Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.

Reuters NewMedia - Sunday, November 30, 2003
Andrew Quinn

"The disaster is already here," said Thandoxolo Doro, a spokesman for the National Association of People Living with HIV/AIDS. "What we have now is just a government announcement. But often government plans do not translate into reality."

South Africa has the world's single highest number of people infected with HIV/AIDS -- some five million, or more than one out of every 10 South Africans.

The government's new plan calls for a sweeping upgrade of the country's health care system, training thousands of new medical personnel, mounting new education programs and building a nationwide network of testing clinics, blood laboratories and drug distribution points.

This alone would present a major hurdle for South Africa, where millions now only get the most rudimentary health care.

Former U.S. President Bill Clinton said in an article published in South Africa's Sunday Independent that the plan was a "milestone" for the country.

But AIDS experts say the country faces an even bigger task in convincing people to get tested and to take new anti-retroviral (ARV) drugs.

Bophelo/Lifeworks, a company which develops corporate HIV policies, estimates only about three percent of HIV-positive South Africans who have access to ARV medication through private insurance have actually made use of the drugs.

This mirrors the low uptake of drugs provided through large company programs such as those run by the mining firms.

STIGMA A BIG ISSUE

"Fear of confidentiality is the biggest issue," said Sean Jelley, Bophelo/Lifeworks chief executive officer.

"People don't want to be tested, or feel they are at low risk. This means they only find out their diagnosis when they hit the AIDS stage, and that's a disaster."

The government has not helped matters by publicly questioning the usefulness of ARVs and claiming they are toxic.

Stigma is also the problem. One of the first South Africans to go public with the AIDS, Gugu Dlamini, was stoned to death in 1998 by a group of men who said she had brought shame on their town.

Many AIDS activists and health workers blame the government, saying moral leadership from the top is crucial.

That has been slow in coming as President Thabo Mbeki questioned the link between HIV and AIDS and officials resisted the use of ARV drugs, the only proven treatment for the disease.

Mbeki's government, faced with angry public protest ahead of general elections next year, finally agreed to bring ARV treatment to the public sector by gradually rolling out medication to the sickest while upping prevention efforts.

But the epidemic is seen corroding an already fragile social fabric as it leaves an army of orphans in its wake.

The U.N. children's agency UNICEF says by 2010 more than 15 percent of South African children under the age of 15 will have lost one or both parents -- most of them to AIDS.

This may fuel already terrifying levels of violent crime and increase poverty in a country with glaring income disparities.

The new program is expected to cost some 12 billion rand ($1.875 billion) over the next three years. But whether it will do enough remains to be seen.

"Even if every single person was on ARVs they will still ultimately die, and many more are still becoming infected," said Samantha Willan, an AIDS expert at the University of Natal. "We still need to see more political commitment."

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