MY COUNTRY is being devastated by AIDS. I witness it every day in my work as
a doctor around Cape Town. A few weeks ago, for example, an entire family I knew
died from AIDS within a few days of each other鈥攖he mother on the Friday,
the father on the Sunday and their son on the Monday.
A woman I know, whose husband and youngest child have died from AIDS and
whose surviving son is ill with it, is about to lose her house because she
cannot afford the rent. I know another couple, both HIV-positive and both blind,
whose child, who is also HIV-positive, fell ill and was taken to a hospice. Then
the father fell ill and was taken to a mission. The mother has been left alone
to fend for herself.
Tragedies like these are being played out all over South Africa. The rate of
HIV infection is greater here than in any other country. Around four million
people are carrying the virus鈥攁bout a tenth of the population. By 2010, a
quarter of the population will be HIV-positive. Between 1600 and 1800 people are
being infected every day. At least 200 of these are newborn babies, who pick up
the virus from their mothers. In just five years, South Africa will have a
million AIDS orphans.
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The country had done a lot to reduce infant mortality and increase life
expectancy, but the AIDS crisis has wiped out these gains. Infant mortality
rates have increased by 25 per cent in certain areas over the past year.
AIDS is unlike any disease we have seen before. But the government鈥檚 attitude
to the crisis is deeply perplexing. President Thabo Mbeki and the former health
minister鈥攏ow foreign minister鈥擭kosazana Zuma have consistently
refused to supply AZT鈥攐ne of the most effective antiviral drugs鈥攖o
HIV-positive pregnant women, claiming it is toxic, ineffective and too
expensive. Last October, Mbeki told parliament that AZT was dangerous. As
reported in New 杏吧原创 last week
(29 April, p14), he has even asked
advice from dissident AIDS scientists such as David Rasnick and Peter Duesberg,
who do not even believe that AIDS is caused by a virus.
This has left local scientists, activists and nongovernmental organisations
baffled. Mbeki鈥檚 position defies logic. The suggestion that AIDS is not caused
by HIV, and is not a relatively new disease, is totally at odds with what is
happening on the ground. South Africans are burying husbands, wives, children,
relations and friends every day. People are terrified. No one has seen anything
like it before.
South Africa has had a National Aids Plan since 1992. It covers all aspects
of prevention, including the distribution of condoms and education on safe sex
and sexually transmitted diseases. However, the implementation of this plan has
been piecemeal, uncoordinated and inconsistent. The government channelled a lot
of money for HIV prevention through NGOs, but because of excessive bureaucracy
the money took a long time to reach them. Many NGOs fell apart because of the
lack of funding.
The government has tried to persuade more men to use condoms, something many
are reluctant to do, and Mbeki himself appeared in a television advertisement to
spread awareness of AIDS. Despite this, it is estimated that only 8 per cent of
men use condoms.
Crucially, though, the plan did nothing to tackle the transmission of the
virus from mother to child, through voluntary testing and treatment with AZT or
nevirapine鈥攄espite the mountain of evidence showing the cost-effectiveness
of this approach. Between 1990 and 1998, the rate of HIV infection in women of
childbearing age increased 34-fold. In some areas of the country, one pregnant
woman in three is HIV-positive. A third of infants born to mothers who are
HIV-positive contract the virus in the womb, while another 12 to 20 per cent
pick it up through breastfeeding.
Mbeki鈥檚 stance has created confusion. He has disappointed everyone in the
medical establishment who hoped that mother-to-child transmission would be
dramatically cut using drugs.
The question we are all asking is: why? Cost, toxicity and lack of
effectiveness have all been touted as reasons, but none of them really makes any
sense. I find it very difficult to understand what is going on. Some have
suggested that the government鈥檚 stance on AZT has more to do with anti-Western
sentiment or a refusal to be held hostage by pharmaceuticals companies than with
economics and science. Personally, I do not know if there are any hidden
agendas, or whether Mbeki and others are being naive or overly cautious.
Either way, the government鈥檚 position is having a drastic effect on South
Africans. 鈥淲hat about the orphans?鈥� asked health minister Manto
Tshabalala-Msimang, wondering whether we should be saving the lives of children
who would then have to grow up without a mother. The perception in some quarters
is that preventing a child from contracting HIV from its mother is pointless,
because society could not cope with lots of orphans. The implication is that it
is better to let them die.
Yet ask any pregnant mother and she will tell you that she would sacrifice
her health and even her life to have a healthy, HIV-negative child. Ideally, we
should be treating mothers who are HIV-positive with triple combination therapy
so that they live long enough to care for their child in its early years, but of
course we cannot afford to. In the meantime, communities have rallied around
before and they will do so again to care for these orphans. Should children be
forced to suffer the 鈥渟ins鈥� of their parents?
To wish away orphans, or to fail to try to save life, to me is inhumane and
unethical, let alone economically suicidal. The government鈥檚 position is
baffling. Do the powers that be know things that us mortals do not? Could they
have taken this decision for the greater good of society?
As a doctor I know one thing for certain: there is a virus called HIV that
destroys the immune system, paving the way for infections that kill. To ignore
its existence is to pass a death sentence on millions more South Africans. A
nationwide programme to prevent mother-to-child transmission of HIV using AZT
would cost R80 million (about 拢8 million) a year. Over the next few years,
South Africa will spend R30 billion on arms. This country needs to get its
priorities right, or it will hardly be a country at all.