HEALTH : S. Africa Takes First Steps to Fight Rising AIDS Rate

Dr. Glenda Gray, a pediatrician at the sprawling Baragwanath Hospital complex, remembers how she and other researchers once had to search for patients infected with the AIDS virus.

“That was only five years ago,” she said. “Now we see them every day. . . . AIDS is here. And it’s spreading like wildfire.”

South Africa was the last country to resist the acquired immune deficiency syndrome pandemic that began ravaging much of sub-Saharan Africa in the 1980s. No longer. Health officials now say that the number of South Africans who test positive for the human immunodeficiency virus (HIV) has rocketed from 5,000 cases in 1990 to an estimated 1.8 million.

Experts say about 600 people contract HIV each day--a staggering rate that doubles the caseload every 15 months. About 8,000 people have been diagnosed with AIDS.

“We’re about five years behind the rest of Africa, but we’re rapidly catching up,” warned Gray, co-director of the perinatal HIV research unit at Baragwanath, one of Africa’s largest hospitals.

Already, nearly one-third of children admitted to the pediatric intensive care wards at Baragwanath suffer diseases symptomatic of AIDS, or full-blown AIDS, Gray said. And at least 15% of pregnant women seeking treatment test positive for HIV.

“In a few years, we’ll see one in three women, like in Uganda or Zaire,” she predicted.

Africa may account for 70% of the estimated 4.5 million AIDS cases worldwide, according to the World Health Organization. Some 11 million of the 18 million adults with HIV are in sub-Saharan Africa. In many areas, AIDS has filled hospitals, overwhelmed social services and ruined local economies. It is the leading cause of death in several countries.

The question is why South Africa did so little to prepare. The pariah-like status imposed on South Africa during apartheid helped limit the movement of people who could spread the virus. That provided an opportunity.

“It was the one good thing about our isolation,” said Mary Crew, director of a community AIDS center in Hillbrow, a seedy Johannesburg neighborhood. “Everyone said, ‘Isn’t is wonderful, we’ve got time.’ But it led to enormous complacency. And we frittered away the time.”

A more sinister view blames the racist white-led regime of the time for ignoring what was widely seen as a black and homosexual disease. In fact, as in the rest of Africa, HIV and AIDS here are primarily heterosexually transmitted diseases, with more women than men infected.

But the new black-led government, which took office in May, 1994, also was slow to act. It was only last month that Health Minister Nkosazana Zuma announced what she called the “frightening” new statistics to Parliament and an emergency quadrupling of government money devoted to AIDS prevention and care, to $24 million. Critics say that’s barely enough to combat the disease.

The government plans to give away 97 million men’s condoms and 90,000 women’s condoms, Zuma said, and launch an ambitious public education campaign.

The need is severe. Ian Leslie, an AIDS educator at the Hillbrow center who is HIV-positive, regularly goes to private companies and government offices to teach the basics of AIDS prevention. “Most employers don’t have a clue about what to do if a worker comes up and says he’s HIV-positive,” he said. “They don’t know whether to run away, fire him, or shake his hand.”

The media, in turn, have used scare stories with a distinct South African flavor. At least two women’s magazines have focused on the plight of white homemakers, known here as “madams,” who discover their black servants are HIV-positive.

“Maids with AIDS: the new SA threat,” warned the cover of YOU magazine, which carried photos of maids using rubber gloves to cook and change diapers. In the May issue of Fair Lady, the madam fired her longtime housekeeper, sparking a furor in the letters column and a court battle.

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“There’s been a tremendous scare,” said Mark Hayward, head of the nonprofit AIDS Law Project at University of the Witwatersrand. “We’ve had cases where a woman came and said, ‘My madam forced me to have a test, and I was positive, and I was dismissed,’ or ‘I was tested without my knowledge or consent.’ ”

AIDS activists and health workers face a wrenching dilemma. They need to publicize the epidemic. But many tell their clients not to advise anyone if they are HIV-positive for fear of retribution. “We’re saying to people, ‘Don’t tell,’ ” said Crew. “You may lose your job, your home, your insurance. At the same time, we’re telling the public that this is a national emergency. Why should they believe us? It’s almost invisible.”

Even the Hillbrow center, apparently the largest community AIDS program in the country, struggles with the stigma. Except for the street number, there’s not a single sign outside the three-story building. “There was very much a feeling that if we put AIDS on the door, no one would come in,” conceded Crew.

Still, AIDS is slowly becoming more public. Parliament is considering a bill that would outlaw pre-employment testing for HIV.

Theresa Mokhesi, a 56-year-old nurse, sees AIDS every day. She runs an orphanage for 20 babies in Soweto. Ages 6 months to 4 years, all are HIV-positive.

Most were abandoned at birth; one infant was found in a rubbish bin. The most recent arrival came last month after both his parents died of AIDS.

In the two years since Mokhesi and her aides began caring for the children at the back of a Salvation Army complex, nine of her tiny charges have died.

“Unfortunately, the public hardly believes there is anything like AIDS,” she said sadly. “People must learn the truth.”