South Africa AIDS Journal
By Benjamin Wikler

Benjamin Wikler is the head and co-founder of the Harvard AIDS Coalition. He traveled to South Africa this August to learn about the global AIDS crisis.

Part 1 | 08.14.01 | Blissful Ignorance

CAPE TOWN — My life has been spent in places of plenty. Everyone I've ever been close to has used a computer, placed a telephone call, and ridden an airplane. But tomorrow, I'll visit a town where none of those facts can be assumed.

I'm visiting South Africa to further my work as an AIDS activist. For the past eight months, I've been consumed by my task — writing letters to Congress to request increased foreign aid for AIDS programs in Africa, writing editorials for campus newspapers and holding fundraisers.

I have researched AIDS prevention, AIDS treatment, AIDS orphans, the economic impact of AIDS, AIDS vaccine development, intellectual property rights and AIDS drug access, AIDS and human rights, AIDS and gender and any related topic you could name. But before this trip I'd never talked to a poor person about his or her experiences with AIDS. I'd never encountered it — or international poverty and disease in general — face-to-face.

These problems, which seem to me to be the most important in the world, have always arrived via well-bound books or conversations in American restaurants. Here in South Africa, which is itself the richest country on the continent, I hope to put a human face on the greatest health crisis since the Black Plague.

The Plague had an estimated death toll of 25 million, somewhere between a quarter and a third of Europe's population. According to UNAIDS, AIDS has killed 22 million people already, and threatens to engulf the rest of the world's 42 million additional people living with HIV.

In South Africa, a quarter of adults are already HIV-positive. Unlike the Western world, the main mode of transmission in developing countries is heterosexual; women make up 45 percent of infections. 80 percent of AIDS cases are in Africa, but South Asia (with its nearly two billion people) and the Caribbean are moving towards an AIDS crisis as serious as Africa's.

Developing countries can hardly afford comprehensive prevention efforts, let alone treatment programs. Thirteen million children have already been orphaned by AIDS. That number will more than triple in the next 10 years, overwhelming social-support systems and extended families even as those who would provide the support are themselves dying. The epidemic is ripping apart societies.

In the South Africa I've seen, however, AIDS is barely visible. The only signs of AIDS I've seen so far are highly designed billboards and slick TV ads for condoms. I've been in Cape Town, known as the San Francisco of Africa for its coastal, laid-back atmosphere and chic populace. In this Southwestern tip of the continent, HIV infection rates are creeping up — but the virus takes years to develop into full-blown AIDS, and the people have not yet begun to die in large numbers.

Apartheid, yesterday's nightmare, dominates every conversation I've had. AIDS, tomorrow's nightmare, is not yet part of Cape Town's consciousness. A friend of a friend told me he didn't know a single HIV-positive person. Is this denial? Ignorance? Suppression? Or am I just in the wrong town?

A doctor in the city of Durban told me that 70 percent of those visiting the hospital for any reason — a cold, a broken bone, birth control pills — are infected with HIV. He works in a well-funded hospital in a cosmopolitan city. Tomorrow, I'll be visiting a school in the middle of nowhere, talking to teachers and the principal about what they do to prevent HIV transmission.