Giraffes, bears, and bunnies embroidered on swatches and sewn together adorn the walls of the Entombeni orphanage in a seedy neighborhood of downtown Johannesburg. Giggles and shrieks spill from a ground-floor playroom. But beneath the gaiety is an inexorable sadness--and a foreboding of the grim fate awaiting much of Africa. On each panel of these vast tapestries is a name, a birth date, and a death date: These are AIDS quilts of a sort, hand-crafted memorials to infants or toddlers, most of whom were born to HIV-infected mothers and quickly fell victim to South Africa's AIDS holocaust.
On a continent torn by war and recurring famine, AIDS is nonetheless the No. 1 killer. In Africa, the disease destroys not just individuals, but entire families. In claiming children and threatening already struggling economies, it is a violation of the future. AIDS is endemic across sub-Saharan Africa. But South Africa is an especially tragic case--partly because it is so prevalent here and partly because of the government's inaction. While Uganda has used both education and drugs to beat back the disease, South Africa is unwilling to do much more than study the problem.
Indeed, President Thabo Mbeki has taken South Africa back to square one, spurning useful research while courting widely discredited scientists who question the link between HIV and AIDS. The nation's refusal to use drugs on pregnant, HIV-positive women has stirred outrage here and abroad. The overall impression is of a nation overwhelmed. "Where do we start?" Health Minister Manto Tshabalala-Msimang asked at a press conference recently. That pretty much says it all.
UNHAPPY BEGINNINGS. At Entombeni, nobody knows how many of the 43 children who call the orphanage home are infected, because testing is too expensive. Some arrive as abandoned babies. Others have seen their parents die, or have watched as mothers and fathers entered the wretchedness of the disease's late stages. In some cases, parents have made the ultimate sacrifice: Fearing their children may be infected, too, they have given them up because they couldn't afford food, medicine, or clinic visits. Clearly, the seamstress who periodically visits Entombeni will continue to tell the sad stories of abbreviated lives in needlework: "Charmaine, born Apr. 5, 1998, died Mar. 4, 1999. Nodumo, born Apr. 8, 1998, died Sept. 8, 1998. Thabile, born Jan. 16, 1998, died June 17, 1998." Some 90% of the world's HIV-positive babies are born on this continent; in South Africa, 5,000 HIV-infected babies are born every month.
At the 13th International AIDS conference, held in Durban in July, a high court judge in Johannesburg named Edwin Cameron invoked the newborns, the most innocent of victims, when he blasted the Mbeki government for its failure to act more aggressively. "Their lives involve preventable infections, preventable suffering, preventable deaths," he said. "And if none of that is persuasive, then from the point of view of the nation's economic self-interest, HIV infections entail a preventable expense."
Indeed, beyond Entombeni's walls, you get the fearful sense that the AIDS crisis is spinning out of control. South Africa still relies on migrant labor in mining and agriculture, and that unfortunate holdover from the apartheid era fuels the AIDS onslaught. Experts estimate that 40% of migrant farm workers in high-risk regions such as KwaZulu-Natal province, along the Indian Ocean coast, are HIV-infected; at some mines, the figure goes to 60%.
INFECTED WITH FEAR. It's turning South Africa into a paranoiac society. There was a platinum mine near Johannesburg where men living 15 to a room would shun any worker who started to shed pounds or cough. "Those guys would just disappear, even if they didn't have AIDS," says Ernest Maifo, who worked at the mine until it closed earlier this year. "They were afraid of what might happen to them if they stayed." With good reason: Two years ago in KwaZulu-Natal, the nation's most devastated province, with a 33% infection rate, a 36-year-old AIDS activist was fatally beaten after disclosing--at an AIDS awareness meeting, no less--that she was HIV-positive. Gugu Dlamini was a volunteer field worker trying to help others. She was also the mother of a 13-year-old girl.
New studies in KwaZulu-Natal indicate that half of prostitutes and 56% of the truckers who use them have HIV. Gita Ramjee, a scientist at the Medical Research Council in Durban, which is partially funded by the government and which conducted these studies, says prostitutes report that many of their older clients aren't returning--the suspicion being that they're dying of AIDS. So the prostitutes are moving to Johannesburg, taking the deadly virus with them, and spreading the AIDS tragedy yet further.
There's no shortage of miserable numbers. AIDS will cut gross domestic product by up to four-tenths of a percent yearly from now to 2015, one report says. Employee-benefit costs will double over five years, says another, and triple in a decade. But because labor laws bar companies from testing employees, many businesses don't know the extent of the deepening crisis. It's easier to gauge at small enterprises, such as the KwikSpar supermarket in Umlazi township near Durban. Owner Pearl Goqo, who employs 24 workers, says AIDS has killed four since 1996.
At Tongaat-Hulett Group, a diversified company that cultivates cane in the hills of KwaZulu-Natal, condoms are made available to all 25,000 workers--in rest rooms, factory clinics, and elsewhere. The company also provides counseling on everything from sexual habits to nutrition to coping with illness. But company officials are still left to wonder what they're really in for. "You don't see HIV until it becomes AIDS," says Rick Hawkes, a physician and a medical consultant at Tongaat-Hulett. "We know that on weekends, people are going to more funerals. They used to collect flowers to take. Now they don't--there are too many funerals."
Some big companies, such as mining giant Anglo American PLC, have launched AIDS awareness campaigns and opened clinics that are better than the provincial hospitals. Some, too, are taking steps to protect themselves by cross-training workers in case AIDS devastates one job category more than another. Elsewhere, you find companies hiring more employees than they need --on the assumption that some are going to die in coming years.
BACKS TURNED. But more than a few businesses simply refuse to acknowledge that they have an AIDS problem--which encourages secrecy and isolation among employees. And almost nothing is being done, anywhere, to combat the virus itself. "It's a combination of denial, ignorance, and a sense of impotence," says Wayne Myslik, head of consulting at Lifeworks, a health-care provider in Johannesburg.
At the AIDS conference in Durban, Judge Cameron raised another of the AIDS holocaust's stark realities. White, financially secure, and HIV-positive for 15 years, Cameron is the nation's most prominent AIDS activist--and lives on the safe side of the chasm between sufferers who can afford better health care and the vast mass of others. "My presence here embodies the injustices of AIDS in Africa," he told those gathered from around the world. "On a continent in which 290 million Africans survive on less than one U.S. dollar a day, I can afford medication costs of about $400 per month."
It can be said that AIDS picked up where apartheid left off: It's the poor black majority who suffer most--and the young. Virtually the only people getting company help to pay for anti-AIDS drug therapies are higher skilled and educated white-collar workers, who tend to be white males here. The U.N. predicts that half of today's 15-year-old South Africans will die of AIDS.
At Entombeni, time ran out long before that for Lungelo, an 18-month-old boy, "poz" at birth. He died the week of the Durban AIDS conference. Lungelo's death haunts me: He was the same age as my daughter. Now he makes me think of those many-paneled tapestries that line the orphanage walls: "Akona, born June 16, 1998, died Mar. 3, 1999. Maria, born Nov. 13, 1997, died Sept. 4, 1998." I imagine Lungelo's name is on one, too.