South Africa's government faulted for surging AIDS deaths

CAPE TOWN, South Africa -- Sindiswa Moya has already buried her boyfriend because of AIDS. Now the former police officer battles for her own life.

In an open letter to President Thabo Mbeki, Moya made a desperate plea for medicine. "My immune system is weak and I am running out of time," the 34-year-old wrote in a recent edition of The Sunday Times newspaper.

But Health Minister Manto Tshabalala-Msimang asked her to be patient. She said the government needs more time to roll out the AIDS treatment program that it promised last fall. It will be the world's largest and most comprehensive.

Over the decade of dramatic political and social change since the end of apartheid, the government has made big strides against other health problems, but activ-ists decry its slow response to the AIDS epidemic.

The disease kills at least 600 people a day, decimating the work force, destroying families' earning power and creating a generation of orphans. An estimated 5.3 million of South Africa's 45 million people are infected with HIV.

While South Africa spent millions on AIDS education programs, Mbeki's government resisted providing anti-retroviral drugs.

"That really caused confusion, pain, paralysis in implementation and policy for five years -- at an enormous cost in terms of new infections and a serious death rate," said Zackie Achmat, head of the Treatment Action Campaign.

Achmat, 41, found out he was infected with HIV in 1990. But he refused to take anti-retroviral drugs until last August in solidarity with the estimated half million South Africans with advanced AIDS symptoms who cannot afford the treatment.

Upgrade could take years

Under mounting public pressure, the government approved a plan in November to provide the medicines free to all who need them within five years.

But Tshabalala-Msimang warned Moya and other sufferers that it could take years to upgrade health facilities neglected under apart-heid, hire and train staff, and negotiate contracts to supply drugs.

By going public and braving the stigma still associated with AIDS, Moya found a sponsor to pay for her treatment until it becomes available at her clinic in the sprawling Johannesburg township of Soweto.

Less than 3,000 South Africans have started treatment at a handful of hospitals under the government's program.

The epidemic is undermining what would have been impressive gains in universal health care.

For decades, most of South Africa's blacks -- nearly 80 percent of the population -- went without basic care in a country that pioneered heart transplants in the 1960s.

Since the end of apartheid in 1994, more than 900 clinics have been built or upgraded; pregnant women and children under 6 receive free health care; immunization programs have slashed diseases like measles and polio; pregnancy-related deaths have fallen; and school meal programs have helped combat childhood malnutrition.

But for all the advances, average life expectancy has dropped from 61.5 years in 1994 to less than 50. By 2010, it is expected to slip below 40.

Hospital wards are overflowing with patients suffering pneumonia, tuberculosis or other illnesses associated with AIDS.

Disillusioned health workers are quitting, and an alarming number are succumbing to the same virus as their patients -- including more than 15 percent of nurses, according to one recent survey.

"The South African health system is like a toy car," said Ed Jarvis, a 30-year-old doctor at Soweto's Baragwanath Hospital whose entire career has been spent in the shadow of AIDS. "It looks tough and rigid, but it is going nowhere fast, and the gradient is increasing all the time."

AIDS-related complications afflict nearly half the patients admitted at Cape Town's G.F. Jooste hospital, a bleak, single-story building that serves an area of about 1.5 million people.

Thanks to private funding, it is now treating some of them with anti-retrovirals. "People just used to come here to die," said Dr. Kevin Rebe. "Now they come to be treated."

But even here, help goes to few. Only 60 of an estimated 15,000 qualifying patients are on treatment.

"A lot of people will die while they are on our waiting list," Rebe said.