Inter Press Service - December 25, 2004
Christina Scott

Up to 65,000 people, that's who. These lucky men and women will swallow a series of anti-retroviral (ARV) tablets and pills which will bully the deadly AIDS virus lurking in their bloodstream into submission - if not outright defeat.

And what does the most wonderful present of all look like?

For something so important, you might expect it to be wrapped in glittering paper or decorated with tinsel, ribbons and little bells. Instead it often comes enclosed in a demure plastic container, slightly bigger than the average bottle of headache tablets.

Some pills are yellow and only need to be taken once a day. Others come in different shades - brown or orange or green, depending on the strength of the dose - and have to be taken twice a day.

One of the most well-known ARVs, nevirapine, is white - and comes in silver blister packs, the contents of which are decanted into those plastic containers. Each container, when topped up, has enough life-giving "muti" - as South Africans commonly describe medicine - for its owner to survive for another month.

The snag is that the majority of those who will take the drugs over Christmas do so courtesy of expensive private medical aids. While 2004 was intended to be the year in which government provision of ARVs gained momentum, progress has been slow.

The Joint Civil Society Monitoring and Evaluation Forum, an umbrella body which keeps tabs on the provision of ARV treatment, said at its inaugural meeting in September that fewer than 8,000 people were receiving the drugs at public facilities. Additional reports indicate that this figure had increased to 18,500 by the end of November.

During his state of the nation address in May, President Thabo Mbeki told parliament that government would be providing 53,000 people with treatment by March next year. However, even this figure accounts for just a fraction of those who are in need of ARVs: South Africa currently has the highest number of people infected with the HI-virus - an estimated five million.

Inevitably, the national health department has been severely criticised by AIDS activists for its slow rollout of ARVs.

Publicly-voiced suspicions from officials about the motives of drug manufacturers have only served to aggravate this situation - as have lingering perceptions of government "denialism" concerning AIDS. In the past, Mbeki has come under fire for voicing doubts about the link between the HI-virus and AIDS.

None of this dissension has done a great deal to encourage people showing the symptoms of AIDS to get themselves tested.

Research suggests that nothing encourages people to ascertain their HIV status as much as the prospect of having access to life-prolonging AIDS drugs. So, why get tested if there's nothing you can do about it?

For those who are fortunate enough to be on ARV treatment, however, Christmas is often a season that requires careful planning. Take the patients who receive their drugs from Medecins Sans Frontieres (Doctors Without Borders, MSF), a non-governmental organisation which is doing ground-breaking work with ARVs in some of the poorest regions of picturesque Cape Town.

"Most people come from the Eastern Cape (province) and can only afford to visit home once a year," says Marta Darder, who coordinates a campaign for access to essential medicines for MSF. "So over Christmas they are not around for a month. This happens every year. So we get ready to dispense enough drugs for people to take home."

In October, MSF starts stocking up at a depot in Green Point, to ensure that extra ARVs are on hand at the three provincially-administered clinics where it works in the low-income township of Khayelitsha.

None of the three community health centres will be open on Christmas Day to hand out medicine. But then, the clinics close each weekend anyhow. What will be available is after-the-fact treatment for the many rape victims expected at emergency services sections of the clinics.

By Monday, while others nurse hangovers and wince at their credit card bills, the Michael Mapongwana clinic in the Harare section of Khayelitsha will be back in business. The Site B clinic, in a relatively affluent section of the township that boasts a petrol station, a grocery chain store and a fast food outlet, will be open as well.

A week later, after New Year's eve has come and gone, the Nolungile clinic in one of the poorest squatter settlements in the township will open.

Despite the often depressing news about government ARV efforts elsewhere in the country, Darder has a vote of confidence for what officials are doing in her part of the world.

"Certainly the provincial government is taking more and more responsibility," she notes. "Our site is their site, because we are working in government clinics. We have proved that it is possible to do this, that we can treat people at 100 rand (almost 18 dollars) a month, that people would take the drugs - and would take them seriously."

There are many New Year's resolutions that could be made about AIDS in South Africa. But perhaps Christmas is a time to celebrate. Raise a glass to the survivors of AIDS - and hope there are more around during Christmas 2005.

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IP041222

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