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Last Updated: Friday, 6 June, 2003, 11:06 GMT 12:06 UK
Townships hold breath for HIV decision
By Alastair Leithead

MSF patients
Hundreds are being helped by the MSF programme
Around a quarter of the half million people living in the ramshackle houses and shacks of Khayelitsha township are HIV positive.

It's like any other big township in South Africa, but here some people at least have hope as a small project which provides free anti-Aids drugs is turning a swift death sentence into an illness people can keep under control.

Nokuthenjwa Bulana rattles her small blue tray of pills - a little container for each day, morning and evening.

"I was diagnosed HIV positive in 2001. I had two weeks when I was in bed and I was unconscious. I didn't eat I didn't sleep, I was just staring into space," she said.

"They took me to the hospital and there they found out I had HIV, meningitis and TB. They treated me and then gave me anti-retrovirals. If I didn't have those I think I would be dead now."

If you want to have young people surviving the only chance of that happening is anti-retroviral treatment
Dr Eric Goemaere, Medecins Sans Frontieres
Nokuthenjwa is now healthy. She happily walks the 20 minutes to the clinic, run by Medecins Sans Frontieres (MSF), an international aid agency which will soon be treating 500 people with the drugs known as ARVs - and it costs them only one US dollar a day for each patient.

"It is very simple - anti-retroviral therapy is a question of life or death," says Dr Eric Goemaere, who has been treating people with the virus for two years.

"If you want to have young people surviving the only chance of that happening is anti-retroviral treatment."

No money

But the South African Government is so far still refusing to even formulate a treatment policy as more than 600 of its people die every day.

However, there is hope that this stance could change soon as a government advisory group hands in its own recommendations on HIV drug funding.

Dr Brink set up Anglo-American's HIV policy
KwaZulu-Natal on the east coast of South Africa is the worst hit by Aids.

Saturday is funeral day and at a cemetery outside Durban the hymns and psalms from a dozen different ceremonies mix into a cacophony of mourners.

As people are buried in the simple graves stacked on top of each other there's a queue of hearses waiting for their turn, bus-loads of people winding their way up the hillside.

Professor Alan Whiteside from the University of Durban believes cases in KwaZulu-Natal will double to 360,000 in the next few years - partly due to the confusion and secrecy surrounding the virus.

"The tragedy of this epidemic is that it's only when you start burying people that you realise this is for real. This isn't a play, this isn't an act. This is a real disease killing real people - their brothers, sisters, mothers, siblings and children," he said.

And he suggests that this culture of denial is matched by that of the government, with its excuse that the drugs are too expensive.

"There is no doubt that this country can afford some form of treatment policy," added Professor Whiteside.

"The question of whether or not the government can afford to do treatment can be turned on its head and we have to ask can it afford not to?"

Corporate rescue

In the absence of state treatment even the big corporations are rolling out the drugs. The biggest company in South Africa, Anglo-American, gives drugs to all HIV positive workers who need them.

But at the end of the day it was a moral decision - it's something no employer in South Africa can ignore
Dr Brian Brink, Anglo-American
Dr Brian Brink has implemented the company policy and argues it is affordable and the benefits outweigh the costs.

"The immediate benefit is employees are not getting sick and requiring hospitalisation, which is a saving," he said.

"Clearly employees are not going to be dying so all the costs of death in service and pensions for dependents are reduced. But at the end of the day it was a moral decision - it's something no employer in South Africa can ignore."

Availability of treatment reduces the stigma surrounding the virus, encourages more people to go for testing, and as people become more aware the chances of it being passed on are reduced.

Doctor exodus

However, doctors are leaving not only the profession, but also the country, as they feel they cannot fulfil their Hippocratic Oath unless they can offer treatments for HIV, according to the South African Medical Association.

The government's position has been to question the safety of ARVs emphasising the importance of nutrition and poverty reduction, and favouring prevention over treatment.

Cost has always been the excuse, but the price of drugs is coming down all the time.

The cabinet is considering the findings of a report it comissioned which is expected to back the provision of treatments - and amid mounting pressure some kind of reaction is expected next week.

The country is holding its breath and hoping that finally the life saving drugs will be backed by a previously sceptical government and will give hope to millions of people.

Assignment will be transmitted on BBC World Service at the following times: Saturday at 1006 GMT and 1806 GMT and then Sunday 2106 GMT.

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