Sunday Times, South Africa - Sunday, January 24, 1999

We have for too long condoned silence and the myth equating AIDS and death. To accept this is to accept that three million South Africans with HIV or AIDS have to die in the prime of our lives because we don't have access to treatment.

Have all of us accepted this "fact"? Is this cost acceptable to our society?

Wrench is spot-on. The main reason people die prematurely of AIDS-related diseases is money. He points to the difference between South Africa and Britain. Here, only the very wealthy can afford treatments that make AIDS manageable. There, the yearly cost of R100 000 for his treatment is carried by the state.

Wrench leaves us with the unasked question - why are poor people in South Africa allowed to die when they can be treated? For me, this is both an intensely personal question and a human rights issue.

In December, I was diagnosed with systemic thrush. This fungal condition is one of the symptoms marking the transition from HIV to AIDS. My doctor told me: "You can take medication to restore your immune system or you'll cause irreparable harm to yourself and die."

I asked him about cost - anywhere between R2 500 and R4 500 a month, but immune monitoring and other treatments could make it a little more than that.

By South African standards, I am not poor, but I cannot afford the medication because I earn less than R4 000 a month.

My friends rallied round me, offering to give me the money. I panicked. I grew up in a proud working-class home where, despite having little food, we did not beg. Dignity was an important element of poverty.

I also have an ethical dilemma. I don't want to die but I feel sick at the thought that I would get treatment denied to the majority of people with HIV or AIDS in our country because my relatively affluent friends are prepared to sacrifice.

More than 60 percent of employed South Africans earn less than R1 500 a month. Much of that is in turn used to support unemployed dependants.

Those with HIV who are poor and unemployed will not have access to medication that can make them live longer and healthier lives and may, in the end, control the virus. Our government does not have Britain's financial resources - it cannot afford to supply all HIV-positive South Africans with new life-saving drugs.

But the economy cannot afford to lose workers. Employers cannot bear the enormous losses in productivity alone.

These are complex questions. We cannot solve the world's health woes in a day. But we can ask whether we are even addressing the basics. Are we treating basic conditions in our hospitals? Are we treating sexually transmitted diseases that hasten the spread of HIV? Is the government providing vitamin supplements to people with HIV - simple additives that can prolong life and health?

What about clean water to stop unnecessary stomach bugs? Preventing, detecting and treating tuberculosis is crucial in managing AIDS - how effective are our programmes? PCP, the pneumonia associated with AIDS, can be prevented.

Efforts to make health care more accessible are not the responsibility of government only. They are also the duty of every health-care professional, the private sector and every individual. But from government we have the right to expect leadership and the political will to make treatment affordable.

We expect government to play a galvanising role in raising resources from the private sector; in negotiating with pharmaceutical companies; in encouraging and involving the public through fund raising.

And we expect government to make a serious effort to find resources within its budget and from international agencies to cover effective AIDS responses within our national reach.

A simple illustration: the denial of the cost-effective drug AZT for pregnant mothers. Some people, even in government, argue: "If the baby does not have HIV it will live and the mother will die of AIDS. Who will look after the orphans?"

The cynicism is self-evident and terrible.

Hiding my own fears, I joke with friends and comrades: "Is this a nightmare?"

The HIV in my body, and in those of millions in Africa and elsewhere, symbolises the fact that ineffective responses still mean unnecessary deaths.

In December, the HIV community sustained two acute losses. Simon Nkoli, veteran anti-apartheid leader, gay activist and HIV/AIDS campaigner, died of AIDS-related complications.

A few weeks later, KwaZulu-Natal HIV/AIDS activist Gugu Dhlamini was murdered because she publicly disclosed her HIV-positive status.

In the last newspaper interview with EXIT, a gay newspaper, Nkoli said: "If we are going to die we should not die silently, even if we have to go on a hunger strike in the Department of Health".

Her murderers may have been driven by the lie that AIDS is fatal. That AIDS means certain death is a myth encouraged by a lack of vision and leadership from government and the private sector. The myth protects the breathtaking profits drug companies make from the state and health-care industries in Britain, Australia and the US.

--Achmat is the director of the National Coalition for Gay and Lesbian Equality
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