In South Africa, a family and a nation slowly confront HIV

By SHASHANK BENGALI
McClatchy Newspapers

ALEXANDRA, South Africa -- He was never a big kid, but Vuyani Ngxalaba was starting to look frighteningly skinny. He turned up at soccer practice in a cold sweat, with sores spread across his hollowing cheeks. His family had little to eat, yet he seemed to vomit constantly.

Ingrid Moloi, a local charity worker who ran Vuyani's soccer team, had seen this kind of illness countless times. It had raced through the narrow, mazelike streets of Alexandra Township over the past decade like an unseen tornado. Three years earlier, it had killed Vuyani's mother, leaving him in the care of four older siblings, none of whom had a steady job.

When his sister learned from a blood test that 14-year-old Vuyani was infected with HIV, the virus that causes AIDS, she and Moloi faced the grim task of telling the shy, soccer-crazed teenager that he had a disease that much of South Africa still considers a death sentence.

How Vuyani slowly came to accept his HIV status offers a glimpse into how South Africa and its ravaged families are finally confronting an illness that's spread to one in five adults, one of the highest rates in the world, and stained a nation that's otherwise embodied sub-Saharan Africa's highest hopes in the 15 years since the end of white apartheid rule.

Around the world, while the spread of HIV slowed over the past decade - thanks largely to multibillion-dollar anti-AIDS campaigns that taught people to have safer sex and made life-saving antiretroviral drugs widely available - South Africa was a glaring exception.

South Africa's AIDS epidemic got worse. It was driven, many experts say, by a government policy marked by denial and misinformation that still echoes in overcrowded black townships such as Alexandra, outside Johannesburg, where few people openly discuss a disease that's nearly wiped out entire households.

Now, South Africa is trying to turn it around. Doctors, researchers and AIDS activists cheered in September when two officials left their posts: Thabo Mbeki, the president who questioned the science surrounding AIDS and for several years refused to subsidize antiretroviral drugs, and Manto Tshabalala-Msimang, who as Mbeki's health minister argued that a proper diet, including garlic and beetroot, could fight the disease.

The government has nearly doubled its anti-AIDS budget over the past five years, to $878 million, and expanded its treatment program into the largest in the world. A new health minister, Barbara Hogan, a respected former political prisoner, is spearheading a plan to cut new HIV infections in half by 2011.

Still, officials acknowledge that only half the people who need the drugs are receiving them, while the number infected with HIV - 5.7 million, the United Nations estimates, in a country of 49 million - is far and away the largest in the world.

"This is a terrible public health problem that required visionary leadership," said Francois Venter, the president of the Southern African HIV Clinicians Society. "Instead, what we got was arrogance and buffoonery that literally cost hundreds of thousands of South African lives.

"So I'm heartened by the change in tone. But the new minister has inherited a problem from hell."

Many think the battle against HIV can only be won in places such as Alexandra, a sprawling labyrinth of simple homes and cement-box shacks north of Johannesburg. Unemployment is high, schools are poorly equipped, children are initiated into sex at an early age, and along the narrow streets of Moloi's neighborhood, few households have been spared from HIV.