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S. Africans With AIDS See Ray of Hope

"The way she looked," said Mbatha, "we were all waiting for her to die."

Across South Africa, AIDS had already taken a toll. That year, according to United Nations calculations, 270,000 people died from AIDS in the country of 46 million.


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 nearly became one of them. But her mother immediately began taking her to doctors, and she soon reached the Church of Scotland Hospital. At that point antiretrovirals, which cost thousands of dollars a year, were unavailable to all but the wealthiest patients. But under Moll's guidance, the hospital grew adept at prolonging the lives of AIDS patients.

Malembe was given antibiotics to ward off infections that were exploiting her depleted immune system. She improved enough to begin working in Tugela Ferry, selling secondhand clothing on the sidewalk outside some shops.

Over the next two years, she continued struggling with AIDS. She suffered from diarrhea, cold sweats, thrush and persistent coughs. By early this year, she could barely walk, was unable to bathe and could not tolerate solid food. She had sores all over her body and slept constantly. Her viral load -- the most accurate measure of the disease's progress -- reached levels that signaled imminent death.

Then in March, the antiretroviral program began at a handful of clinics, including the Church of Scotland Hospital. Malembe was among its first group of nine patients.

"She really just got her foot through the door at the right time," Moll said.

The government was able to purchase antiretrovirals for $65 per patient per month, and it offered them in a simplified regime that consisted of taking one capsule and one pill each morning and then, 12 hours later, one capsule and two pills.

In wealthier nations, AIDS patients had been taking a complicated cocktail of pills. Researchers feared such a schedule would be difficult to manage in regions with poor electricity, water supplies and transportation. Strict compliance is crucial because a missed dose can allow the development of resistant strains of HIV.

In the first days of taking antiretrovirals, the body's immune system begins to revive and battle infections, often causing various side effects. For Malembe, the first two days brought on diarrhea and bad dreams. One night, she imagined she heard crying outside. She awoke terrified and confused.

But within a few weeks, Malembe was strong enough to return to work, and after four months, she had enough strength to carry a heavy bag of clothes again. Her own weight also began to bounce back.

The change was so astonishing that acquaintances approached her to ask about her recovery, she said. Some also shared a secret: They, too, were sick and wanted to know how to get better.

In the end, she told them, she prayed to God, accepted her diagnosis and put her trust in the doctors. The medicine did the rest.


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