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AIDS in South Africa

Tonight, as I took my evening stroll along the beachfront, many of my fellow sundown seekers were wearing red ribbons. Earlier in the day an assembly of ecclesiastical dignitaries, in town for the Parliament of World Religions, held a special service for AIDS victims. Today is World AIDS day and HIV/ AIDS is a subject that has recently been on my mind a great deal. I have been struggling to come to terms with it. I am sorry to choose such a morbid subject but, if I may outline the situation briefly to you, AIDS is fast becoming the dominant issue for those who live in this wonderful country.

Stored blood samples indicate that HIV entered the human population in central Africa the late 1950s. It seems to be related to SIV, which is an infection found in monkeys, although it has now diverged into 4 separate strains of HIV. How the transfer occurred is a matter of debate - some say that it was the practise of eating monkey brains, a recent book (the River by Ed Hooper) suggests that Monkey kidneys, used as the culture for a widely used polio vaccine, were in fact the cause.

Today 33 million are infected with the disease. Five hundred a day die in Kenya. But it is South Africa which is regarded as the AIDS capital of the world. Ten years ago the disease had hardly entered the country. Then the state was still run by the old apartheid regime - but Mandela was released in 1990 and a long period of negotiations followed. All eyes were on the political tightrope that South Africa successfully crossed, but meanwhile a disease was growing rapidly but imperceptibly which now threatens to overwhelm the new state.

Mandela did not like to talk about sex in public - it was awkward for him to break with the traditional silence of older men on such issues. The health minister - a combative woman - was caught up in legal battles with pharmaceutical companies and a radical programme to re-distribute wealth away from 'white' hospitals to rural clinics. Her half-hearted AIDS projects all ended dismally in scandals over corruption and incompetence (in one campaign 40,000 condoms were stapled to postcards).

The new government of Thabo Mbeki is much more focused and efficient - but in the intervening decade the infection has spread dramatically. 10% of the population are thought to be HIV+ . There 1,500 new infections per day (some say 1,700). Primarily it is the black population aged 17 - 45 which is effected. 21% of teenagers are infected. In many mining and industrial companies over 25% of the workforce is HIV+.

In another ten years the rate will be up to 30% of the population and proportionally higher among the young and middle aged black population. At that time the current HIV cases will start to die in large numbers. There will be 700,000 orphans. What does all this mean in purely economic terms? Businesses and the civil service will face extraordinary productivity problems as their workers fall sick more regularly, take leave to attend funerals and eventually cease to be able to work. The costs of replacing them will be huge. To maintain current health standards the budget of the health service would need to be increased many tenfold (which it cannot be). The effect on the political system is harder to predict but certainly the ANC will, literally, lose much of its support.

Why has the disease spread so fast? Knowledge about the disease has been very scant until recently, although now the government and NGOs are working hard to educate the population. But still there is a stigma associated with the disease. People will not change their behaviours - they resent the government telling them how to live. They disdain condoms as 'unafrican'. Many believe that the disease is a ruse to frighten Africans away from having children. Ignorance, blind tradition and a live-for-today attitude is proving a difficult troika to overcome.

Against all this there are wonderful stories - as ever in South Africa. The AIDS victims who are working as AIDS ambassadors, touring the townships speaking about the disease, often in the face of hostility. Newspapers are printing regular columns to discuss the epidemic. Business, the media and the government are launching 'Partnership Against AIDS' projects. And hospices and homes for AIDS orphans are being opened up by caring people.

One feels a little hopeless - one can support local orphanages, but one feels that they are only sand castles in the tide. If a vaccine is found now, still many will die - but the larger consequences will be relatively limited. If a cure is found, then all the scenarios of population loss will be unfounded. But if the disease rolls on exponentially it is hard to know where it will stop.


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