Sir - Further to Paul Cullen's excellent article (July 15th) on the AIDS pandemic in Africa, I would like to describe the situation in South Africa where currently the government seems to be in a state of denial about the level and implications of the HIV epidemic.
With an estimated 4.2 million people infected with the virus, debates over the "actual" cause of AIDS are wasteful rhetoric. While I agree with Paul's statement that the long-term provision of anti-retroviral drugs to HIV infected people would be inappropriate, there is a case for their provision to pregnant women. Data presented at the AIDS conference in Durban have shown that administration of anti-retrovirals can significantly reduce the rate of vertical transmission of HIV from the mother to the infant. Recent estimates by an economist at the University of Capetown predict that the net cost of not providing such drugs will be in the region of R800 million per annum, mainly in treatment costs for the HIV positive infants.
However, drugs are only half the story. AIDS awareness campaigns are woefully lacking or are so discreet as to be risible. Capetown's information campaign stretches to a sketchy condom, which apparently caused outrage when first displayed on a high-rise building. In addition, there are a number of billboards on one of the highways, one of which says "Safe driving and condomising helps keep love alive". The writing is so small it takes several efforts to decipher it. This lack of an aggressive information campaign, a coyness if you like, has helped to spawn incredible ignorance.
Myths abound, including the one that sex with a virgin can cure AIDS. The question "But who uses condoms?" caused me to choke recently when I heard it from a 40-year-old, sexually-active woman with an MBA, someone who, theoretically at least, should have known better. Friends come back from visiting their families in KwaZulu-Natal and the Eastern Cape with tales of yet more people who have died from "pneumonia".
The situation is frightening. With an estimated 12 per cent of educators HIV positive, the government will soon face a scenario where it will not be able to train teachers fast enough to replace those who have died. Chillingly, a UN report suggests that AIDS orphans will constitute between 9 and 12 per cent of the population by the year 2015.
President Mbeki has said that he wants an African solution to this problem, but he and his minister for health seem not to have taken on board the experience of Uganda. Having visited there in 1996, I was struck by their AIDS awareness program, which was very blatant indeed. Huge billboards in unambiguous terms told of the dangers of HIV infection and advised the use of condoms or preached abstinence. Public figures regularly spoke out on the need for prevention of HIV infection. The result was a high level of public awareness of the causes and devastating effects of the disease and this has helped to turn the tide. The percentage of the Ugandan population that is HIV positive today, is lower now than it was five years ago.
Whatever the reason for this inexplicable behaviour by the government, and whatever means are used in combating the epidemic, strong and decisive action must be taken, now. - Yours, etc.,
Dr Nora M. Carroll, Capetown South Africa.