In South Africa, AIDS sparks fears of devastation

Business, government leaders fear epidemic will ruin the country

By Charlayne Hunter-Gault
CNN

JOHANNESBURG, South Africa (CNN) -- From the coal face to the college campus, in the delivery room and the board room, HIV/AIDS in South Africa is growing at an alarming rate.

Despite government and social campaigns to "condomize" and other programs put in place to stem the onslaught of the disease, the South African government reports some 1500 new HIV infections a day.

If unchecked, AIDS will devastate South Africa's economy - an economy that desperately needs to grow if it is to fulfill a promise repeated by the countryÕs black-led government to create "a better life for all." Millions of poor and destitute black South Africans believed that promise would be fulfilled at the end of apartheid.

In recent weeks, the South African Chamber of Business and other business leaders have begun sounding alarms, calling for urgent intervention to prevent the spread of the disease. Because of a South African government death toll estimated to be at 1 million by 2008, some business leaders say that if present trends continue, companies will have to train three people for every job. Such alarming prognoses have led Big Business to embark on a controversial plan to try and deal with the problem.

South Africa's largest company, Anglo-American Corporation of South Africa Limited, dominates the country's mining industry, employing millions of workers from the entire southern African region. The mining industry is the hardest hit, with the rate of HIV infection between 7 and 17 percent above other groups, according to South African government records. Anglo-American has joined with other big businesses in a plan to make available anti retroviral drugs widely and cheaply to its workers, of whom 5 to 45 percent may be infected with HIV/AIDS, according to unofficial estimates from Anglo-American and other groups.

Brian Brink, senior vice president at Anglo and a medical doctor, says Anglo's decision to participate was based on recognition that what they have been doing over the past 15 years has not worked.

"I think what's driving the strategy is saying, given where we are today, what is it that we can do that is different to what we have done in the past. That's going to change the way this epidemic unfolds. Because if we don't change it, then we are all going to be in trouble."

The trouble is, not everyone is as convinced as Brink that this is the right way to go. There is division even within his own company about the efficacy of the as yet uncompleted plan.

The anti-retroviral Nevirapine, which has proved successful in reducing transmission of HIV from pregnant women to their unborn children, is being used in a demonstration project at 18 public hospitals around the country. But the South African government has been unwilling to approve it for widespread use until the project is complete, which could take up to two years.

A major issue has all but been removed, as prices have fallen dramatically since the courts recently affirmed the government's right to import or manufacture drugs at prices the average South African can afford. But no one knows when those drugs will be available in the public sector, for the government's reservations are not limited to price alone. The country's president, Thabo Mbeki, has expressed concerns about the toxicity of anti retroviral therapy (ART) and about the fact that many mothers must bottle-feed their babies in environments where clean, safe water is not guaranteed.

Even proponents of the therapy, like Brink, acknowledge some of the problems with ART.

"They are difficult to administer, the drugs do have side effects," Brink says. "You (must) manage those side effects and some people are beginning to say the cost of treating the side effects is more than the cost of the drugs."

But Brink says he believes it's time to move -- at least on a small demonstration project.

"I have a list of 100 difficult questions that we need answers to. We will never get answers unless we set out and start doing it," Brink says. "And I think progressively. With time, we will get those answers and hopefully it will come clear that this intervention with the drugs is hugely, profoundly effective. Not only looking after people are who are sick from AIDS, but in also preventing the spread of HIV.''

South Africa's powerful unions have parted company with the President and have endorsed the use of ART. But the unions say they won't endorse Brink's plan unless it is more comprehensive.

Eric Gcilitshana, national secretary for Health and Safety of the National Union of Mines says they should take a closer look at who will get treatment.

"We need to negotiate first and determine what drugs will be issued and to whom, because they issue only those drugs only to their members or those who are working," Gcilitshana says. "But what about the children? What about the families -- the wives of those people? Some of them are not staying with miners (the union members) in their working places. They are staying far away in other rural areas."

Meanwhile, as the debate over solutions rages on, the behavior of people at risk - not just in the mines but at all levels of society - has not fundamentally changed, experts say.

On pay day, the men who work the mines far away from home, find companionship from single women who have settled nearby because that's where the money is. The sex workers and the miners know about HIV/AIDS, and they are sometimes provided condoms, free of charge from private sources, as well as the government. But clearly, with the infection rate as high as it is, there is a disconnect somewhere.

"Some people still believe AIDS is a myth. They don't believe it's real," says one miner, 25-year-old Justice Nemukombame.

But, Nemukombame says, when he first came to the mines a few years ago, he used to go to one funeral a week. Now, he says, he goes to four and five - all deaths resulting from HIV/AIDS-related causes.

Nemukombame, who calls the mining management's efforts to date "window dressing," says he is nevertheless encouraged that new attitudes are slowly starting to emerge -- especially at the top of the mining company.

"We won democracy because everybody was involved, everybody fought for democracy, and the same thing we need with AIDS. If everybody gets involved, and we fight AIDS, we will win at the end of the day."

That being the case, the two remaining questions are: When? And at what cost?

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