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S. Africans With AIDS See Ray of Hope

'Dying Like Flies'

A few yards from the counter where Malembe collects her medicines is a dreary ward where dozens of thin men and women lie motionless in bed. Some already look dead, and an average of three a day will die here of complications from AIDS.

These patients are doomed not by lack of medicine, but by lack of time. Antiretrovirals take two or three months to break the reproductive cycle of HIV and allow the immune system to rebuild itself. Even after starting the medicine, 12 patients here died because their immune systems were too damaged to revive.

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.

But because of stigma, denial and lack of knowledge, most AIDS patients do not even approach the hospital until they have a week or less to live, staff members said. Most of those who die here could have been saved had they arrived just a few months earlier.

"It is very frustrating," said Phikhona Mbongwa, 57, a nurse who has treated AIDS patients at the hospital since 1987. "Our children, they are dying like flies."

The pace of death has so overwhelmed the hospital that doctors sometimes stack two bodies in each refrigerated steel drawer at the morgue. Of 24 bodies in the morgue one day, Moll estimated that 75 percent had died of AIDS. Glancing at the green cards attached to each drawer, he recited the ages of the deceased.

"Twenty-one," he read, frustration creeping into his voice. "Twenty-four. I mean, why should somebody die at 24?"

Although thousands of South Africans with AIDS continue to die, the tide has begun to turn. After years of questioning the safety and effectiveness of antiretrovirals and resisting calls to make them widely available, President Thabo Mbeki's government announced last year that it would provide the drugs at low or no cost to all who needed them.

The policy shift was partly driven by the soaring number of AIDS deaths, and partly by the sharp reduction in prices for antiretrovirals, including drugs produced by Western pharmaceutical firms and generics made in India and Brazil.

The price of AIDS medicines in South Africa has dropped tenfold, allowing public hospitals to begin offering them, said Christopher Jack, a doctor who oversees the antiretroviral program for KwaZulu-Natal. The biggest obstacles to treating AIDS patients now, he said, is the lack of facilities and trained staff.

"There was no way we could do this [before]. It wasn't affordable, at least not in any sustainable way," said Jack. Now, he added, "We're walking in the right direction."

Narrow Escape

Malembe has beaten particularly long odds. In 1996, she left her home in a hamlet near Tugela Ferry to search for work in Johannesburg, a five-hour drive north. She found boyfriends but no job, and she believes she contracted the disease while living in run-down urban townships, she said. Her family lost track of her almost completely.

"I thought that maybe she had died," said her mother, Esther Malembe, 64.

Also left behind were Malembe's three children and a large extended family centered on her father's eight wives. Such marital arrangements, common in Zulu culture, are among the factors blamed for the rapid spread of HIV in KwaZulu-Natal, where experts estimate that more than one-third of people between the ages of 15 and 45 are infected.

Rumors began reaching Malembe's village that she was sick and thin. Finally, in 2001, her mother decided it was time to bring her home. Her half-sister, Ntombifuthi Doris Mbatha, dispatched a son to Johannesburg. He found Malembe, but she had already lost 30 pounds.

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