ELIZABETH FARNSWORTH: It's hard to grasp the scope of the AIDS catastrophe engulfing southern Africa, until you see it up close: the hospitals overflowing with patients ill from pneumonia, meningitis, or TB -- opportunistic infections that kill as a result of AIDS. The desperately sick; nearly all of them young; a 33-year-old accountant, husband and father; a 26-year-old bakery manager; and Issac Nakhupe, age 30, with a newborn at home. On this day his brother had to prop him up in bed. Children are sick too -- they get HIV from their mothers in utero, during birth, or while nursing.
Eleven percent of the one million with HIV/AIDS in Malawi are kids. This woman has three children. She probably has AIDS but there's no way to know, because the hospital often can't cover the cost of gloves or clean needles -- let alone the chemicals necessary to test widely for the disease. Dr. Ajib Phiri struggles to provide what care he can. He suffers from his own sorrow.
ELIZABETH FARNSWORTH: Have you lost friends and family yourself?
DR. AJIB PHIRI, Mulanje District Hospital: Yes, I have lost a sister --
ELIZABETH FARNSWORTH: To HIV?
DR. AJIB PHIRI: -- to HIV/AIDS.
ELIZABETH FARNSWORTH: When?
DR. AJIB PHIRI: It was three months ago.
ELIZABETH FARNSWORTH: Dr. Phiri's sister, the sick in this hospital, the almost one million in Malawi with HIV/AIDS. They join 25 million more in the region -- in Botswana, Zimbabwe, South Africa and the other sub-Saharan countries where rates of infection are higher than anywhere in the world. In some parts of these countries, including Malawi, one-third of all adults are infected. Seventeen million people in Africa have already died of AIDS. This is the scope of the African AIDS catastrophe, which Malawi's vice president says the rest of the world must begin to grasp.
VICE PRESIDENT JUSTIN MALEWEZI, Republic of Malawi: HIV/AIDS in Malawi and everywhere is more than a disease. It affects everyone; it affects all sectors of society, and everyone in Malawi is either affected or infected one way or the other. This is not an African problem; this is a world problem.
ELIZABETH FARNSWORTH: And there are questions the world must answer says nurse Maryline Mulemba of the group Doctors Without Borders.
MARYLINE MULEMBA, Doctors Without Borders: Is the world ready to lose one million people in Malawi and 30 million people in Africa? I don't know if we really can afford this... I don't think….
ELIZABETH FARNSWORTH: Malawi, once called Nyasaland, is one of the 15 poorest countries in the world. It's also very beautiful -- especially Lake Malawi, which is rich with history. Dr. David Livingstone sailed north on these waters in his quest for the source of the Nile. But the colonial rulers that followed his explorations, and a post-independence dictatorship misused this country, and now the best land is planted in tea and tobacco for export, while most people barely survive on the corn, sorghum and beans they grow on tiny plots.
Poverty -- with its accompanying malnutrition, worker migration and lack of education -- has helped fuel the epidemic, and scenes of sadness like this are now common. A three-month-old baby had died in the night in Ntonya village not far from the southern border with Mozambique. A neighbor offered condolences and a prayer; she regularly visits the sick in this village -- as part of a government health program supported by the U.S. non-profit, Project Hope. She said the baby probably died of AIDS. The mother died a few months ago; the father last year. The grandmother, Line Urwe, is caring for what's left of the family: five orphans. I asked her how she survives.
LINE URWE (speaking through interpreter): It's difficult to take care of the children. I do piece work in the fields when I can, but it's hard.
ELIZABETH FARNSWORTH: Right now do you have enough to eat?
LINE URWE: No. We don't have enough food for the coming year because all of our crops were washed away with the floods.
ELIZABETH FARNSWORTH: There has often been hunger here and life expectancy has always been low. But villagers say they have never seen anything more devastating than AIDS.
MAN (speaking through interpreter): Out here, there have always been diseases, but what we have now is different. Our major concern is AIDS. In my lifetime, I've never seen anything like it.
MARYLINE MULEMBA: If you would say tomorrow one million people will die because of an earthquake, everybody will rush here and bring help; but people will die slowly and in silence more or less; the help coming in is still very slow.
ELIZABETH FARNSWORTH: The Malawi government, led by President Bakili Muluzi, has launched an effort -- highly praised by the United Nations and others -- to prevent more deaths. Here -- as elsewhere in southern Africa -- the HIV/AIDS epidemic is spread mainly through vaginal sex between women and men. In every part of the country, billboards warn that "AIDS kills" and urge Malawians to "change their behavior." The government also mandates AIDS education in schools.
The U.S. group, Project Hope, helps fund the "AIDS club" in this school in southern Malawi; and when we visited, the kids put on a show for their benefactors. They sing: "AIDS is almost everywhere. Boys and girls, don't forget that it can send you to the grave!" The government is also enlisting the help of traditional healers, often referred to as "doctors" here, who had in the past performed circumcision and other procedures without clean razor blades but who now know better. This healer is regularly preaching abstinence or safe sex, and advising patients like this one to get tested for HIV.
ELIZABETH FARNSWORTH: Do you know where you got HIV/AIDS? Do you have any idea how you caught it?
JACKSON ALLIE (speaking through interpreter): Yes, I'm a carpenter, and I'm only 26. I move around a lot with my carpentry and go with lots of women, so I'm suspecting I got it from there.
ELIZABETH FARNSWORTH: Are you using a condom when you have sex?
JACKSON ALLIE (speaking through interpreter): The doctor here has advised me to stop any sexual activity right now; so I've completely stopped while I'm taking this medication from her.
ELIZABETH FARNSWORTH: The healer claims the medication -- a potion made from tree roots -- cures AIDS, and in the absence of any other medical solution, many people, including highly educated ones, are seeking this kind of help. The vice president says the scientific validity of the potion is immaterial; what counts is the safe sex message.
VICE PRESIDENT JUSTIN MALEWEZI: When she gives her potion and says when I'm giving my potion there should be no sexual relationship, that is what it is important to me because it will prevent, help to prevent the transmission
ELIZABETH FARNSWORTH: The government is also doing what it can to improve care for those with AIDS but lacks the funds to do much, says the chief physician at Queen Elizabeth Public Hospital in Blantyre.
ELIZABETH FARNSWORTH: I asked him why there isn't enough funding.
DR. C. M. NYIRENDA: Lack of money -- the lack of financial resources.
ELIZABETH FARNSWORTH: And is it just that the government doesn't have enough money or that they're not devoting the money?
DR. C. M. NYIRENDA: The government hasn't got enough money. It's not only Ministry of Health -- it's all ministries… it's Ministry of Education, of Agriculture, it's all the ministries who are equally involved, but here we do feel we're talking life and death.
ELIZABETH FARNSWORTH: And so in villages like this one, where corn crops are uncertain, water is unclean, and some people are very sick, volunteers are stepping in to fill the gap. Goodwin Horiab is one of 72 members of a volunteer organization called SASO, the Salima HIV/AIDS Support Organization. He visits the sick in this village several times a week. He believes this woman -- Livetia Moluzi -- has AIDS. Her husband died a few years ago -- her daughter and a grandchild more recently.
She lives with her three surviving children, one of whom is disabled from polio, and with her orphaned grandchild, who does most of the chores. Moluzi got an antibiotic at the hospital for sores on her head and special salts for rehydration. And Goodwin Horiab reminded her to take the medication as prescribed and to be sure to boil the water. But these medications can't save her life; and Goodwin Horiab says he's angry the AIDS drugs being used in developed countries are not available here.
GOODWIN HORIAB (speaking through interpreter): Well, unfortunately everything good starts from those countries, and then the last scraps come to Africa. And we're always getting the bottom of everything. Since things have been that way, I guess with AIDS that's the way it's going to be.
MARYLINE MULEMBA: Of course we need to continue focusing on prevention, to try to reduce transmission and that less people get contaminated, but we need also to treat the ones who are infected because we can't afford to lose them all. And to be able to treat them we need to have the drugs in -- and we need to have the infrastructure to be able to do it.
ELIZABETH FARNSWORTH: Goodwin Horiab is convinced that he and other volunteers could be part of that infrastructure.
GOODWIN HORIAB (speaking through interpreter): We have home-based care volunteers who have been trained to deliver medication. One way to do it would be to have the same home-based care people trained in AIDS treatment and come give the medication to patients.
ELIZABETH FARNSWORTH: SASO volunteers have already been trained to test for AIDS, and they said they could also monitor patients on AIDS drugs, if doctors had them to prescribe. The monitoring would be crucial because the virus develops resistance when pills aren't taken correctly. At Queen Elizabeth hospital in Blantyre, the government already has a very small pilot program providing anti-retrovirals -- ARVs as they're called -- to a handful of people who can pay. But the government is also committed to making the ARVs much more available.
VICE PRESIDENT JUSTIN MALEWEZI: We are advocates for anti-retrovirals… as part of the prevention as well as treatment, because, as you know, once a person is on the ARVs, the transmission rate is greatly reduced; so it is part of the prevention.
ELIZABETH FARNSWORTH: First there is much to do. The plan is to seek more financial help from abroad to get the chemicals and training to upgrade labs like this one. Pilot programs would test whether the pills can be safely administered to the very poor. Already, healthcare workers are being prepared to give the medication, which prevents mother-to-child transmission, and groups like Doctors Without Borders are gearing up to help.
MARYLINE MULEMBA: If you want to do anti-retrovirals, it has to start somewhere, and we need to learn how to do it in this context, because actually nobody has done it in this context.
ELIZABETH FARNSWORTH: Malawi is negotiating now with a German pharmaceutical company to get the mother-to-child drug free or very cheaply, as are other governments in the region. But to serve all the people who need help, the vice president says a huge flow of aid from outside will be necessary.
VICE PRESIDENT JUSTIN MALEWEZI: For Malawi the figure is about $4.6 billion over a five-year program.
ELIZABETH FARNSWORTH: So far, the United States, the United Nations and others have pledged only a little over $100 million for Malawi's anti-AIDS program. So for Livetia Moluzi and others who are sick here, the outlook is bleak. Four people have already died in these huts in the past three years. Livetia Moluzi wonders if she will be next.
GWEN IFILL: In Africa and in the West there is a growing debate over the best way to provide treatment. Elizabeth is preparing additional reports on AIDS in Africa, which will air next month; they will also feature Botswana and more on the debate over drugs, pricing, international assistance and AIDS.