JOHANNESBURG, South Africa -- Refiloe Serote spends most of her days trying to convince black South Africans that there really is a disease called AIDS and that it stands a good chance of becoming South Africa's latest plague.
The disease has come late to South Africa, after killing thousands in other African countries, and medical experts are hoping to avoid an epidemic of similar proportions here.
The experts can see it coming, as millions of workers cross the borders regularly from Zambia, Zimbabwe and Malawi, and as thousands of political exiles return from places where the population is being decimated by acquired immune deficiency syndrome. They also anticipate its spread by indigenous migrant workers, who routinely move from wives in rural areas to girlfriends in urban areas, and by truck drivers on long-distance routes that take them into Africa's AIDS belt.
But the experts are having trouble getting a suspicious population, already plagued by poverty and apartheid, to focus on a disease.
"They don't believe altogether that there's such a thing as AIDS," said Ms. Serote, who runs the Township AIDS Project in Soweto, a Norwegian-funded program of education and counseling.
"Some say it's an American idea to discourage sex. Others think it's a government plot to distribute condoms to limit the number of blacks so there won't be so many of us when we're in a one-man, one-vote situation.
"Others think it's a disease for whites, homosexuals and sex workers [prostitutes]," she said. "Others refuse to use a condom. They think it belittles a man."
There are also blacks who think AIDS is a government or right-wing plot to discredit the African National Congress, whose members have been returning from exile in countries with high AIDS rates, said Ms. Serote. She said a pamphlet was distributed anonymously in the black township this year warning women that they would get AIDS if they came in contact with men from Umkhonto we Sizwe, the ANC's military wing, which has bases outside the country.
"It made people hate for you to talk about AIDS," she said.
AIDS in South Africa, as in the United States, first appeared in the white male homosexual population and is believed to have come from contact with Europeans and Americans. The first cases appeared in 1982, while the first case among black heterosexuals was not seen until five years later, and not even among black South Africans. Doctors say the first black AIDS patients in South Africa were from Malawi and Zaire.
There have been 3,000 AIDS cases reported in Zambia; 3,134 in Zimbabwe; 7,160 in tiny Malawi; 9,139 in Kenya; 11,732 in Zaire; and 12,444 in Uganda. Mozambique has reported only 120 cases and Angola only 104, according to World Health Organization figures, but Dr. Richard Sher, director of a 3-year-old AIDS center at the South African Institute of Medical Research, a private medical institute, said there has been serious underreporting in most countries.
South Africa has recorded 500 cases of the disease. But a recent study estimated that between 45,000 and 63,000 people already were infected with the human immunodeficiency virus, which causes AIDS. It projected that up to 168,000 people would be infected by the end of this year and up to 446,000 by the end of 1991, based on an infection rate that doubles every 8 1/2 months.
"The only advantage of apartheid was that it kept the local indigenous black people separated from the North. Maybe that's one of the reasons why it was delayed," Dr. Sher said.
The delay has not necessarily given South Africa an advantage in tackling the disease or in preventing an epidemic. "We've done a lot of education, but there are social and cultural problems. . . . People are worried, but they are not changing their behavior," Dr. Sher said.
Dennis Sifris, head of the AIDS clinic at Johannesburg Hospital, said black patients have been reluctant to come for treatment at the hospital, which was until recently a whites-only facility. "A lot of black people still inherently fear the big white hospital on the hill," he said. There are also language problems to overcome, although the clinic employs a black social worker who speaks several African languages.
Nicky Padayachee, who runs the AIDS program for the city of Johannesburg, complained that conditions in the townships made it difficult for people to heed the advice being provided about AIDS.
"We tell people they must use condoms, but how many pharmacists in Soweto are open on Saturday night? I know of one pharmacist for 3 million people."
He said that condoms should be available in township nightclubs and not just in clinics that are open during work hours, when people are unable or unlikely to go.