An update on the AIDS crisis in South Africa as the nation prepares for the 13th International AIDS Conference.
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FRED DE SAM LAZARO: When democracy came to South Africa in 1994, it was supposed to bridge the huge gap between the two South Africans, one a nation of vast wealth occupied by whites, the other a country of third-world poverty inhabited by its black majority.
One in ten South Africans HIV positive
SPOKESPERSON: Thank you, ma’am.
FRED DE SAM LAZARO: But an already difficult task has become much more complicated by one of the worst HIV epidemics in history. The modern infrastructure, the new democracy have not helped, and the numbers are staggering. Already, one in ten South Africans is HIV-positive, and as more HIV infections convert to AIDS cases, the epidemic is becoming visible.
SPOKESPERSON: What you’re seeing over here is what we call floor bed, which is just a blanket on the floor with a pillow underneath a bed of another patient.
FRED DE SAM LAZARO: Hospitals like this one in rural Kwazulu Natal Province are seriously overcrowded. Joeman Magizi is one of its 400 patients.
JOEMAN MAGIZI (translated): I have not been able to work now for about six months. I’m unable to provide any support for my family.
FRED DE SAM LAZARO: Families are especially hard hit. One in five pregnant women in South African clinics is HIV- positive. The AIDS virus accounts for most pediatric cases in hospitals. And the worst is yet to come, since most of the infected have not yet developed AIDS symptoms. In fact, most don’t even know they’re HIV-positive, and many still feed an infection spiral that is creating about 1,700 new cases every day. So dire are the predictions that economist Alan Whiteside says a new word has been created to describe the situation.
ALAN WHITESIDE, University of Natal: I came across a term which I hadn’t come across before, used by some people from the World Bank, which is emiserization, and it describes the process of becoming more miserable. The levels of misery and impoverishment that we’re going to see in rural and peri-urban South Africa are just not appreciated yet, and it’s something that fills me with horror.
HIV rates fueled by apartheid and democracy
FRED DE SAM LAZARO: How did Africa’s most modern nation find itself so much worse off than its far poorer neighbors in dealing with HIV? Experts cite several factors, beginning with the segregationist apartheid regime, which created a migrant labor system to build the modern nation. Black men traveled to distant urban and mining areas, separated from their families 11 months of the year, a recipe for disaster, says public health scientist Mark Lurie.
MARK LURIE, Public Health Scientist: If you wanted to create the conditions conducive to the spread of HIV, What you would like to do is find as many young rural men as you could, remove them to urban centers, give them easy access to commercial sex workers and alcohol, and very soon you’d have an HIV epidemic on your hands.
FRED DE SAM LAZARO: Ironically, the freedom movement that democracy brought only accelerated the HIV Infection rate.
MARK LURIE: The levels of movement have increased dramatically in South Africa over the last few years. What’s happened is that trade unions have been empowered to negotiate more flexible work contracts, transportation infrastructures have developed, so that people are much more easily able to move from one place to another, and HIV, like other infectious diseases which follows… which spread by individuals, will naturally follow the flow of the movement of individuals.
FRED DE SAM LAZARO: Unlike other African nations, South Africa had resources. Soon after the new government took over in 1994, it crafted a comprehensive AIDS plan that looked at care, treatment, research, human rights, and with private groups launched an AIDS awareness campaign.
CHILDREN IN UNISON: AIDS.
(TEACHER SPEAKING ZULU)
CHILDREN IN UNISON: AIDS.
FRED DE SAM LAZARO: So why didn’t awareness translate into changed behavior? Why is condom use much lower than in many African countries where they’re far less available? Why did the grand plan fail to yield results? Mary Crewe has a theory. She runs the center for AIDS study at the University of Pretoria.
MARY CREWE: We’ve fought an epidemic which is at every level and in every respect irrational, and we’ve fought it rationally, so we’ve expected that people would take on the epidemic in a rational way when it’s driven by absolutely irrational forces.
FRED DE SAM LAZARO: Sexuality, that is. Crewe says it’s an issue the leadership at many levels has been reluctant to address. Nelson Mandela, for example, only mentioned AIDS once in his tenure, in 1998. His successor, Thabo Mbeki, was criticized for seeming to reopen a debate over whether AIDS is caused by HIV. Scientists say it only distracts from the tough issues involved in implementing the AIDS plan.
MARY CREWE: People didn’t recognize that to implement the plan took a lot of courage: Giving real creative leadership, of giving some vision of tackling the difficult issues of how South Africans behave sexually, and what the kind of breakdown of family life has meant for the epidemic; and for a real vibrant leadership to say, our behavior is wrong, and what we’re doing is wrong, and not wrong in a moral sense, but wrong in the sense that that’s what’s driving the epidemic, and that we have to address it.
Churches confronting morality and sexuality
FRED DE SAM LAZARO: Churches in this mostly Christian country have long taken on the moral leadership role, but church leaders admit they failed where AIDS is concerned.
DR. NELDA SWART, Christian Service Foundation: You cannot do AIDS education without addressing sexuality and sexual behavior. Those are not topics that the church has ever been comfortable with, especially not from a pulpit or not as part of an organized church program.
FRED DE SAM LAZARO: Dr. Nelda Swart and colleague Margaret Muchai, who work for a church-based health service, say the churches’ squeamishness reinforces the stigma of AIDS. Many AIDS patients are abandoned by family and community. Like Louisa Godsha, they’re often left to die.
LOUISA GODSHA: The future… It’s done for me. It’s done for me. Even if I die, I will have nobody to… to bury me. My son is too small, ten years old. Nobody helps. I’m struggling on my own.
FRED DE SAM LAZARO: Swart and Muchai say it is in fact people like Louisa Godsha who have forced churches to face the AIDS crisis.
MARGARET MUCHAI, Christian Service Foundation: The rippling effect has now touched the church, where the church is sitting with having to give out food vouchers, where the church is sitting with having not just to do the funerals, but to take on the burden of taking care of those that have been left behind. I must say that, at the moment, the South African Church is very awake.
A crisis of epidemic proportions
FRED DE SAM LAZARO: There also has been little leadership from the business community, run mostly by whites who are not directly affected in large numbers by HIV, however, businesses slowly are starting to realize that they’re losing customers, according to economist Whiteside, who in an upcoming book cites a study done by a large retail company.
ALAN WHITESIDE: They looked at the overall prevalence in their consumers and estimated that although there would be continued growth until 2010, they then estimated that there would be an 18 percent decline in their customers by 2015.
FRED DE SAM LAZARO: But Bongali Khumalo expects that all those who have stood back in the past — business, churches, and government — will step forward. Khumalo is a corporate executive who was recruited by the government to spearhead the overall AIDS effort.
BONGALI KUMALO: The question of credibility, as far as the leadership of government is concerned, is very, very critical, and that is where I’m going to be assisting government to provide leadership, to provide championship and encouragement, so that we participate in this fight against HIV and AIDS by stimulating participation without usurping responsibility and initiative from the people who are taking part. If we lose this fight, we perish.
FRED DE SAM LAZARO: What has perished for many South Africans is the dream of a prosperous, hopeful nation at the helm of a continent. Pastor Fano Sibisi ministers to a rural church in Kwazulu Natal.
REV. FANO SIBISI: I think it’s one of the darkest periods in the history of this country. Having overcome apartheid, having gained our freedom, we’re dying, and are not able to experience it.
FRED DE SAM LAZARO: Even if the epidemic is stopped in its tracks with no further infections, the HIV epidemic and its deadly AIDS sequel will still be among the gravest ever witnessed, and could claim the lives of up to a quarter of South Africa’s 38 million people.