More 23/01/2000

The Price of Life

The tiny tin-roofed church in the South African mining area of Marikana is packed, as it is every Sunday. There is no piano or organ, but none is needed. The congregation sing the complex harmonies of southern Africa exquisitely, without accompaniment.

Busi Chamane and daughter

Among the congregation is Busi Chamane, mother of three children, a devout Catholic and HIV positive. At first sight, she would seem to have little reason to be singing cheerfully. She was infected with HIV by her former husband who left her and sold their house. Her employer sacked her when he discovered she was HIV positive and her family threw her out.

But Busi is a fighter. Her greatest fear was that her youngest child - born after she was infected - would also carry the HIV virus. She remembers the moment when she discovered that the little girl - now five years old - was not infected. "I can't express it. I thanked God in so many languages. I prayed".

Although Busi can't afford the medicines routinely given to people in her position in developed countries she has managed to keep herself healthy so far. "I think she's the reason for my being healthy" she says of her daughter. "Every time I think of her I'll do anything to be alive, just for her."

Harrowing though her story is, Busi's experience is typical of many in South Africa where AIDS is an epidemic which threatens the future development of the nation, yet few individuals openly admit that they are HIV positive.

The seriousness of the epidemic is hard to grasp. Busi now lives and works in a mining area, north of Johannesburg. According to South Africa's Ministry of Mines, forty five per cent of mineworkers already carry the HIV virus. Few will be treated with the expensive, life-prolonging drugs used in developed countries. And the harsh reality is that in less than ten years time, nearly half of today's mineworkers will have died of AIDS.

This is a vast human tragedy. It's also nightmare for South African business. They face the prospect of falling productivity as workers fall ill, spiralling healthcare bills and the costs of constantly training new workers to replace those who have died. According to Peter Piot, of the United Nations, "AIDS is the biggest threat to Africa's economic and social development".

But in the face of such a catastrophe, is enough being done to contain the epidemic? In the village of Hlabisa, in rural Kwazulu Natal, the local hospital is run by Sean Drysdale, a former British army doctor. A third of the adult population of this area are HIV positive. And Sean Drysdale knows that his hospital has not got the resources to cope as more and more of the infected population develop full blown AIDS. According to Dr Drysdale, "it's like standing on the beach watching a tidal wave hurtling towards you".

One of the problems is access to drugs. A disease which kills large numbers of people carrying the HIV virus is a form of meningitis. It is treatable with a drug called Fluconazole which was developed and patented by the American pharmaceutical giant Pfizer.

Fluconazole is not available to many of the people who need it in South Africa because it is too expensive. Health campaigners in South Africa are urging the South African government to import generic equivalents of the drug from countries where patents don't apply and it's available at about a tenth of Pfizer's price in South Africa.

There's also intense controversy about the drug AZT, patented by Glaxo-Wellcome. If AZT is given to pregnant women who carry the HIV virus it greatly reduces the risk of the child being born HIV positive and therefore doomed to an early death. Glaxo are offering the drug to the South African government for 25 per cent of the average price at which it's available in the developed world. But although the treatment is widely used elsewhere in the world to prevent mother-to-child transmission of HIV, the South African government has so far refused to recommend using AZT to prevent mother to child transmission of HIV.

Glaxo-Wellcome packaging plant South Africa

According to Health Minister Dr Manto Tshabala-Msimang "the fundamental issue here is the efficacy and the safety of the drug [AZT] for us". Health campaigners in South Africa are baffled and frustrated by their government's refusal to implement a strategy for preventing HIV being transmitted from mother to child.

Giving appropriate drugs in pregnancy might save the lives of many children. But it does not extend the lives of the mothers. And South Africa is already expecting to have a million AIDS orphans by the year 2005.

The Ethembeni Children's home for AIDS orphans is a heartbreaking glimpse of the future. In some of the cots babies are dieing of AIDS. Others carry the HIV virus and although they are playing happily in the sunshine, they are very unlikely to reach adolescence. Others again do not have HIV and will join the swelling ranks of long term AIDS orphans.

One of the many babies at Ethembeni Children's Home

Lieutenant Tersia Finn, in charge of the home, is in no doubt that the current ways of caring for orphans, often involving extended family, will simply not be able to cope with the consequences of the AIDS epidemic. It's widely feared that many of the orphans in future will end up on the streets and this poses a major threat to South Africa's future development.

Perhaps the single most important contribution which the developed world could make to containing the AIDS epidemic and reducing the number of AIDS orphans would be to develop an effective vaccine to prevent people becoming infected. It is an awesome scientfic challenge. But leading AIDS doctors in Africa are frustrated by the unwillingness of the major pharmaceutical companies to take up the challenge.

The reason the drug companies are steering clear of AIDS vaccine research, according to Professor Kalim of the Medical Research Council of South Africa, is economic. Most of the countries which need it are very poor and there would be pressure on the developer to make it available very cheaply, as there already is with some existing drugs. "They [the drug companies] don't consider it profitable and they think it's more trouble than its worth".

Gathering in Kwazulu Natal to promote HIV vaccine trial

In a tiny village of thatched huts in Kwazulu Natal early preparations for a vaccine trial are under way. Traditional Zulu dancers dressed in animal skins dance to a deafening drumbeat. The gathering has been called by researchers preparing the community to take part in an AIDS vaccine trial which will begin late next year. In the absence of commercial interest from pharmaceutical companies this work is largely funded by charities and government. It means the work is going slowly but Professor Kalim remains optimistic. "I think that we will have a vaccine in the next seven to ten years", he says.

In the meantime the fight to contain the AIDS epidemic has become a personal crusade for Busi Chamane. In a crude tavern near the pit-heads of Marikana, Busi is at work educating prostitutes on the importance of safe sex. It is an uphill struggle. The women are poor and as one of them tearfully admits, if you are hungry you do what a man wants. In spite of the efforts of Busi and people like her the rate of HIV infection in South Africa continues to rise.

What future for the youth of South Africa ?

The battle against AIDS is one which South Africa and many other African countries cannot afford to lose, but show few signs of winning. And it is a battle which the developed world, no longer directly threatened by an AIDS epidemic of its own, chooses largely to ignore.

Reporter: Nils Blythe
Producer: Emma Jones

Contact Numbers:

Terence Higgins Trust helpline - 0207 242 1010
(open every day from 12 noon to 10pm)

Ethembeni Salvation Army Home
63 Sherwell Street
Doorfontein
Johannesburg 2094
South Africa
Tel: ++ (0) 11 402 8101
Donations always welcome