Associated Press - December 1, 2006
Terry Leonard

The women, sent home to die by doctors at a state hospital, arrived critically ill. Their immune systems barely registered in tests and their blood was brimming with the virus that causes the disease.

"These are people who were already in the coffin but forgot to fall down," said Dr. Hugo Templeman, the Dutch physician who founded the Ndlovu Medical Center a dozen years ago in this remote and dusty crossroads in the South African countryside.

Remarkably, Templeman said about 85 percent of those admitted to the clinic's small ward in critical condition not only survive but recover. Over months of treatment with antiretroviral cocktails the immune system revives. The patients are not cured, but are restored to the manageable status of HIV positive.

"This is all about hope," said Templeman.

Here among treeless, rock-strewn hills and the abject poverty of rural townships a hundred miles northeast of Pretoria, the Ndlovu Medical Center offers a blueprint on how to bring a successful AIDS treatment and awareness campaign to remote corners of the African bush.

It also offers something rare in South Africa: a hopeful AIDS program in a country where the president has questioned the link between the virus and the disease and the health minister has been pilloried for questioning the effectiveness of antiretroviral drugs and instead promoting garlic and African potatoes.

"Many people still think that HIV positive is a death sentence, it is the end of their lives," said Dudu Nkosi, 28, who was sent home to die by a state hospital in 2003. At the time, she weighed just 61 pounds and her immune system had collapsed.

Today she counsels patients at Ndlovu, helping them overcome the shock of discovering they are HIV-positive and commit to a lifetime of treatment and monitoring.

"Being HIV-positive is not the end of the world. The patients believe me when I say this because they know I survived," said Nkosi.

The clinic has a laboratory for monitoring treatment and adherence. It has X-ray machines, a pharmacy and a program designed to prevent mother-to-child HIV transmission. Teams provide testing, counseling and treatment to workers on their farms and others take HIV education to schools and remote townships. Some go to patients' homes to count pills and ensure treatment programs are followed.

Templeman and the clinic also carry out research on AIDS treatment with the University of Utrecht in the Netherlands.

Roads leading to the clinic are littered with hand-painted signs with slogans promoting safe sex, HIV testing and adherence to treatment and monitoring.

"We still have two or three deaths a week in the waiting room," said Templeman, adding that the stigma attached to the virus makes many wait too long to seek help.

In October, Deputy President Phumzile Mlambo-Ncguka was appointed to take the lead on AIDS policy, sidelining the health minister, and the government on Friday, World AIDS Day, outlined a new plan to increase access to treatment.

But the government's slow response has contributed to the epidemic's spread, said Templeman.

"They have confused the whole population by not giving the right information. We have lost something because of it," the doctor said. He said many South Africans think antiretroviral drugs "are poison."

South Africa has an estimated 5.4 million people infected with HIV, the second highest in the world after India. AIDS kills more than 900 South Africans a day. The World Health Organization says about 26 percent of the economically active adults are HIV-positive, but Templeman says the rate is higher among the rural poor.

"The prevalence is over 30 percent among farmworkers. With a prevalence of 30 percent, nobody can keep up," said Templeman. "They are dying like flies out there."

Ndlovu takes its program to farms because so few farmworkers have the means to get to the clinic. With so many workers dying of AIDS, Templeman said farmers have been convinced it is in their economic interest to pay for treatment.

Of 130 births by HIV-positive women at the clinic since 2003, 128 of the newborns were HIV-negative. Templeman said the two women who transmitted their virus to their babies joined the program too late.

Without the treatment protocol, there is a one in three chance the mother will pass the virus on to the child.

HIV-positive women are given prenatal care and put on antiretrovirals immediately to try to reduce the virus to almost undetectable levels in the bloodstream. The babies get antiretroviral treatment and the women are prevented from breast feeding and given a year's worth of formula.

"What we do here is insignificant if it is not reproducible," said Templeman.

With financial help from the United States, the Anglo-American Corp. and Sir Richard Branson's Virgin Atlantic among others, Ndlovu is establishing another clinic at Bushbuck Ridge, 100 miles farther northeast. Eventually it could sponsor up to 20 clinics in rural South Africa. Templeman does not want to expand too rapidly to ensure the success of each new clinic.

The formula, he said, would also be replicated at government community centers all over the country and copied in remote areas in the rest of Africa.

When Lettie Wendy was admitted she could not walk and was little more than skin and bones. Her immune system had collapsed and she had three large bed sores that forced her to lie only on her stomach.

"I was at a government hospital. I was really sick and they sent me home to die," said Wendy, 26. "My aunt brought me here in 2004 and they put me on anti-retrovirals."

Two years later, Wendy is still in a wheelchair, but she has gained weight, her sores have healed, her immune system has rallied and the clinic treats her like a poster child for its treatment.

From her wheelchair, Wendy pointed toward the women in the critical care ward.

"When they see me," she said, "they know you don't have to die of AIDS."

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