We have met some interesting patients in the last few days, and i just wanted to tell you about them.

The first I’ll call William for privacy’s sake. He has spina bifida which means that his spine never fully developed before he was born. Because of this birth defect, he is paralyzed from the waist down. In addition he has to have a shunt in his brain to drain excess fluid. He never learned to read or write because he was always in the hospital as a child, and now he is in mid-twenties and completely dependent on his mother, both financially and physically. Despite all this, he maintains an optimistic view on life and greets everyone with a cheerful smile. The head nurse I was traveling with lamented the lack of facilities in George that would teach a useful trade to adults with disabilities. William would love to be able to at least partially contribute to his own financial support.

We also met Tandy, a former patient. She lives in Lawaaikamp, one of the poorest and most dangerous areas in George. She is a former prostitute who was diagnosed with AIDS in 2000. At that time ARVs (anti-retroviral drugs which can treat and manage AIDS) were not publicly available because former President Thabo Mbeki banned their use in public hospitals until 2002. Mbeki denied that HIV causes AIDS and appointed a South African health minister (Manto Tshabalala-Msimang) who advocated using lemon juice, beetroot and garlic to cure AIDS rather than the “poisons” of ARVS. Public outcry and international criticism finally forced Mbeki to allow the use of ARVs in 2002, but he continued his personal support of AIDS denialism. Independent studies have arrived at almost identical estimates of the human costs of AIDS denialism in South Africa. According to a paper written by researchers from the Harvard School of Public Health, between 2000 and 2005, more than 330,000 deaths and an estimated 35,000 infant HIV infections occurred “because of a failure to accept the use of available [antiretroviral drugs] to prevent and treat HIV/AIDS in a timely manner.” * Nicoli Nattrass of the University of Capetown estimates that 343,000 excess AIDS deaths and 171,000 infections resulted from the Mbeki administration’s policies, an outcome she refers to (in the words of Peter Mandelson) as “genocide by sloth.” ** Tandy’s mother spent her own money to buy her daughter ARVs from Pretoria (a/b 800 miles away). In the 18 months that she had to pay for the drugs, Tandy’s mom borrowed and spent R30,000. That’s more than her yearly salary. (R30,000 is currently equivalent to almost $4,000.)

Nine years later Tandy is a healthy woman in her late twenties. No longer a prostitute, she now travels throughout the Western Cape of South Africa as a motivational speaker in schools and women’s conventions. Her sister disowned her because she is open about being HIV-positive, but Tandy remains undeterred in her honesty. After her diagnosis she called every single phone number she had of her former customers, informing them of her status. She also took out a classified ad in a national newspaper in which she stated her name, her occupation, her new diagnosis, and her phone number and encouraged anyone who might think they had used her services to get tested. She has since gotten married and has two children who are both HIV-negative thanks to her pregnancy precautions. Tandy attributes her health and lifestyle improvement to her new-found faith in Jesus Christ and her willingness to honestly confront her infection.

Despite being surrounded by fatalistic attitudes, Tandy and William have chosen to live openly and courageously. They are role models in their communities.

*Chigwedere P, Seage GR, Gruskin S, Lee TH, Essex M (October 2008). “Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa”. Journal of acquired immune deficiency syndromes (1999).

**Nattrass N (February 2008). “Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa”. African Affairs 107 (427): 157-76.