Among the most vulnerable, researchers said, are women with only one sexual partner -- their husbands -- who either have the virus when they marry or acquire it later through an extramarital affair. For these wives to insist on the use of condoms would mean forgoing pregnancy, the cornerstone of marriage according to most African traditions.
Thobi Segabi, a physician at Soweto Hospice, recalled a woman last year who spent four weeks there in increasing misery. Segabi asked whether something was troubling her and learned that years earlier the woman had left her husband abruptly after being told she had HIV.
Former South African president Nelson Mandela, center, attended the funeral of his eldest son last week with wife, Graca Machel, left, and grandson. Mandela announced publicly that his son had died of an AIDS-related illness.
(Themba Hadebe -- AP)
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The husband, who had never been told, visited the hospice soon after and spoke with his wife for the first time about her illness. The woman died the next day.
"She had this heavy load that she hadn't released," Segabi recalled. "She was blaming herself."
As AIDS activists try to make the issue more visible and less shameful, T-shirts declaring "HIV Positive" have become a common sight throughout South Africa. Yet physicians, researchers and AIDS activists say the disease remains little understood even after years of public education campaigns.
Among families, an HIV infection is often kept secret. South Africa's newspapers are filled with death notices that refer euphemistically to a "prolonged illness." Pneumonia or tuberculosis, rather than AIDS, is often listed as the cause of death, which, while technically accurate, neglects the overriding point: that HIV led to the lung ailment.
Contrary to popular belief here, AIDS is not necessarily fatal. A small but growing trickle of antiretroviral drugs is reaching those with AIDS in South Africa, allowing dramatically prolonged lives for the few people with access to the medicine. And the government, after years of resistance, is now offering the drugs at some public health clinics.
Yet most of the estimated 5 million South Africans infected with HIV have never even been tested for the virus. Many of those who die of AIDS complications are unfamiliar with the illness and do not appear at hospitals until they are too sick to gain much benefit from potentially life-prolonging drugs, physicians say.
And even those knowledgeable about HIV can find it difficult to tell others. Harry Nyathela, 30, an AIDS activist in Soweto, told a friend soon after the disease was diagnosed in him in 1998. The friend quickly accepted the news but requested that his wife not be told, fearing that she would ban Nyathela from the house.
At his family home, Nyathela had to buy his own wash basin. One relative threw out a loaf of bread he had touched. Friends asked him to take home cups after he had used them.