Part 4 of 8. UPI Medical Correspondent Steve Mitchell recently toured rural health facilities and wildlife reserves in South Africa and filed this report.
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PORT ELIZABETH, South Africa (UPI) -- Ten years after the collapse of apartheid in South Africa, AIDS is rampant in the slums -- or townships as they are called locally -- and the situation is likely to grow worse before it improves, those on the front lines told United Press International.
Although precise figures are difficult to come by, due to the overcrowded and disorganized conditions in the townships, some estimates put the prevalence of the disease at 20 percent in these squalid areas, said Mzwandile Sokapase, director of an AIDS education initiative supported by the Ubuntu Educational Fund in Port Elizabeth.
This would be about the national average, but the actual level is probably much higher, Sokapase said.
"There's a lot more than that," he commented. "That's just a drop of water in a big ocean."
Jordan Levy, a U.S. resident who worked for Ubuntu's office in Hoboken, N.J., before coming to the Port Elizabeth office three months ago, told UPI, "It could be 30 percent, it could be 40 percent, we really don't know."
Many township residents have tuberculosis and other conditions indicative of weakened immune systems that probably due are to advanced AIDS and these cases are not included in official statistics, Levy said.
"It's, unfortunately, growing," he added. "It's a sad situation in a lot of ways."
Although Ubuntu is making some progress in the Port Elizabeth slums through educational and awareness programs, in other townships scattered on the outskirts of cities all over South Africa, most residents do not have access to health education or other efforts like Ubuntu, so the AIDS situation may be even worse than in Port Elizabeth, Levy said.
The townships, which are squalid areas of hundreds of shacks crammed side by side, were first formed under the apartheid system of government, when black people were not allowed to live in the cities, were denied jobs and were segregated from the ruling white minority.
Though there have been improvements in the townships since apartheid collapsed in 1994, conditions still are deplorable, with unemployment rates approaching 90 percent and most children in these areas receiving less than one meal per day.
This reporter recently visited a shack in a Port Elizabeth township. The occupants said 10 people lived in the ramshackle house, which consisted of a small room that served as a kitchen, a bedroom large enough for only one queen size mattress and a living room. There was no running water or electricity, and another family was living in a smaller shack in the backyard.
The lack of sanitation in the townships is apparent. Two children were observed digging through trash from an overflowing dumpster in the Port Elizabeth slums.
The South African government has started building new homes complete with running water and electricity and plans to build 26,000 new units this year in the Port Elizabeth townships alone, but that may only make a small dent in the overall situation.
There are hundreds of thousands of people living in some townships and in Soweto, South Africa's largest township, which covers about 58 square miles just outside of Johannesburg, there are anywhere from 2 million to 4 million people living there.
The AIDS problem in the townships could spill over into the cities if it is not brought under control, health officials said. Many township residents commute into the cities to work, and the youth and young adults, the age group with the highest rate of AIDS in South Africa, are by and large not practicing safe sex.
Simnikiwe Malusi, a 21-year-old student at the University of Port Elizabeth, told UPI that most young adults her age are not concerned about contracting AIDS and frequently engage in unprotected sex.
"Everybody knows about AIDS and the risks, but nobody cares," said Malusi, or Simi, as her friends call her.
Some young women will avoid men they consider to be high-risk, but she also knows of women who knowingly have had unprotected sex with men that were rumored to be infected with AIDS or known to have had many sex partners.
The largest-ever survey of South African youth released this week supports Malusi's views. Conducted by the University of the Witwatersrand, the survey of young people ages 15 to 24 found although 94 percent were familiar with safe sex practices, many still persisted in risky sexual behavior because they did not think they were personally at risk of contracting the disease.
The rate of AIDS in this age group was 10 percent overall, but in women, between ages 20 and 24, it shot up to 25 percent, and in men of the same age range it was 7 percent, suggesting women are most at risk of contracting the disease.
Levy said tackling the AIDS problem in the townships is "a monstrous challenge." He thinks, given the magnitude of the problem and the limited resources, the only way to attack it is with education and programs such as the ones offered by Ubuntu.
The University of Port Elizabeth currently is evaluating Ubuntu's AIDS education programs to see how they affect behavior. If the programs are effective, they could serve as a model for launching similar programs in other townships, Levy said.
Sokapase said Ubuntu already is seeing an impact from its programs. When the organization opened the doors at its present location in 2002, community use of condoms -- offered by the center to the community for free -- was minimal. Only a few condoms per month were distributed. Now, in less than two years, that number has jumped up to 70,000-80,000 condoms per month, Sokapase said.
"There's been a change of perception," he added.
This type of impact only prevents infection, however, and does nothing to help the more than 4 million people nationwide already infected and suffering from the disease.
The government promised to roll out a free AIDS medication plan, but Sokapase said the drugs have not yet become available in the Port Elizabeth townships.
"They keep talking of rolling it out, but I have not seen it rolling here," he said. "It's just in the politician's mouth at the moment."
Some have complained the free AIDS drugs plan is merely a political ploy to garner votes by the majority party the African National Congress because it was announced two weeks before elections, which are scheduled to be held April 14.
Vuyo Toto, the ANC's regional secretary in Port Elizabeth, recently told a group of reporters: "We're doing everything to make sure people can access these drugs. We're quite concerned about it."
Toto said AIDS "is a problem that is well-managed," and added that rates of infection are going down due to some of ANC's efforts.
This differs from the results of the University of the Witwatersrand survey, which suggest rates among youth and young adults may be stabilizing, but not diminishing.
Meanwhile, Sokapase and Levy brim with undaunted hope their efforts are making a difference and eventually will conquer the problem, despite the dour circumstances.
"It could be overcome," Sokapase said. "Absolutely."
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This story originally was published on April 9. E-mail [email protected]
