South Africa struggles to build AIDS program

Uphill fight against scope, poverty, cultural factors

October 14, 2003|By John Murphy | John Murphy,SUN FOREIGN STAFF

GUGULETU, South Africa - AIDS has claimed the lives of Phumela Tsodo's 9-month-old daughter and a teen-age cousin, and earlier this year it nearly brought an early end to her own life, shriveling her to 55 pounds from 124 and leaving her hospitalized for months.

But on a recent morning in the dimly lighted hallway of Guguletu Township's Community Health Center, Tsodo sat on a long wooden bench waiting to see a doctor, beaming as if she were holding a winning lottery ticket. Which in a way, she is.

The soft-spoken 24-year-old is one of a handful of AIDS patients in South Africa who are receiving lifesaving AIDS drugs without charge. Without them, Tsodo, who is too poor to pay for the treatment, has no doubt that she would join the ranks of the estimated 600 South Africans a day who die from AIDS-related complications

"I am lucky," says Tsodo, one of 150 patients receiving treatment from a charity-funded AIDS program in this bleak township outside Cape Town. "There are a lot of people who want to be on anti-retrovirals, but the drugs are few."

Soon, however, it might no longer require a stroke of good fortune for AIDS patients to stay alive in South Africa. It might require only a need for treatment.

That's the hope of AIDS patients in South Africa when the government is expected to approve a national anti-retroviral treatment program this year.

With an estimated 5.3 million people infected with the AIDS virus, more than in any other country, South Africa is faced with creating the largest treatment program in the world.

Unlike the West, where AIDS treatment is widely available, in Africa most people cannot afford the drugs and their governments are too poor, and in some cases unwilling, to create programs.

There are exceptions, including Botswana, Senegal and Uganda, where governments are beginning to provide anti-retrovirals for free or a nominal fee.

But the gap between those who need treatment and those who get it remains wide. Only 50,000 people in sub-Saharan Africa have access to treatment, 1 percent of those who need it, according to the United Nations.

For many AIDS activists, South Africa's treatment plan is long overdue. Despite having one of the best health care systems on the continent, South Africa's government had been reluctant to distribute AIDS drugs, arguing that treatment costs were too high, that some drugs might be toxic and that the government lacked the resources to support the treatment.

Much of the reluctance originated from the office of President Thabo Mbeki, who consulted dissident scientists and raised doubts about whether HIV causes AIDS.

Timing questioned

But earlier this year the government relented, announcing that it would develop a plan to roll out a treatment program for all AIDS patients in the country. It is a change of course that left many activists questioning the government's motives.

"Even though we welcome the roll-out plan, we have mixed feelings about whether the government reached a turning point because of [national] elections next year," says Tembeka Majali, head of the Western Cape Province's Treatment Action Campaign, the country's largest AIDS lobby organization.

The government, however, has said that it had always planned for an anti-retroviral program as part of its nationwide effort to combat the AIDS epidemic.

The government has not announced details of its plan, but the challenge before it is daunting. According to Treatment Action Campaign, 500,000 people in South Africa who have developed AIDS need treatment now.

Most will not be able to receive the treatment they need for months or years, as the government scrambles to train doctors and nurses in administering the drugs and monitoring the patients. New or expanded clinics and laboratories must also be built to meet the demands of the mammoth program.

Negative influences

Meanwhile, the government must also confront the social problems facing many AIDS patients who struggle with poverty as well as discrimination by family and friends - factors that can discourage patients from sticking to the strict treatment regimen.

Just how much is required of health care workers, as well as patients, to make a treatment program successful can be seen in Tsodo's experience here in Guguletu.

During a recent staff meeting, more than a dozen doctors, nurses and counselors reviewed a long list of patients who had problems with the treatment regimen: some who had drifted away, others who failed to take their medicines, and one who had died because the treatment did not work for him, which is the case in about 10 percent of the patients.

A counselor reported that after 32 weeks of receiving treatment, one patient stopped taking the medicines because she was afraid her new boyfriend will find out she is infected. There was a gasp of disbelief in the room.

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