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The death of just another AIDS orphan?

Nkosi Johnson Credit: AP Photo/ themba Hadebe

AIDS was first reported 20 years ago last month in the United States Morbidity and Mortality Weekly Report. Since the start of the epidemic, the disease has cost the lives of nearly 22 million adults and children—12-year-old South African AIDS activist Nkosi Johnson being just one of them.

Johnson died last month and during his short and difficult life he did more than most to bring some simple truths to bear on the question of AIDS in South Africa. Sadly, his government seems unable to act on these truths.

Johnson sought to understand it himself and to help others understand it. In 1997, for example, he and his foster mother successfully campaigned to allow HIV-positive children to attend state-funded schools. Their fortitude led to a new policy of non-discrimination against HIV positive school children.

However it was during last year's 13th International AIDS conference in Durban (Nature Med. 6, 843; 2000) that he shot to international fame. Speaking during the opening ceremony of the most important event on the international AIDS calendar, Nkosi wondered why his country shunned HIV-positive people and did so little to help them: “I just wish that the government can start giving AZT to pregnant HIV mothers to help stop the virus being passed on to their babies. Babies are dying very quickly...”

And the government's response? Nothing more than a year of politics, prevarication and a virtually useless report questioning the role of HIV in AIDS (Nature Med. 7, 515; 2001).

Johnson contracted the virus from his mother and was orphaned at an early age by her death. Mother-to-child transmission of HIV gives rise to 70,000 HIV-positive babies every year in South Africa. In 1999, Nature Medicine took Nkosazana Zuma, then Minister of Health, to task for failing to provide anti-HIV drugs to pregnant HIV-positive women (Nature Med. 5, 1; 1999).

It was as clear then as it is today that the third-trimester treatment of HIV positive women with cheap antiviral drugs such as AZT and nevirapine significantly reduces the likelihood that their babies will become infected. Since then, several pharmaceutical companies have offered to supply the drugs for free or at reduced cost. Yet only last month the present Health Minister, Manto Tshabalala-Msimang announced that the government's policy on antiretroviral drug treatment has not changed. Due to their ongoing concerns about the drugs' toxicity and the fact that antiretroviral drugs are not a cure for AIDS, the government has no plans to introduce them wholesale into the public sector. Nor has there been any indication of progress on the launch of an 18-site nevirapine-testing program.

South Africa faces many health-related challenges. But none can be greater than AIDS. According to a report in the South African Medical Journal last month, hospitals in KwaZulu-Natal, the country's most AIDS-ravaged province, are at breaking point. As much as 80% of their beds are taken by AIDS patients.

Tshabalala-Msimang is running out of excuses. She must persuade her government to change its AIDS policies. If she is unwilling or unable to do so, then her position is surely untenable and she should step aside and make room for someone for whom the needless death of Nkosi Johnson is more than just a statistic.

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Ivinson, A. The death of just another AIDS orphan?. Nat Med 7, 755 (2001).

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