Posted on 6-10-2003
As
Millions Die
By Nicholas D. Kristof, The New York Times, 2 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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