By Vernon Wessels and Mike Cohen
Feb. 27 (Bloomberg) -- Thandi Mabaso refused to take drugs when she and her newborn were diagnosed with HIV. She had heard they were dangerous on the car-battery-powered radio in her home in South Africa's KwaZulu-Natal province.
Mabaso relented last year when, at almost 3, her daughter wasn't walking or talking after treatment with traditional herbal remedies and vitamins. Her girl has gained more than 2 kilograms (4.4 pounds) and now enjoys playing among the goats and chickens that roam near the corn fields outside their front door.
The 34-year-old single mother is saving for Thando Nkosi's future. ``She must get an education to show everyone that people with AIDS can live a normal life,' Mabaso says in her native Zulu, holding Thando on her hip.
Stories like theirs are helping doctors in Africa's biggest economy persuade people to take AIDS drugs in record numbers. President Thabo Mbeki's government is finally backing them in the battle against the deadly virus after years of misinformation. By mid-March it will present a new strategy aimed at trebling the number of people receiving AIDS treatment, a shift from the health minister's focus on nutrition and prevention.
``This is the kind of leadership we've all been crying for,' says Sipho Mthathi, head of Cape Town-based Treatment Action Campaign, South Africa's main AIDS activist group.
Mbeki's legacy, when his second term ends in 2009, will include an HIV epidemic that has infected one in nine South Africans and hurt the nation in ways ranging from sky-rocketing health-care costs to lower worker productivity in gold mines.
2.16 Million Deaths
South Africa has 5.5 million people infected with HIV, second only to India, whose population is 22 times larger. The virus robbed 250,000 children of their mothers in 2005. By the end of July, more than 2.16 million South Africans will have died from AIDS since 2000, the year after Mbeki took office, according to the Actuarial Society of South Africa in Cape Town. Its statistics don't go back further.
Mbeki failed to stem the HIV epidemic he inherited from his predecessor, Nelson Mandela. It infects 1,500 people a day.
Mbeki confused the message in 2000 by questioning the link between HIV and AIDS and the efficacy of the drugs. Four years later, his government increased funding for AIDS programs by 21 percent to provide free treatment. He also didn't silence Health Minister Manto Tshabalala-Msimang when she advocated traditional cures and urged AIDS patients to eat beetroot and garlic to boost their immune systems. Both refused to take public HIV tests.
Doctors and AIDS activists in South Africa found themselves battling against cultural barriers as well as intransigence at the top in a country with the means to fund advanced medical treatment.
South Africa has per capita income of $3,152, according to the International Monetary Fund. Its adult HIV infection rate is 19 percent, higher than all but five of 42 countries in sub- Saharan Africa, according to UNAIDS, the United Nations AIDS program. Uganda, with per capita income of $274, has an infection rate of 6.7 percent.
In South Africa, 21 percent of HIV patients that needed anti-retroviral drugs in 2005 received them, compared with 56 percent in Uganda.
``The president and health minister have a huge amount to answer for,' says Francois Venter, president of the Southern African HIV Clinicians Society in Johannesburg. ``Hundreds of thousands of people have died while we have prevaricated.'
Mbeki's government began to change its stance on AIDS at the end of last year when Tshabalala-Msimang, dubbed ``Dr. Beetroot' by local newspapers, was in the hospital with a lung infection.
Her deputy, Nozizwe Madlala-Routledge, said the government had erred.
``What has happened in South Africa, which is tragic, is that people are confused about treatment,' Madlala-Routledge said in a Dec. 10 interview in the Sunday Telegraph of London. ``I think it was irresponsible of leaders to say people have a choice, because what traditional healers do we know who know how to treat AIDS? I don't know of any.'
Having lost two family members to AIDS, she publicly took an HIV test to encourage people to find out if they'd been infected.
The government hasn't officially announced a change in strategy, although it placed Deputy President Phumzile Mlambo- Ngcuka in charge of the new five-year AIDS plan. Tshabalala- Msimang, 66, has remained health minister. She was hospitalized again last week with fluid in the lining of her lungs and severe anemia.
Mbeki's spokesman, Mukoni Ratshitanga, said on Dec. 15 that the government's entire AIDS program is based on the assumption that HIV causes AIDS, a situation that's ``come about under Mbeki's leadership.'
Cutting Infection Rates
``The government commits itself to intensify the campaign against HIV and AIDS and to improve its implementation,' Mbeki said Feb. 9 in his state-of-the-nation address to parliament.
The government's goal now is to cut HIV infection rates in half and provide drugs that interrupt the virus's infectious cycle, called anti-retrovirals or ARVs, to four-fifths of those who need them by 2011.
While they don't cure AIDS, the medicines extend life expectancy by transforming the virus from an imminent threat to a chronic condition. In the U.S., they reduced AIDS deaths by 80 percent from 1990 to 2003, according to UNAIDS.
The biggest supplier of AIDS treatments in South Africa is Johannesburg-based Aspen Pharmacare Holdings Ltd. International companies, including GlaxoSmithKline Plc and New York-based Bristol-Myers Squibb Co., also sell the drugs there.
The return to an active life for people like Mabaso and her daughter may help the government reach its AIDS treatment goals.
``People who were sick in the past are looking beautiful now,' says Bernhard Gaede, a doctor who treats the two at Emmaus Hospital about 20 kilometers (12 miles) from Bergville in the heart of KwaZulu-Natal. ``It's the best advertisement for ARVs.'
Gaede, chairman of the Rural Doctors Association, and his colleagues supply more than 1,200 people with AIDS drugs from a temporary shelter outside the 160-bed hospital, a former Lutheran Mission built in 1947.
By working with traditional healers and clinics to persuade people to be tested, Gaede's team is getting about 20 new people on medical therapies a week, up from five when they started two years ago. They're aiming for twice as many.
Gaede says that when Mabaso agreed to take AIDS drugs only after watching her daughter's health improve, he asked himself, ``Why do we need to wait for little children to convince their mothers to start ARVs? Why are the messages not clear enough?'
South Africa now has the fastest-growing rate of new patients getting treated for AIDS and the largest number of people on the drugs, says Macharia Kamau, chairman of the United Nations' AIDS program in South Africa.
``It hasn't moved fast enough,' he says. ``Every child wants mummy and daddy alive, and if their parents are ill, treatment is central to keeping them alive.'
AIDS has struck the nation's black population and poorest people hardest, aggravating divisions in a society that is working toward healing the wounds of apartheid.
The rate of HIV among blacks is 13 percent. It's 0.6 percent for whites, a 2005 government study found. At least 23 percent of low-wage earners have HIV, more than double the 8.5 percent rate for the high-income bracket, according to a Jan. 30 study led by Johannesburg-based research firm Markinor.
South Africa's struggle with AIDS is a drag on the economy at a time when Mbeki is banking on growth to slash the nation's 25.6 percent unemployment rate. Lost worker productivity will reduce economic growth by half a percentage point a year over 14 years, Stellenbosch University's Bureau for Economic Research forecast in July.
Death in Soweto
Poverty and unemployment in turn are aggravating the spread of AIDS, says Sibongile Mafata, a coordinator at the Hospice Palliative Care Association of South Africa's Soweto branch.
The hospice initially served mostly cancer patients in Soweto, site of a 1976 massacre of anti-apartheid protesters. Now more than 90 percent of the 500 people it cares for have AIDS. It registers about 40 new HIV patients a month and 20 to 30 deaths.
``We deal with death almost daily,' Mafata says as she checks on patients in the women's ward. ``Some families have been entirely wiped out by AIDS.'
In the ward made from a shipping container, one patient lies in one of the four beds, staring at the ceiling. A younger woman sits on a couch that's yellow with age next to crutches. She has just started walking again after taking AIDS drugs, Mafata says.
In Engoba, 450 kilometers from Johannesburg, Mabaso says she wants to tell her story to help save lives and end discrimination against people with AIDS. Thando, dressed in a bright red T-shirt with a heart on it, doesn't get diarrhea or a white rash in her mouth like she used to.
The two live on a monthly 190 rand ($27) childcare grant and an additional 840 rand disability payment. They barter vegetables and collect water from a tap half a mile up the road.
Mabaso takes Thando to see Dr. Gaede once a month, hiking several kilometers to catch a minibus that traverses dirt roads along treacherous mountain cliffs. She now heeds his advice, keeping the drugs on the kitchen table to remember to take them.
Mabaso doesn't know whether Thando's father has HIV. He lives 100 kilometers away and refuses to do a test. More than 20 friends and neighbors have died of AIDS in her village surrounded by green fields and views of the Drakensberg mountains.
``Most people here don't believe there is AIDS,' she says. ``They think it's something you've eaten or that you are bewitched. People should go for blood tests. It's the only way something can be done about it.'