TUGELA FERRY, South Africa -- Every evening, by candlelight, Sithombi Malembe swallows two pills and one capsule with a gulp of water hauled by hand from the Tugela River. Under conditions once feared too primitive for such treatment, she is journeying back from the brink of death.
Three years ago, Malembe, 42, was a lost soul, far from her home here in KwaZulu-Natal province and wasting away from a disease she did not understand. Today she is one of Africa's rare success stories in the battle against AIDS.
Sithombi Malembe has been able to work selling used clothing since she started taking a cocktail of drugs.
(Photos Greg Marinovich For The Washington Post)
_____AIDS in S. Africa_____
Photo Gallery: While the disease still ravages the country, new antiretroviral drug programs offer hope of stemming the epidemic.
Malembe is still thinner than she would like, but seven months after starting treatment with antiretroviral drugs, she no longer has the emaciated frame or mottled skin common to AIDS patients in final decline, and she is recovering with her three children in a new mud-brick home she did not expect to live long enough to occupy.
"I knew I was going to die," she said. "I wanted to leave something for my family."
One of 280 patients receiving medicines from a hospital in this busy river town, Malembe is proof that antiretrovirals, which have largely tamed AIDS in wealthy nations, can offer similar hope in Africa. The disease has already killed more than 15 million people across sub-Saharan Africa, and an estimated 5.3 million South Africans are currently infected with HIV, the virus that causes AIDS.
Yet more than a year after the South African government decided to offer low-cost antiretroviral treatment to everyone with AIDS, only about one out of every 50 AIDS patients who are medically ready for antiretrovirals receive them from the public health system, said researchers who track the disease.
At least 500,000 people with HIV need antiretrovirals immediately, experts said. The public health system is delivering them to about 11,000, while private insurers and employers are reaching tens of thousands of others. But by any measure, the vast majority of those who need the medicine are not yet getting it.
The expanding availability of antiretrovirals, moreover, has not slowed the death rate from AIDS, which continues to kill more South Africans with each passing year, researchers and activists said.
Stymied by shortages of clinics, doctors and nurses, the government program will take years to reach every South African sick enough to need it, officials said. Moreover, the medicine is effective only if patients have the support and knowledge required to take the regimen of various pills correctly and on schedule.
"If you're dying of AIDS in South Africa at this point, you'll be lucky to be getting medicine," said Nathan Geffen, spokesman for the Treatment Action Campaign, an activist group based near Cape Town. But he added that the new government program had brought progress against the disease. "It's better than it was last year."
The Church of Scotland Hospital, where Malembe receives her medicine, operates one of the country's most ambitious rural AIDS clinics. The conditions are far from ideal, with sagging roofs and patients waiting for hours under nearby trees. One doctor and three nurses tend 700 patients.
Since antiretrovirals became available in March, however, dozens of patients such as Malembe have begun to recover, many from near death. One man, a convicted criminal so sick he was released from jail to die, has returned to health. People who had checked into a nearby hospice, expecting to die, have checked out.
Yet even here, medicines are reaching only a small fraction of those who need them, according to Tony Moll, the tall, soft-spoken doctor who directs the AIDS clinic.
"We're just treating a drop in the ocean," he said.