close to 5.5 million of the 47 million South African population are infected with HIV, and up to 2,000 patients are dying each day from AIDS complications, according to statistics from the Actuarial Society of South Africa.
But in recent weeks, the South African government has placed its deputy president, Phumzile Mlambo-Ngcuka, in the forefront of this AIDS effort, and she seems to be turning around negative perceptions of the government's performance. She's called for intensification of the fight against the disease, imploring all sectors of the society to get on board.
Moreover, with the minister of health ailing, the deputy health minister, Nozizwe Madlala-Routledge, has moved in an unprecedented way, publicly acknowledging the government's confusing messages on HIV and criticizing the emphasis on traditional medicine touted by the ministers, saying, "It is absolutely irresponsible to say to people who are desperate and want to live, 'Oh, go to your traditional healer if you want,' because which traditional healers do we know who know how to treat AIDS? I don't know of any in my country."
The minister says she's been told in the past she could lose her job, but that she believes the government now wants a clear and consistent message. And until recently, she was pulling out all the stops to deliver it.
Top government officials have suddenly gone silent, saying that they've said all they have to say, that, in fact, there is nothing new about their approach to the HIV and AIDS pandemic. But in these streets and elsewhere, people living among and working with HIV-infected people say that there is new leadership, they see a new direction, and as a result they have new hope.
SISTER SUE ROBERTS: Things are definitely starting to turn around. We're lucky because of the high volume of patients we see here.
Community education campaigns
CHARLAYNE HUNTER-GAULT: Also, new hope in the streets of places like the Alexander Township, people like these, part of an organization called Community Action. They've been trying a new approach to the pandemic: organizing street committees, similar to those that took the place of banned political organizations during apartheid.
Street committees make regular visits to neighbors, many of whom are ignorant about HIV-AIDS and, because of the stigma, are afraid to ask or be tested. They call their approach holistic, hoping to win over people first with offers of general assistance, and over time introduce the subject of AIDS.
In time, Andrnea Chauke became comfortable enough to share that her sister passed away six months ago from AIDS complications. At this point, she's learning more about the disease than she ever knew.
ANDRNEA CHAUKE: I learned a lot of things, because I didn't know how AIDS worked. So now I know lot of things, I'm so happy, because it's very sensitive.
CHARLAYNE HUNTER-GAULT: Mapula Prudence Mokae is one of those teaching her neighbors now. But when her sister died of AIDS complications 10 years ago, she, too, was in the dark. Mapula believes more openness about AIDS could have safe saved her sister, as well as Andrenia's.
MAPULA PRUDENCE MOKAE, Community Action: Yes, if I was having that information about HIV and AIDS, yes, I think she would be alive.
CHARLAYNE HUNTER-GAULT: Some experts, like Dr. Francois Venter, head of the South African HIV Clinician Society, believe inaction over the past decade may have led to at least four million deaths. Mapula inherited her sister's infant daughter, now 10, whom she has reared along with her own two children.
Her ignorance about AIDS meant it would be another 10 years before she realized that her little niece was HIV-positive. But at least she's not one of the almost one million AIDS orphans in the country who've stretched the extended family beyond the limits, and who now must rely on the few, mostly poorly funded orphanages that have sprung up, or make it the best way they can, which often means on the streets.
But now, Mapula says, with more positive messages from government, her job is becoming easier.
MAPULA PRUDENCE MOKAE: When I pass the street, they just call me, "Mapula, come, come here, we want to ask you." Then they just ask, "You see in that house there's something," then I'll be proud for that. At least these people are listening when I'm talking to them.
Waiting for implementation of plan
CHARLAYNE HUNTER-GAULT: For years, activists like Mark Heywood and the Treatment Action Campaign tried talking to the government unsuccessfully. They only got the government's attention when they won a court ruling, forcing it to dispense free Nevirapine, which helps prevent mother-to-child transmission of HIV. Heywood also sees a new approach from government and welcomes it.
MARK HEYWOOD, Treatment Action Campaign: It creates a tangible hope where previously there was a despair and confusion.
CHARLAYNE HUNTER-GAULT: Heywood says, however, that he has yet to see the practical implementation of the new approach.
MARK HEYWOOD: It is a little early, but, you know, when you've got a thousand deaths a day -- as we do still in South Africa -- a little early is very, very late. And if you can advance the process by one week or two week or two months then, in fact, you have the potential to stop a lot of devastation and a lot of pain and a lot of suffering, and that's the urgency that we still think is required.
Challenges remain 'enormous'
CHARLAYNE HUNTER-GAULT: Dr. Francois Venter walks carefully through the streets of this tough neighborhood of poor immigrants from all over Africa. The HIV virus finds many homes here, especially among sex workers plying their trade for their survival and the survival of their families.
Venter's clinic works with them, helping them to at least learn to protect themselves from HIV. He's also working with the government on a new five-year strategic plan to tackle the AIDS pandemic, which he hopes new leadership will help set targets missing now and ways to measure progress.
But he also recognizes a new direction from government, calling it the most significant mind change he's been party to in 12 years.
DR. FRANCOIS VENTER, HIV Clinicians Society: It's teamwork talk rather than this individualist high-handed arrogance and unscientific and incredibly dismissive tone that's been coming from government in the last 10 years.
CHARLAYNE HUNTER-GAULT: But Venter and others argue that the challenges posed by AIDS remain enormous, not least because of the number of new infections equaling the number of AIDS-related deaths and the growing orphan population, along with the infected millions who will need medication for the rest of their lives.
DR. FRANCOIS VENTER: These things are complex, you know, and they need calm, careful analysis. And I think, for the first time, I am starting to have confidence that governments are willing to sit down and engage in that debate.
CHARLAYNE HUNTER-GAULT: A debate that could make a real difference in the lives of people like these, their children, their friends and neighbors infected and affected, all remaining vulnerable to this disease without a cure.