As Millions Die
By Nicholas D. Kristof
The New York Times
Thursday 02 October 2003
JOHANNESBURG - A generation ago, Americans protested and held divestment rallies in a snowballing movement against the injustices of South African apartheid.
These days, an incomparably greater injustice random sickness and death, often striking infants ravages South Africa. Yet the response in America and Europe, as in Africa itself, has been tepid.
The South African president, Thabo Mbeki, for years pursued a disgraceful policy of raising doubts about whether H.I.V. causes AIDS and questioning basic policies to confront the crisis. Even now, although Mr. Mbeki has largely backed down, AIDS sufferers are slow to seek treatment because of the doubts Mr. Mbeki has sown.
Mr. Mbeki's know-nothing obstructionism has killed incomparably more South Africans than any apartheid leader ever did.
South Africa announced this year that it will begin treating AIDS patients with antiretrovirals. I'll believe it when I see it. It is inexcusable that the country with the best medical infrastructure in Africa should also be the one with the most H.I.V. and AIDS sufferers and that in 2003 they should die untreated.
In America, we think of AIDS simply as an epidemic. In fact, like the Holocaust, it is a moral challenge to the world, one we are failing.
"It's mass murder by complacency," declared Stephen Lewis, the United Nations special envoy for AIDS in Africa, adding: "The time for polite, even agitated entreaties is over. This pandemic cannot be allowed to continue, and those who watch it unfold with a kind of pathological equanimity must be held to account."
AIDS is not only killing the sick, but also crushing the healthy. "There are two kinds of people here," says Dr. Marlin McKay, who treats AIDS patients in Johannesburg. "The infected and the affected."
Already, across southern Africa, a new kind of famine is spreading, as those enfeebled by AIDS can no longer work their fields or hold jobs. Those most vulnerable are the 11 million African children who have lost at least one parent to AIDS (the number is expected to rise to 20 million by 2010).
"Getting money for food and clothing is very difficult," said Thembi Mashaba, an AIDS orphan who now is responsible for her school-age younger brother and sister. To help pay the bills, she has found a boyfriend who chips in $27 a month to the family pot; such liaisons help women and children survive, but they also spread AIDS further.
"I'd say 65 percent of girls aged 14 to 18 sleep with older men for money," said Sandile Mohlape, a social worker in Sekhukhune, a rural area northeast of Pretoria. "We do not have 14-year-old girls sleeping with 14-year-old boys. No, the girls sleep with men who are over 30. They do it out of poverty, to get food to eat.
"They are aware of AIDS, but they need food and money, so they can't tell the man to use a condom. Most men won't use a condom. They say it is like eating bread with the plastic bag still around it."
Rape is common and deadly, for 45 percent of the rapists caught in South Africa have the AIDS virus. More broadly, social mores and institutions are eroding amid the desperation, leaving society increasingly a free-for-all.
"Teachers are asking for sex to pass a girl, or to give her a good grade," said Thulani Nkosi, himself a 10th grade teacher with H.I.V., although he says he has never done this himself. Ultimately, AIDS may leave some African countries as failed states; a World Bank study in June warned that if South Africa does not combat the epidemic, it will face "a complete economic collapse."
The little African country of Botswana is ground zero in the epidemic, for some 39 percent of adults have AIDS or H.I.V. You see its impact everywhere on Botswana's streets, in the form of cadaverous adults and children.
Yet Botswana is also a rare place of hope. It has led the way in Africa in providing treatment, and 7,700 people are now getting antiretroviral drugs to fight AIDS. Dr. Ernest Darkoh, who helps run the program, notes that of those getting the drugs, 85 percent have had the virus suppressed after six months of treatment.
Botswana shows that millions of lives can be saved if only we act aggressively which simply raises the question: Why aren't we?
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