From two people to over four million in 21 years

Twenty years ago, the Nationalist government refused to give R20000 to activists who wanted to run Aids education programmes in the gay community.

Their attitude was that homosexuality was illegal, says Dr Dennis Sifris, one of the country's pioneering Aids doctors.

But, he rages on, that was the bad old apartheid government and we expected it from them. Now, with freedom and democracy, we did not expect a government that questions the existence of HIV and tells us that antiretroviral drugs are poisonous.

Sifris was one of the first doctors contacted by immunologist Dr Reuben Sher early in 1983 after an eye-opening trip to the US where he had met pioneering Aids virologists.

At that stage, two South African were known to have died of Aids. Both were young white male cabin attendants for South African Airways who travelled frequently to the US and Europe.

I was looking for something to specialise in and here was this new disease that involved a virus and immunity, both of my interests, says Sher, who was working for the SA Institute for Medical Research (SAIMR).

When he returned to South Africa, Sher contacted Sifris, who had a big gay practice.

I called my patients and spoke to them about Aids, says Sifris. Everyone knew there was 'something' but no one knew what it was. About 200 patients agreed to come in and be tested.

Throughout 1983, Sifris and Sher took the men's histories and blood samples. Because there was no antibody test, we kept the blood samples locked up in a freezer. When the HIV test became available in 1985, we went back and tested the samples and found that 11% to 12% were already HIV-positive, says Sher.

The two doctors approached Johannesburg Hospital in 1986 and were given permission to start an Aids clinic. They saw most of the early Aids cases in the city.

I saw many SAA cabin attendants who had been infected overseas. We saw some haemophiliacs who had been infected by blood transfusions, but the sexually transmitted cases all involved white homosexuals until 1987, when the first two black South Africans were diagnosed, says Sher.

We were faced with young men whose parents didn't even know they were gay. Now they were being called to see their sons dying of Aids in hospitals. I learnt a lot from them about not being judgmental.

It was very difficult dealing with young people who were dying and we could offer them nothing more than empathy.

Around 1987, the drug AZT - initially a cancer treatment - was found effective in treating people with HIV. But, says Sher, the government was not interested, as they felt their money could be better spent on other things.

Sifris remembers how Johannesburg Hospital's administration decided to give AZT to blameless haemophiliacs but not to people who acquired HIV sexually, the implication being that it was their fault that they were infected.

Between 1986 and 1987, Sher was involved in a major study with the Chamber of Mines in which about 30000 mineworkers were tested for HIV.

Malawian miners were the only group where there was significant HIV infection. About 3.76% were HIV-positive, said Sher. The Chamber of Mines wanted to pre-test Malawian mineworkers before recruiting them but the Malawian government refused. So in 1988 the chamber stopped recruiting from Malawi, says Sher.

The SAIMR became the Nationalist government's think-tank on HIV/Aids, with Sher and SAIMR director Jack Metz forming an Aids Advisory Group together with health officials.

There was a lot of prejudice. First Aids was seen as a gay disease, then a black disease. One got the feeling that the [apartheid] government didn't really go out of their way, says Sher.

He says there were a lot of ethical problems in the early days, involving doctors breaking patient confidentiality, mainly because doctors were scared of being infected. As one of the few people dealing with Aids, I ran around all over the place giving talks about how it was transmitted.

But after 1994, Sher believes that the white doctors involved in Aids were shunned by the new black government.

I can understand government 20 years ago being reluctant about AZT because one could say then that it was an experimental drug, says Sifris.

But the shame and the disgrace of this Aids Day is the shilly-shallying the present government has shown towards antiretroviral drugs.

Why isn't anyone in government telling people that the drugs work? Why isn't the [drug] roll-out working? No one should die of Aids today.

Aids stalwart Dr Clive Evian was a young doctor in rural Gazankulu when he first read about the gay disease.

I didn't pay too much attention. We were too busy battling with primary healthcare issues, he recalls.

It was several years later, in 1989, that he encountered the human face of the disease. He was approached by the Johannesburg Health Department to manage the city's response to the disease in his final year as a registrar.

Reuben Sher was almost the only person who knew anything about it at the time. It was quite scary, says Evian, who helped to establish the HIV clinic at Johannesburg Hospital shortly after his appointment. Thousands have since passed through the clinic's doors.

It was basically a gay men's clinic at the time. That room was a safe place for so many people - a place where they could talk about their fears and the huge stigma they faced.

I have had so many deep and enriching relationships with patients there that I still work there on certain days, seeing my patients, some who have been with me for 12, 13 years, says Evian.

He read more and became aware of epidemics in Uganda and Zimbabwe.I realised it was moving south and that pretty soon we would be in trouble. We were on a time bomb, but amid the political turmoil it was impossible to get anyone to listen or to get it onto any political agenda.

Evian now highlights two issues that are hampering efforts to stem the tide - an absence of political commitment from the President's office and a country he accuses of being completely oblivious to safe sex practices.

We need Thabo Mbeki to show the same urgency and commitment he shows towards handling conflict in the Ivory Coast, says Evian.

Dr Des Martin saw his first patient in 1987, although he does not remember the specific patient.

Anonymous testing among the heterosexual population showed zero or very low prevalence, he says.

Martin, who has been instrumental in establishing the South African HIV Clinicians' Society, left his general practice to study tropical medicine at Wits in 1986, three years after the virus was isolated for the first time.

We spoke among one another about this interesting disease and I remember doctors commenting: 'Oh, in a couple of years they will have found a vaccine', he remarks wryly.

In the early 1990s a complete reversal started taking place and we saw more and more heterosexual people.

Now the disease has become a chronic but manageable disease. This keeps me going and the excitement that around the corner a vaccine will come. Not in my lifetime, but it has to come. ( Source: Health-e , Sunday Times, 28 November 2004)