Sunday Times, South Africa - Sunday, October 11, 1998
Laurice Taitz

Now Virginia, established in the '50s after the discovery of the Free State goldfields, faces another disaster - being swept away by the AIDS epidemic.

Dr Tony de Coita, the manager of health services at Harmony mine hospital, says people are dying regularly. "Here at the hospital we have two to three people dying every week."

Twenty percent of the 12 000 people at Harmony mine are HIV-positive, according to De Coita. The provincial figure for HIV infection is 14 percent.

Most of the mine's workers are migrant labourers from Lesotho. The second largest group is Xhosa-speaking and the third is Mozambican.

"Most choose to stay here and die because of the poor health facilities back home," says De Coita. "They also don't want their families to see them like this."

Another doctor at Harmony, Dr Jana Viljoen, says: "The families come to collect the bodies and take them back home. We try to look after the patients, and we have a system. We put them on the 'DI' list - it stands for 'dangerously ill' - and then we notify the family: 'Your husband is dying.'

"It all makes me so cross, the fact that this disease is kept so secret. I know a man in town found to be positive. He refuses to tell his wife and children, and the doctor can't tell them without his consent. How do I sleep knowing there is a woman who is going to be killed and there is nothing we can do?"

De Coita says the financial impact on the mining industry will be huge.

"A person with HIV will cost a lot, particularly in the last two years of his life. A conservative estimate, taking into account hospitalisation, compensation for TB, medical repatriation, labour turnover and decreased productivity is R35 000 for each infected person."

Thousands of condoms are handed out each month in the mining hostels but the message doesn't always get across, says De Coita.

"We have always battled with a high rate of sexually transmitted diseases, and studies have shown that this is the reason Africa has such a high rate of AIDS. We need to be able to reach those people who have had sexual contact with the infected person. But sex on the mines is casual or commercial."

Local lore has it that sex in Virginia is cheap. With not much else to do, it is also a popular form of recreation.

Says Tina Fidler, who works at a doctor's practice: "Most domestic workers earn R200 a month, which is not a living wage. They supplement their salaries in the back rooms of suburbia. I've heard sometimes they do it for a bottle of beer. That's the price."

Dr Vuyelwa Manzana, who runs a private practice and works at the local township clinic, says: "I sit here counselling patients about using condoms and I can see they can't wait until I am finished. Then there are those who have told me they want flesh on flesh."

Dr Rhett Kahn, a family practitioner, blames the migrant labour system. "The mines employ a lot of foreign workers, and they come here without their wives and families."

Doctors in the town say another problem is that sex workers don't see state hospital services as serving them. De Coita says state health care workers have judgmental attitudes, a major stumbling block in preventing the spread of infection.

"In Virginia, the mines are working together on the problem. We believe we are at the forefront of a preventative policy. But we need action at the highest levels of government."

Kahn is not convinced, however, that the mines are offering infected workers a place to die, saying he has seen many sick workers retrenched or dismissed and has fought many battles for workers' compensation.

He says official figures from an antenatal survey done in Welkom and Virginia in 1996 showed a 22 percent HIV infection rate, but "my personal estimate is that a third of the sexually active population is infected".

The "bottom line", he says, is that a lot of patients are not getting treatment.

"We could be screening pregnant women at a cost of R17 a test, but it is not being done. The attitude is that there is nothing we can do. People are being written off. But the disease is treatable. Our energy needs to be put into delaying the progression of HIV to AIDS.

"There is a 60 percent chance of an infected mother giving birth to a baby with the disease. We have 200 000 infected pregnant women. For less than R500 for a once-off treatment of AZT we could be saving thousands of babies.

"If you have TB, the progression to AIDS is much faster. But you can treat TB for 10c a day. If you add in zinc, vitamin A and C, it makes a big difference. If you are malnourished, full-blown AIDS happens much faster.

"There are interventions that can be made, but the government is doing nothing to improve the quality of life of people with AIDS. The Sarafina budget alone could have saved about 4 000 babies."

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Drugs slow AIDS deaths

* AIDS deaths in the US plunged by an unprecedented 47 percent between 1996 and 1997, according to government statistics released here this week, writes CHARMAIN NAIDOO in New York.

* The fall in the death rate has been attributed to the use of new drugs, but there has been no similar dip in the 40 000 new HIV infections reported annually.

* Medical experts believe the epidemic is still raging out of control. Researchers say there are signs of an increase in unsafe sexual practices among gay men.
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