In the past five years (1993-1998), South Africa has seen a marked increase in the amount of people infected with HIV. Even in the face of this growing epidemic, there is a great apathy among the people who are in a position to begin to address this problem.
FRED DE SAM LAZARO: Dr. Glenda Gray began working with patients in this Soweto clinic near Johannesburg five years ago. South Africa was on the verge of becoming a democratic nation. It was also on the verge of perhaps the most explosive outbreak of HIV in history.
DR. GLENDA GRAY: In 1993, when I first started working in HIV, the sero-prevalence amongst pregnant women was 3 percent. Now, a couple, five years later, we’re looking at 20 percent HIV sero-prevalence amongst pregnant women in Soweto. So, half of the people who get admitted each day in the medical wards are HIV-positive. One third of all our children in this hospital who get admitted are HIV, so we’re seeing it, you know.
FRED DE SAM LAZARO: More than three million South Africans are positive for HIV, the virus that leads to AIDS. That’s about one of every seven citizens, and the number is headed up perhaps to one in four. It’s not the highest rate on the continent but rising at a rate not seen elsewhere.
RUEBEN SHER: We’re facing a biological Holocaust. There’s no two ways about it.
FRED DE SAM LAZARO: Virologist Rueben Sher says even though South Africa has the continent’s most modern health care system, its HIV problem went largely ignored in a nation preoccupied with political and socioeconomic concerns as it moved from white minority rule to democracy
REUBEN SHER: It was not a priority. Jobs, housing, political freedom, those were the priorities. Maybe the only benefit of apartheid was that we didn’t allow people to the North of us to come in to the country, and we didn’t allow most of the local indigenous population to travel North. And when the doors were opened, you started getting people with HIV infection coming into the country.
FRED DE SAM LAZARO: Apartheid may have kept HIV at bay, but it also left a legacy of mistrust. That’s a huge handicap for a public health system in which most health care providers are white and most patients black. Mark Ottenweller is an American physician with the charity Hope Worldwide.
MARK OTTENWEILER: They don’t trust authority figures. White South African doctors are not trusted by black South African migrant workers. So there’s a lot of distrust, perhaps some misinformation in the past.
FRED DE SAM LAZARO: That misinformation has allowed HIV to flourish. For example, AIDS is still widely viewed as a disease of gay white males. In fact, the vast majority of cases are heterosexual black South Africans, more than half of them female, many seemingly naïve about their risk.
LORRAINE NYABANE: You know, I thought in my heart that those virus is only get by those people who are sleeping around. I didn’t think that I would get the virus. So it’s painful.
FRED DE SAM LAZARO: Like most young HIV-infected women, Lorraine Nyabane only learned she was HIV positive after becoming pregnant and seeking prenatal care. For most, this discovery is only the start of their pain, according to Nurse Practitioner Jacob Moetlo.
JACOB MOETLO: So, now they’ve got to maybe disclose this to either their husbands or their sexual partners, and so they always have a problem, because, you know, unfortunately, we still have a problem where we men around in this country, we still, you know, oppress women. That’s another problem.
FRED DE SAM LAZARO: The women in Moetlo’s clinic are part of a study in which they are given the drug AZT during pregnancy and also infant formula to substitute for breastfeeding. That lowers the risk of HIV transmission to the babies, but it increases the risk of social sanction for their mothers.
JACOB MOETLO: If you are a black woman and you are not breast feeding, you know, you are faced with a lot of questions from the in-laws, you know, from your husband and even from the health workers, you know, why aren’t you breast feeding, or they just don’t find that situation.
FRED DE SAM LAZARO: Moetlo says women risk being thrown out in the street if they reveal their HIV status. Most are still able to conceal it, since they haven’t progressed to full-blown AIDS. However, on a broader scale, public health workers say this appearance of normalcy has worked against them.
LATISA MABE, Public Health Worker: People knew just about AIDS, they just knew about people who lose weight, people who are very sick, people who cannot do anything. But now if you bring someone who is very healthy but who is HIV-positive, they still don’t believe, and this is something we really need to work out on.
Treating the sick.
FRED DE SAM LAZARO: For the growing number of HIV cases beginning to show signs of disease, there are few places of refuge. The Ark Ministries is one — located in a converted railroad hostel in the coastal city of Durban.
WALLY HILL: This guy here we actually found on the beachfront, in worse condition than he is now. As you can, see he’s still very frail.
FRED DE SAM LAZARO: The Ark has served those down on their luck for some years. Now, AIDS is the primary reason they come, especially younger tenants, many of them casualties of years of civil strife. Winnie Sibiya says she became HIV-infected as a result of being raped. She’d wandered into an area of her village that a rival group had declared off-limits.
WINNIE SIBIYA: It was really hard, because I failed to introduce a condom culture to my partners. I decided again to abstain myself from sex, but due to the fact that I was under stress, coping with HIV and the rape case, it was hard for me to be alone. So I tried to get a friend, although I didn’t open anything about my status. So they used to ask why I said we have to use a condom. I just beat about the bush. I didn’t say the truth, that I was one of the carriers. So no one agrees to use a condom, so I did continue having that love affair, or doing that lovemaking, but my conscience was there.
FRED DE SAM LAZARO: Sibiya has spent a year at the Ark. Her health has now stabilized, although she’s been unable to find work. Still, she is among the more fortunate, according to Pastor Shirley Pretorius, the Ark’s director.
PASTOR SHIRLEY PRETORIUS: There must be hundreds of thousands of people who die in the rural areas probably from AIDS-related conditions but they’re never diagnosed, because they just die in the family home, and they’re buried and that’s it. So as I say, we’re not even touching the tip of the iceberg.
FRED DE SAM LAZARO: No one’s yet tallied the economic toll HIV AIDS will take on South Africa, but the mining industry, long the mainstay of the economy, offers a sobering barometer. One of every three miners already is HIV-positive. And the mining companies say for every job that opens up in the next few years, they’ll need to train four workers. The rippling effect is a serious setback to government plans to improve the standard of living for this nation’s impoverished black majority. As for the government’s approach to HIV, critics say its been mired in scandal, inefficiency, and missed a rare opportunity in Africa to prevent the epidemic.
A country in denial.
DR. GLENDA GRAY: We should have been able to curtail it. You know, we have a sophisticated media infrastructure, we have a good public health system from the apartheid, and we’ve got grass-roots organizations that – with political organizations, and we should have used the same strategy to combat HIV, but the country’s in denial, and no one seems to care, you know, at levels where decisions are made about this.
FRED DE SAM LAZARO: But Rose Smart, who heads the government’s HIV/AIDS program, says the epidemic is the result of a complex set of factors.
ROSE SMART: We are a country in transition. We have a past which certainly laid the foundation for a fully fledged epidemic. We have factors such as migrancy; we had low grade wars in various inner parts of the country, particularly Kwazulu Natal, which were the perfect conditions to get an epidemic such as this well-established. It’s an epidemic that is fueled by social factors like poverty, like family disruption, like illiteracy, lack of jobs, those sorts of elements are common in South Africa, despite the fact that many people see us as being a first world – third world country. For most of the population we are definitely a third world country.
FRED DE SAM LAZARO: Smart says South Africa should be able to provide basic health care to its AIDS patients, although the country cannot afford the expensive antiviral therapies available in the West. However, Gail Schultz, who runs a Salvation Army hospice for young HIV-positive children, doubts the public health system will be able to cope with the load.
GAIL SCHULTZ: We’re already getting to the stage where the hospitals say there is nothing we can do for this baby, take her home, she is dying.
FRED DE SAM LAZARO: Part of the strategy at this facility is to enlist teenagers from local schools to care for the infants.
GAIL SCHULTZ: Our aim is to teach them about HIV/AIDS. B, our aim is to show them how they can work with these children but C, our main aim is to make them comfortable with HIV and AIDS, that when they get into their personal lives, they’re going to be able to deal with it, instead of rejecting the infected person.
MARK OTTENWELLER: It’s going to take a generation to mobilize people for education, for health, for jobs, for lots of the redistribution things in South Africa. And, unfortunately, with the AIDS epidemic, we don’t have that generation to wait
FRED DE SAM LAZARO: Ottenweller calls his patients “the lost generation.” He says their predicament is a metaphor for a nation that hasn’t yet fully come to grips with a grave health crisis.