Southern Africa Faces 'Disaster' as AIDS Spreads

By DEAN E. MURPHY

Dec. 1, 1998 12 AM PT

TIMES STAFF WRITER

JOHANNESBURG, South Africa —

Two startling reports on AIDS show the disease is spreading so rapidly in South Africa that it threatens to cripple the economy and devastate families for decades, perpetuating the ills of apartheid.

Released to coincide with World AIDS Day today, the reports say that while the AIDS epidemic was slow in coming to South Africa and its neighbors compared with other parts of the continent, it now has arrived with a vengeance. The region has become the hardest hit in the world. One in 10 people infected with HIV worldwide lives in South Africa.

“Some of the advances made by the new South African democracy will be reversed unless we act now,” said J. David Whaley, who coordinates United Nations programs in South Africa. “South Africa’s history demonstrates that in partnership the nation fought and overcame . . . apartheid. It will surely not be defeated by an insidious new threat over which it can have control.”

U.N. officials, authors of one of the two reports released here Monday, have chosen to focus World AIDS Day for the first time on southern Africa because of what they characterize as an “unprecedented emergency” only fully recognized in the past year.

On average, one person is infected with HIV--the human immunodeficiency virus that causes AIDS--each minute in South Africa, according to data compiled by the U.N. Program on HIV/AIDS, or UNAIDS. If the trend continues over the next decade, government officials here say, the average South African can expect to live just 40 years.

About 130,000 South Africans have died so far this year of AIDS complications, according to the South African Department of Health. The number of deaths annually is projected to double during the next three years, and to exceed 500,000 by 2008, if current rates of infection continue.

The worst-affected countries in the world--Botswana, Namibia, Swaziland and Zimbabwe--are neighbors of South Africa, and the U.N. says South Africa is catching up rapidly.

About 25% of the adult population is infected in Botswana and Zimbabwe. Estimated rates of infection vary widely across the major countries of sub-Saharan Africa, from 4% in Nigeria to 10% in Ivory Coast and 11% in Kenya. South Africa’s rate is 13%.

In the past year, according to one estimate, about 1.4 million people between the ages of 15 and 49 were infected in nine southern African countries. About half of the new infections were in South Africa. In all, more than 3.2 million people in South Africa are infected with HIV.

“Be it man-made catastrophes such as apartheid, colonialism, or natural disasters such as drought, none of these will claim so many victims,” said Dr. Peter Piot, executive director of UNAIDS. “We now know that despite these already very high levels of HIV infection, the worst is still to come in southern Africa. The region is facing human disaster on a scale it has never seen before.”

With the disease arriving relatively late to the region, government and community responses are lagging. Piot said his agency’s stepped-up interest in southern Africa is meant to pressure governments to do more.

Most Africans cannot afford life-prolonging drugs common in the United States. But some countries in Central and East Africa, where AIDS struck hard and early more than a decade ago, have established education and prevention programs that have helped reduce infections. Many southern African countries, by contrast, are just now understanding the dimension--and ubiquity--of the problem, U.N. officials said.

A 1994 AIDS plan went largely unheeded in South Africa, for example; the government has only now put together a new national strategy for dealing with the economic, social and medical implications of the disease. Among other things, the strategy calls for dedicating more resources to community-based programs for women, who, statistics indicate, are more likely to be infected than men and who bear the brunt of AIDS’ social and economic fallout.

The government recently decided to stop subsidizing treatments with the drug AZT for nursing mothers, saying the drug was too expensive and the money better spent on treating other sexually transmitted diseases and tuberculosis--common illnesses of people with AIDS. Health officials say they also will devote resources to developing more community care programs, which are cheaper than hospitals and usually preferred by patients.

“The reaction has been late here, that is for sure, but it is never too late,” Piot said. “What matters now is there is a really good plan and a good strategy. But it has to be implemented.”

The South African Department of Health, which commissioned the second report released Monday, identifies the spread of AIDS as a major obstacle to reducing poverty and the still-enormous income disparity between blacks and whites. It predicts that poor families will be made poorer, while those beginning to escape the shackles of apartheid will be thrust back into despair.

“The greatest impact will be felt at the household and family level, where the impact is often most disastrous,” said Geraldine Fraser-Moleketi, South Africa’s minister for welfare and population development. “There is no longer any time on our side to continue the luxury of both denial and of stigmatization of this pandemic.”

Officials and AIDS experts are largely unable to explain why the disease is striking southern Africa so hard.

During the past eight years, according to the UNAIDS report, the prevalence of HIV infection at prenatal clinics has increased more than 21 times in South Africa. The legacy of apartheid, from its migrant labor system to widespread poverty, is blamed for encouraging casual and commercial sex, but apartheid does not explain skyrocketing infection rates in neighboring countries.

“We have to accept that we don’t understand it completely,” Piot said. “This is something that can’t be fixed overnight.”

Dr. Mark Ottenweller, Africa director for Hope Worldwide, which operates AIDS clinics in 12 African countries, said economic development has helped the virus spread in southern Africa. Roads and highways, for example, are in relatively good condition, allowing people to visit remote areas. Unfortunately, he said, health care has not kept up with economic progress, leaving newly infected people in faraway places with nowhere to turn for treatment.

About 1,500 volunteers for Hope Worldwide distributed AIDS awareness brochures and condoms to 150,000 people in some of Johannesburg’s poorest neighborhoods during the weekend. Gone are the days when people told volunteers that AIDS was a white man’s myth, Ottenweller said.

Denial, however, is still widespread.

In a survey of 1,000 people in the nearby black township of Soweto this year, 90% of the respondents identified AIDS as deadly, but 70% believed they were at little or no risk of becoming infected with HIV. Nearly two-thirds said they had never used a condom; half of the respondents said they did not even know where to get one.

Nomusa Njoko, a 26-year-old mother who is HIV-positive, said the denial is a form of self-protection in a society hostile to people with AIDS. When she went public with her infection, Njoko said, she was asked to leave her church choir.

“There is discrimination everywhere,” said Njoko, who works for an AIDS support group in Durban. “It is unfortunate that it has taken our government quite a while to stand up and say there is a problem.”

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

AIDS in Africa

South Africa’s AIDS rate is catching up with that of its hardest-hit neighbors:

% of adults with HIV/AIDS

Kenya: 11%

S. Africa: 13%

Namibia: 20%

Zimbabwe: 25%

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New HIV Cases in 1998

N. AMERICA: 44,000

LATIN AMERICA: 160,00