REPORTER: ALFRED MUTUA
An empty village by the shores of Lake Victoria in Uganda.
Here, silence greets those who ask why there are no adults taking care of the teenagers and young children. It is the silence of death. Of what happens when the hand of AIDS comes knocking.
Across the lake and over the mountains is neighbouring Kenya. Here some prostitutes have baffled science. They are immune to the HIV virus.
Further south are Botswana and the Republic of South Africa, countries where nearly 3 out of 10 people are infected with the virus and are staring at an early grave.
JOY PHUMAPHI, BOTSWANAN MINISTER OF HEALTH:
It is the responsibility of every African to assume the task of determining the destiny of Africa. We ourselves must control this epidemic. We must have comprehensive national programs, the political commitment must be absolute.
AIDS first became an epidemic in the United States but it was in Africa where the disease bared its killer fangs and many are asking why Africa?
I went back home to find out what Africans think of the disease and why AIDS has chosen our continent.
Johannesburg, South Africa.
Last year, 200,000 people died of AIDS in this country alone.
Here, poor girls have been forced into prostitution and despite the dangers of AIDS have to choose between using protection and making more money. In other words, if they have sex without a condom, they are paid more.
TAXI DRIVER: If you don`t want to use your condom, you pay 150 Rand to 120 Rand ($5), if you don`t want to use the condom.
But if you use the condom you pay 50 Rand ($1.5). The last price is 25 Rand (60cents). That is the price of the condom in South Africa.
The legacy of apartheid is obvious in Johannesburg. Lack of education during the difficult times, as that era is now known, means that majority of black people are not qualified for employment. Crime is rampant and the country has not yet recovered from years of oppression and discontent.
In this environment, AIDS has aroused suspicion.
JOE, GUY IN STREET: I think it has been planned, this thing. What do you say about the condoms that that have been found in Africa that they got the HIV virus? What do you say?
REPORTER: So, you believe that condoms actually have viruses in them, so if you use a condom you get HIV?
JOE: I believe it has been planned. I believe the disease has been planned to get rid of us poor people so that the rich can enjoy life. While we are dead.
REPORTER: Who do you think has done this, who has planned it?
JOE MIKE: The superior of the world.
There is a general lack of knowledge about the disease. People are still asking questions such as, is AIDS a man-made disease? Does HIV really cause AIDS? Why are heterosexual Africans the most affected and why are AIDS drugs so expensive and out of reach of those who need them the most?
REPORTER:I am standing outside ward 34 in the largest hospital in the world, the Chris Hani/Baragwanath Hospital that sits just outside Soweto in Johanneburg, South Africa.
Every day, HIV infected mothers and their HIV infected children come to this ward to receive counselling and the little medical care they might receive. But most of them come here petrified that their neighbours, friends or even relatives might find out they are HIV infected. This is because of the stigma that is attached to AIDS in this country.
Because AIDS is still seen as a disease caused by sin and immoral behaviour, the stigma attached to it is so powerful that it hinders efforts to get people talking about it and even prevents people from seeking treatment.
Therefore, the disease remains a silent and rapid killer.
Princess and her son Johannes are HIV positive. When she found out, she confronted her husband who then blamed her for the disease and kicked her out of home. Her relatives and friends shunned her and today she is so poor that at times her children are forced to sleep hungry.
PRINCESS(subtitled): When I get to the hospital for my child`s treatment, like today, they asked me for 13 Rand. I didn`t have it so my child got no tablets.
This thing for me is shame. I don`t know what to do about it. I`ve accepted it. There`s nothing I can do but accept it. This is shame.
Despite the shame, Princess has chosen to volunteer at the hospital as an AIDS counsellor. This, though has not made life any easier.
PRINCESS: It is hard to live with this disease without support. I`ve got no money to take my babies to school. I am not working. My family is poor. They are drinking, all of them.
Princess is afraid and hoping for a miracle. Like many in South Africa, she confused by President Thambo Mbeki`s statements on AIDS.
A year ago, President Mbeki questioned whether HIV is the only cause of AIDS. His statements caused an outrage around the world. Some interpreted his comments as a rejection of established scientific beliefs.
Others have said he is running away from the main issues surrounding the fight against AIDS.
I spoke with South African Health Minister, Dr. Manto Tshabalala-Msimang for clarification.
REPORTER:Do South Africans understand HIV causes Aids?
DR. MANTO TSHABALALA-MSIMANG, SOUTH AFRICAN HEALTH MINISTER: South Africans have never doubted that. They have never! They have never doubted. Somebody misquoted the president and started to plough in some of our people`s minds that they are beginning to doubt but South Africans have never doubted that.
ALFRED: They know HIV causes Aids through sexual transmission?
TSHABALALA-MSIMANG: They have never doubted that but I think also they are very much convinced that even if you knew HIV causes AIDS, if you are forced to go be a sex worker because you are unemployed, it is difficult for you as a woman to demand to use a condom. All these factors if you do not address them together, you can`t win the battle.
REBECCA (Aids Counsellor): I cannot really blame President Mbeki because what he said it was from his own opinion. And really and truly, the most people who are infected with AIDS are from the rural areas, poor people, let me put it that way.
JIM DLAMANA, Banker: African men are having this thing that you cannot eat a sweet with a wrapper on. Understand what I mean? You can`t feel the sweetness of this sweet with the wrapper on.
LAWRENCE, nurse:The government has done a lot this far and there is nothing more they can do. They can`t get into rooms and make sure you put on a condom. That is all I can say.
REPORTER: Some people have said that HIV is an economic driven disease and this is very evident in South Africa. In Capetown, a mostly white and rich town, you find that the disease is found in the poor black communities such as this one that lives here in Khayailichi.
The community`s main radio station spends considerable time educating people on the dangers of AIDS. The population served by the station has been hard hit by the epidemic and messages on the use of condoms are repeated over and over again.
South Africa is not alone in preaching prevention.
Just to the northwest of South Africa is the nation of Botswana.
Its capital is Gaberone. Here, the government has tried to combat the shame of HIV with strong public campaigns that portray HIV as a disease like any other.
From a single, unprotected sex act, research has shown that the chance of getting infected with HIV is 1 in 1000 for a man and 1 in 300 for a woman.
How then do you explain the high rates of infection? Does it mean Africans are more promiscuous than say Australians?
JOY PHUMAPHI, BOTSWANAN MINISTER OF HEALTH: It is not promiscuity as such. It is that people do not protect themselves as they should. I do not believe that people in Botswana or in the rest of Africa for that matter that people have more sexual partners than other parts of the world.
Dr. OMU ANZALA, KENYAN AIDS VACCINE INITIATIVE: I don`t think the epidemic we are experiencing in Africa has anything to do with promiscuity.
Dr. Omu Anzala has been studying the spread of AIDS since the 1980s.
DR. ANZALA: People are more concerned about other issues than health and they look at it and ask themselves, I could die of hunger, I could die of this, I could die of this. There are so many things one could die of, so that just being alive itself, being able to put food on the table seems to be the most important priority. So, the issue of promiscuity as some people say, that is not the issue at all.
JOY PHUMAPHI: The major factor that has contributed to this high rate of infection is the stigma that has been attached to the HIV/AIDS epidemic ever since it started around the world. People have associated it with loose morals and because of this most members of the population feel they cannot become victims of the epidemic because their moral standards are high or they are morally upright.
According to the government of Botswana, 27 percent of sexually active people are infected with the virus. This means that in a few years, unless a cure is found, nearly one third of Botswana`s working population will be dead.
JOY PHUMAPHI: A body that is already compromised by poor nutrition or by lack of access to good nutrition because of poverty is going to find it that much more difficult to fight any infection.
But there are other contributing factors, Botswana and most of sub-Saharan Africa suffers from high rates of untreated STDs such as gonorrhea, canchroid and syphilis. These, according to Dr. Omu Anzala and his colleague Dr. Ephentus Njagi, of Kenya`s Nairobi university are major factors in HIV transmission.
DR. ANZALA: There is a direct link between STDs and HIV and there is a direct link between the time somebody goes for treatment and the time they linger around with a sexually transmitted disease.
Many Africans either receive partial treatment for their STD`s or no treatment at all. AIDS has taken advantage of this.
DR. ANZALA:In the presence of an STD, one sexual act increases the chances of infection by maybe 10 to 20 percent.
ALFRED: It`s a big figure.
DR. ANZALA: It`s a big figure, yes, it`s a big figure.
AIDS in Africa struck with a vengeance in the communities around Lake Victoria. These communities suffer from high rates of STD infection. But there is yet another crucial element – they do not do not circumcise their men.
DR. EPHENTUS NJAGI,KENYA AIDS VACCINE INITIATIVE: People who are circumcised have a lower risk of acquiring HIV than uncircumcised people.
ALFRED: Why is this?
DR. NJAGI: And of course it makes sense. The reason behind it… in uncircumcised people there is a lot of a actually dirt which surrounds there and the foreskin has a lot of cells which are susceptible to HIV. Or which get infected by HIV.
ALFRED: Would you then encourage people to circumcise their children?
DR. NJAGI: Definitely. And I think there are programs within this country which are encouraging tribes which do not circumcise their people, even adult ones to go to be circumcised.
ALFRED: So, adults, you are encouraging adults to be circumcised?
DR. NJAGI: Adults and children to be circumcised. And quite a quite a number of people who never used to be circumcised are circumcising their children in this country.
Dr. Njagi and Dr. Anzala are very excited. They have been working with prostitutes in Kenya.
In the capital Nairobi, a group of prostitutes has baffled scientists.
They do not contract HIV even after constant exposure to the virus. They are immune to AIDS.
DR ANZALA: These are women, despite repeated exposure to HIV and we know they are exposed because they come to the clinic with other sexually transmitted diseases, these women have remained HIV negative and these are the women we call the resistant women.
Agnes Munyiva is one of those resistant women. She has been a commercial sex worker for 28 years.
REPORTER: Why do you think you have never been infected?
AGNES: I don`t know, I think it is God`s will.
REPORTER: Doctors have said that you . . .
AGNES: I see it as being lucky because I am an orphan and have my children here.
REPORTER: How many children do you have?
AGNES: Five. The oldest was born in 1972 . . .
DR. EPHENTUS NJAGI:The factor that we think is at play is what we call the killer cells. A number of them, when we investigated them, they had high levels of killer cells and we assumed these killer cells were killing the virus.
Salome too, is another of the `resistant women`. She does not understand the concept of killer cells but now insists that her clients use two condoms. She wants to be on the safe side.
SALOME: I don`t know whether it is my strength or the food I eat. All I know is that I was created this way. Because other illnesses don`t affect me either.
Uganda understands what it means not to lose hope.
Between 1966 and 1985, Ugandans were tortured and murdered by the notorious dictators Idi Amin and Milton Obote. After Amin and Obote were sent packing, those who had survived their treachery were immediately claimed by a disease they did not understand.
PAUL: Many people died during this time because they did not know what disease actually was killing people.
Paul is an aspiring photo-journalist. In the last seven years, he has been using his skills to feed and educate himself, his brothers and sisters.
REPORTER: Did you lose any people that you knew?
PAUL: Yeah, yeah, many people died. Parents, brothers, in fact roughly here, you can check the houses here. Some people died and they left young children like this one.
REPORTER: Even like some of these houses we are seeing here?
PAUL: You can see a house like this one. You can see the number of us here. Mostly our parents died and they remained only us. And anyway, we are trying to keep safe because we know the epidemic which, the disease which killed our parents. We are trying to keep safe.
DR. Harriet Mayanja-Kizza, of Uganda`s Mulago hospital, saw many of these parents die and realised that there was another factor causing the high transmission rate in Africa. Tropical diseases.
DR. HARRIET MAYANJA-KIZZA, Uganda /Mulago Hospital: We have more diarrheal diseases and of course we have malaria. I don`t know but this is a theory that could these make our bodies immune system more susceptible to getting HIV? This is a theory which needs investigation. Studies were done in TB and it seems that people with Tuberculosis would be more prone to getting HIV infection than those without.
REPORTER: So, we face abject poverty. We also suffer from high rates of sexually transmitted diseases and now we have heard that tropical diseases put us at a disadvantage. If this is not bad enough, a new study by the Centers for Disease Control and Prevention in Atlanta, has shown that by the virtue of being born black, it is easier for me to get infected with the HIV virus.
DR. HARRIET MAYANJA-KIZZA: Studies have been shown that there is a gene defect found in Caucasians which protects them from HIV. Absence of this gene is protective against HIV. This defect has not been found in the African population although studies have been done.
Dr. Kizza`s fellow researchers at Mulago hospital were conducting studies on transmission of HIV when they established that the use of a drug called AZT can limit and even halt the transfer of the HIV virus from mother to baby.
However, anti AIDS medication is expensive and this has put many Africans in a bind. Even though drugs can lengthen their lives, most are left to die because of the enormously high costs of anti-Aids medicine. Activists argue that drug companies are simply driven by greed.
ZACKIE ACHMAT, AIDS activist, Treatment Action Campaign: Many of these companies have blood in their hands.
South Africa`s Zackie Achmat of Treatment Action Campaign, TAC, has become a thorn in the flesh of pharmaceutical companies.
ZACKIE ACHMAT: In 1999, when TAC was started, the United States government put undue pressure upon our government not to make medicines affordable to South Africans. And in particular drug companies who make anti-HIV drugs, anti-retrovirals – GLAXO, SMITH KLINE now, BRISTOL MEYERS SQUIB. BOHRINGER INGLEHEIM and some of the others, particularly PFIZER also, they put pressure, they took our government to court.
Next week, the case will be heard here in South Africa`s constitutional court. The drug companies contend that South Africa`s threat to override patent law and produce and import cheap anti-Aids drugs is against South Africa`s constitution.
DR. MANTO TSHABABALA-MSIMANG, SOUTH AFRICAN HEALTH MINISTER:
They are saying to us our patent legislation which we drafted and formulated is unconstitutional. Now I don`t know what is unconstitutional about your saying you want to access drugs in a way which you can afford.
Despite World Trade Organisation agreements that allow countries facing an epidemic to ignore patent laws, many nations in the third world have been scared to manufacture cheaper generic AIDS drugs or import them from other sources.
REPORTER: Due to international pressure, some drug companies are starting to crack. After eight months of intense negotiations, Pfizer has now offered South Africa the free anti-AIDS drug Duflacon to South Africa. This may sound good but activists argue that this two year offer is loaded with a lot of negative conditions.
It is important to note that other drug companies have announced major funding initiatives that include supply of free drugs and education campaigns in several African nations. This is very good. However, critics argue that these are public relations ploys that are meant to deflect us from the real issue. Drug companies are profiting from AIDS.
ZACKIE ACHMAT: South African government figures show that last year in our country 200,000 people died of HIV related illness. The vast majority of those people could have lived. They died prematurely and unnecessarily without any reason whatsoever other than they couldn`t afford the medication. We believe this is genocide against poor people. It is a genocide that in our country is conducted predominantly against black and African people.
And for us, especially for people of my generation who grew up fighting for the dignity, equality and freedom of black people, to now live in a situation where black people are not being denied dignity but simply the right to life because of the absence of those medication. And we think there is no other way to describe it than evil.
Drug companies, however, argue that they are doing as much as they can to reduce the prices of anti-retroviral drugs, ARVs but they have to recoup massive research and manufacturing costs.
Zackie Achmat has decided he will not wait for drug companies to lower their prices.
He travelled to Thailand and purchased cheap generic anti-retroviral drugs. In Thailand, a generic of the drug fluconazol sells for about $50 dollars a box. The brand name, invented and manufactured by Pfizer, markets for about $1000 a box in South Africa.
JOY PHUMAPHI, Minister of Health, Botswana: I would also like every citizen of this planet to appreciate that the provision of drugs, the development for a vaccine, the research for a cure, is not the responsibility of the sick or the infected or affected alone, but it is a moral imperative for all the citizens of this planet.
ZACKIE ACHMAT: Any person who takes medication and does not fight for the rights of others to get medication, is complicit in the genocide that is being committed against poor people.
DR. HARRIET MAYANJA-KIZZA, Mulago Hospital: It is a bit disheartening to know that some people can get ARVs and do very well. We have patients here who very sick and they are doing well with ARVs, one, two, three years. And other people you look at them and say, for you sorry, I think pack your bags. There is nothing much we can do because you are poor.
Why can`t ARVs cost about the same as anti TB treatment, like treatment for malaria, like treatment for typhoid, so that it is within the affordable range?
Uganda has brought down the rate of infection from 36 percent to 8 percent. Even though this may look like a success, it is a far cry from the 0.01 percent in many Western nations.
From my journey through Africa, it is clear many Africans don`t care what the rest of the world thinks of Mbeki`s claims on the link between HIV and AIDS. They are more concerned with fighting poverty and trying to understand why AIDS has chosen their continent.