S. Africa's AIDS program will help about one in 10

Government to give drugs, but painful decisions loom

April 01, 2004|By John Murphy | John Murphy,SUN FOREIGN STAFF

JOHANNESBURG, South Africa - After years of watching South Africa's AIDS victims being sent home to die because they could not afford lifesaving drugs, nurse Lydia Baloyi should be pleased that today the South African government will start providing these medicines for free.

But sitting on a bench in Helen Joseph Hospital's AIDS clinic this week, she shook her head thinking about the agonizing life-and-death choices her hospital will face now that the drugs are available.

"I've got a lot of fear," says Baloyi, "because everyone wants to live."

The reality of South Africa's treatment program, however, is that thousands of AIDS patients will still die because there's not enough treatment immediately available for everyone.

The new government program promises by 2008 to treat all AIDS victims, prevent nearly a million children from becoming orphans, and turn an epidemic into a treatable disease.

But, for now, the reality of treatment falls hopelessly short of the promise.

Faced with the highest number of HIV/AIDS infections in the world and a health system unprepared for the task at hand, South African health workers such as Baloyi are quietly doing the arithmetic and calculating that demand for treatment will far exceed their resources.

South Africa has an estimated 5.3 million people infected with the virus that causes AIDS. According to the latest government estimates, about 400,000 to 500,000 people have developed AIDS and need treatment.

But the treatment will not start for everyone all at once. By 2005, the government hopes to target about 30 percent of those patients. And the worst of the AIDS crisis has yet to hit because of the long delay between infection and the onset of symptoms. By 2008, when the government plans to treat all AIDS patients, 1.5 million people will need treatment.

One person in 10

Helen Joseph Hospital is one of 23 hospitals where the government will start treatment in Gauteng Province, home to the cities of Johannesburg and Pretoria and a population of more than 8 million. During the next 12 months, the government plans to provide 10,000 patients with medicine. Yet health officials estimate more than 100,000 in the province are in need.

"We have a lot of sick patients," says Baloyi. "You feel bad that there are patients who can't be helped because drugs are few."

No one knows who will receive the medicines, says Sue Roberts, AIDS clinic coordinator at Helen Joseph Hospital, where 1,000 people are awaiting treatment and a flood of new patients is expected within weeks.

If the rush occurs, Roberts says, the hospital could decide on a first-come, first-served basis. Or it could choose those who are sickest. Or it could decide to treat those with the most dependents - a 19-year-old woman on the hospital's waiting list is supporting five siblings.

Whatever the criteria, the options are not pleasant, she says. Some people might not receive treatment at all.

"It's nightmarish," says Roberts.

Despite having one of the best health care systems in Africa, South Africa's government has been reluctant to distribute AIDS drugs, arguing that they are dangerous and too expensive. Many doctors and nurses are untrained in prescribing AIDS drugs and treatments. Hospitals, especially in the rural areas, do not have the facilities or staff to support the program.

After years of outcry by AIDS activists, the government relented last year and promised to provide treatment. But it now faces the task of hiring and training thousands of health care workers, building or expanding clinics and hospitals and finding funds to pay for it.

Helen Joseph Hospital will be one of the centers for AIDS treatment because it has conducted AIDS treatment trials before and provides drugs to patients who can afford them.

Before the expected flood of patients starts this week, the hospital has organized some of the first patients ready for treatment from its waiting lists.

They are people such as C.F. Maake, who grew weak and ill in November. The 59-year-old gardener found it increasingly difficult to push a lawnmower. His weight dropped to 176 pounds from 209. When he finally went to see his doctor, he learned he was suffering from AIDS.

His doctor told him he could buy the AIDS drugs - known as anti-retrovirals - for $100 per month. His monthly salary, however, is $150, which he uses to house and feed his wife, three children and his mother and father. So, he put his name on the hospital's waiting list, hoping that someday the government would provide free treatment.

Last week, he learned he would be one of the first people eligible for the program.

Feeling fortunate

On Tuesday, he sat in the gloomy AIDS clinic, holding his medical file and waiting proudly to see a doctor. On the walls, posters inform visitors of the warning signs of hypertension, stroke and diabetes. Under dim fluorescent lights, other patients sat on orange plastic chairs staring at an unplugged television.

"I know I'm very, very lucky," Maake said, smiling.

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