South Africa mounts major campaign against AIDS

SOVANE, South Africa — South Africa, trying to overcome years of denial and delay in confronting its monumental AIDS crisis, is now in the midst of a feverish buildup of testing, treatment and prevention that U.N. officials say is the largest and fastest expansion of AIDS services ever attempted by any nation.

The undertaking will be expensive and difficult to pull off, but in the past month alone the government has enabled 519 hospitals and clinics to dispense AIDS medicines, more than it had in all the years combined since South Africa began providing antiretroviral drugs to its people in 2004, South African health officials said.

To accomplish this, the government has trained the hundreds of nurses now newly prescribing the drugs — formerly the province of doctors — and will train thousands more so that each of the country's 4,333 public clinics can dispense AIDS medicines, a step the health minister, Dr. Aaron Motsoaledi, called essential to combating "this monster amongst us" in a country short of physicians.

President Jacob Zuma, who recently admitted to having unprotected sex with a much younger woman, last Sunday inaugurated a campaign to test 15 million of the country's 49 million people for HIV by June 2011.

In a speech at a hospital east of Johannesburg, he disclosed that his fourth test again showed he was HIV-negative and said he made the result public "to eradicate the silence and stigma that accompanies this epidemic."

Michel Sidibe, executive director of UNAIDS, the U.N. AIDS agency, said in an interview that South Africa's AIDS undertakings offered hope to the entire continent. "It's the first time one country has scaled up so quickly, to so many people," he said.

South Africa, the region's richest nation and a symbol of democracy, has an estimated 5.7 million HIV-positive citizens, more than any other country.

"In my village, when we want to kill the snake, we don't hit the tail, but the head," said Sidibe, who is from Mali. "The head of this epidemic is South Africa."

The South African Finance Ministry said it expected that the widespread testing and broadened access to drugs would put a million more people in treatment in the next few years, roughly doubling the current caseload. It has budgeted an extra $1 billion for it. Motsoaledi said Zuma reopened the budget to get more money for AIDS when it became clear that costs would be higher than expected.

South Africa's understaffed public-health system and the ballooning cost of treating millions of people for life will pose daunting challenges to the government's ambitious goals.

The United States has long been South Africa's principal donor in the fight against AIDS, giving the country $620 million this year, including an extra $60 million to help with the rising demand for drugs. But some advocates worry that international donors will not provide enough money to sustain a rapidly growing treatment program.

For now, though, there is an optimism among the scientists and advocates who had despaired as the nation dithered on AIDS under its former president, Thabo Mbeki.

"I've never known such a gathering of momentum around HIV as in the last month or so," said Mark Heywood, who directs the AIDS Law Project based in Johannesburg.

Mbeki had questioned whether HIV caused AIDS and suggested that antiretroviral drugs were harmful. Harvard researchers estimated that the South African government could have prevented the premature deaths of 365,000 people during the previous decade if it had provided the drugs to AIDS patients and widely administered medicines that help stop pregnant women from infecting their babies.

"If we had acted more than a decade ago, we might not have been in this situation where we are," Motsoaledi said. "Obviously, we did lose time."

Zuma, in office for almost a year, has broken sharply with the Mbeki record, broadening access to AIDS drugs for HIV-positive pregnant women and babies, as well as for people with tuberculosis. The government is moving toward routinely offering HIV tests to all who come into the public-health system, rather than waiting for people to ask for them.

Hundreds of private pharmacies, including the retail chains Clicks, Link and Dis-Chem, will offer free HIV tests for the next year with kits provided by the government. More than 2,000 retired nurses, doctors, pharmacists and other health workers have volunteered to help with the drive.