Posted Sunday, April 11, 2004; 2.15BST
No mystery runs deeper or deadlier than South Africa's baffling relationship with the HIV virus. AIDS is the gravest threat facing the country — 5 million are infected with the virus, and more than 600 die from the disease every day — yet the ignorance and denial that surround it are even more pervasive. "What can I get it from?" and "What is HIV?" are often the first questions people ask Xoliswa Xobololo, an AIDS counselor near the town of Orkney, two hours west of Johannesburg. Xobololo's clinic is run by South Africa's largest gold-mining company, AngloGold, which estimates nearly one-third of its 44,000 workers may be infected. Like many South Africans, the poorly schooled mine workers are in dire need of education.
South Africa has more HIV-positive citizens than any other country in the world. Since 1994, the proportion of adults infected with the virus has rocketed from 1 in 20 to 1 in 6, as a fatal combination of poverty, ignorance and unprotected sex swelled the epidemic into a viral tidal wave. But South Africa's leaders have been frighteningly ineffective at dealing with AIDS. President Thabo Mbeki spent much of his first term questioning the link between HIV and AIDS and stressing the potential toxicity of lifesaving antiretroviral (ARV) drugs. The government has backed programs to prevent the spread of the disease, encouraging condom use and education for schoolkids. But it has dragged its feet on helping those already infected. In February Health Minister Manto Tshabalala-Msimang said a program to supply ARV drugs to thousands of sufferers would be delayed because the health system was "in shambles." Her best advice to HIV-positive people has been to eat roots and vegetables to ward off infection. "I think garlic is absolutely critical," she said at a briefing in February. "Lemon is absolutely critical. Olive oil is absolutely critical … just one teaspoon, it will last the whole month." Activists are appalled. "There's an emergency, and I don't know if a lot of people realize this," says Fatima Hassan, an attorney with the South Africa-based AIDS Law Project. Under pressure from AIDS activists, Tshabalala-Msimang finally gave the provinces the go-ahead to begin supplying AIDS drugs late last month. A program backed by former U.S. President Bill Clinton to make cheap generic AIDS drugs available should also help.
As the government tries to make rhetoric cope with reality, the disease is taking a massive human and economic toll. A recent survey by the South African Business Coalition on HIV/AIDS found that the disease has already cut the profits of 45% of medium-sized and large businesses in the country. Researchers at the University of Port Elizabeth say AIDS is one of three main factors that cause nearly 80% of the country's start-ups to fail. (The other two are crime and a lack of expertise.) The Johannesburg Stock Exchange is considering a proposal to require listed companies to declare the impact of HIV/AIDS on their revenues.
Understandably big companies have been among the first to offer antiretroviral treatment. Last April, AngloGold began offering its employees ARV drugs once their immune cells fall below a certain threshold. The program costs the company about $200 per patient per month. (The lowest-paid workers earn around $300 a month.) But not treating the disease would be even more expensive. An early study found that providing treatment would add as much as $6 — about 2% — to the cost of producing each ounce of gold. Letting the disease take its course would add $9 to the cost of an ounce, as reduced productivity, absenteeism, health-care costs and the burdens of replacing a dying workforce took their toll. "The bottom line is money," says the AIDS Law Project's Hassan. "It makes more economic sense to keep people alive and treat them than to let them die."
But corporate initiatives can only reach a fraction of the population — and they face challenges of their own. AngloGold estimates that between 3,000 and 4,000 employees qualify for treatment, but by the end of 2003 only 534 had started taking the drugs. Some turned down treatment because their spouses were not eligible, others have reported sharing the pills, which renders them all but useless. Mostly, the miners don't sign up because of the culture of stigma and denial. "As long as people think that drugs are toxic, that HIV doesn't cause AIDS," says Liesl Page-Shipp, AngloGold's assistant manger for HIV/AIDS, "then we have to go out and convince every single patient." It would be a big help if somebody could convince a single non-patient: President Mbeki.
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