SOUTH AFRICA: AIDS versus economic wealth in the East

SOUTH AFRICA:
AIDS versus economic wealth in the East

by Dominique THIBAULT

Rising from its ashes after apartheid, South Africa is bearing the standard of revival on all socio-economic fronts, but is still helpless before the AIDS virus - a new and formidable adversary that is gaining ground.

Paradoxically, the virus is proliferating there where the economic heart of the East beats: Durban, the country's third-largest city, with its flourishing port industry.

Here is a report from Kwazulu-Natal, land of contrasts and legends...

Durban is the closest coastal city to Johannesburg, 557 kilometres away. Landing there at night is spectacular: its vast bay, which harbours the largest port in Africa (and ninth-largest in the world), sparkles with a thousand lights. Dozens of sodium streetlights illuminate the imposing silhouettes of cranes that tower above the port facilities with a view over the string of cargo and container vessels ready to ship out. Getting off the plane is another surprise. Just barely attenuated by a sea breeze blowing in off the Indian Ocean, a damp heat envelops travellers as soon as they arrive. This natural harbour, protected by two sandy points (the "Bluff" to the South, the "Point" to the North), was discovered by Portuguese discoverer Vasco da Gama in 1495 on his way to India. He called it the "Bay of Natal", and the name soon was extended to the entire region. In 1835, the port city was named after d'Urban, the governor of Cape Town. From the nineteenth century on, Durban developed remarkably fast, thanks to the sugar commerce that attracted a growing stream of immigrants from India. Indian immigrants now represent 20% of Durban's total population; the rest is of Zulu (60%) and European (20%) descent. In just 150 years, this large cosmopolitan city of 3 million inhabitants has managed to become the leading port in Southern Africa. Criss-crossed like an American city by skyscrapers and office buildings (Miami-style) Natal's leading city has become a highly popular seaside resort over the years, due to the ideal year-round temperatures there (an average 25°C) and the Golden Mile, its exceptional seafront. Protected from sharks by a barrier, it is a veritable Zulu paradise for swimmers and surfers. It is also a favourite holiday location for an upscale business clientele mainly from Johannesburg, which comes to recharge their batteries between meetings in Durban's luxury hotels like the Beverly Hills, a highly sophisticated five-star hotel with peerless views out over the sea. Durban is also the second most popular place for tourists to meet (after the Gauteng region) en route to the huge nature reserves in the northern part of KwaZulu-Natal, including one of the "jewels", the Phinda Private Game Reserve in lush Maputaland near the Mozambique border. "The specific thing about this 17,500-hectare park is that to our international clients who are interested in safaris all in one place, we can propose a number of different accommodation lodges in natural environment (five sites, in forest, savannah, or riverside environments) and let them explore a splendidly preserved ecosystem with both land and aquatic flora and fauna and the possibility to get close to the South African cheetahs, as well as the authentic traditional Zulu culture," says Lynne du Toit, Director of the Safari Company based near Durban.

A dynamic, diversified port industry

Durban is well located along the maritime routes that skirt Africa to the south and is a hub for connections with the Indian Ocean. It is also served by large railway and motorway networks. It serves as the portal for much of the national economy and is a relay between the Witwatersrand mining region around Johannesburg, along with its inland region, and the industries around Pietermarizburg (mainly aluminium); coal mines in the interior, and the agricultural production on Natal's sugarcane, fruit and timber plantations. It brings in 8.76% of national income and provides 11% of the country's jobs. From the sixteenth to the mid-nineteenth century, the site served as a commercial stop along the maritime routes connecting Europe to Asia, and from 1860 to 1910, its urban development got under way. The port was used to import manufactured goods into the country, and industrial activities for domestic consumption developed, such as the food industry in connection with regional agricultural production and wood and chemical industries. Durban also serves as a "routing hub" for merchandise, where goods coming from Asia and North America are transferred to smaller boats headed for East Africa, Madagascar, Mauritius or Australia.

The port's main resource is its multi-functionality and the great diversity of its traffic. It handles 46 million metric tons per year and manages more than 6,000 direct jobs. Cargo imported through Durban accounts for 63% of the freight handled in the country; cargo exported from there accounts for 13%. Containerization activities at the port represent nine million metric tons per year, or 66% of all South African container traffic, making Durban the world's 30th largest container handler. The container terminal is one of the port's infrastructural pride and joys, handling an average 45,000 containers per day. The port itself has two floater cranes, 15.2 kilometres of quays, and extra-high storage capacity that includes a 28,000-ton silo for sunflower seeds, a 38,000-ton grain silo and 520,000-ton sugar terminal that is one of the world's most modern ones.

Brakes on its development

Greater Durban spreads out more than 50 kilometres from east to west and 70 from north to south (from Tongaat to Kingsburgh). The city is highly contrasted socio-spatially, with a tangle of slums and non-urbanized areas on one side, and areas of low-rise housing on the other. This weighs heavily on the daily life of city-dwellers and on urban-management issues like safety management, expanding health facilities, providing housing for slum-
dwellers, and creating a sustainable and integrated urban environment while keeping infrastructures from deteriorating. Another dilemma, despite the genuine economic vitality, is that this changing metropolis doesn't provide enough jobs for the ever-increasing population. Only a third of the labour force has jobs in the formal sector. Estimates on the number of people living on small jobs (as their main source of revenue or in addition to more stable wages) range from 180,000 to 300,000. In the informal sector, 52% are working for themselves and 48% are employees. These jobs are mainly non-declared domestic jobs, jobs in small firms paid on a daily basis, cash-and-carry selling (beverages, food) or cottage-industry activities such as sewing or repair work.

Tourism as a remedy to the rural exodus

From Durban all the way up to the Mozambique border, a profusion of coves and fine-sanded beaches line the eastern coastline, in high contrast to the jagged ridges along the southern and western capes and bays. The Drakensberg mountain range looms majestically in the distance. As you enter Zulu country, the lush green hills give way to thick forests and then thinner ones, and the neat little urban homes on the coast give way to scattered huts and isolated villages where meagre flocks of goats or cattle try to survive on the sparse vegetation. To compensate for the rural exodus, the government is putting its hopes on the tourist industry, the new key to growth. "Tourism offers a number of different ways to take action, to move past the apartheid legacy." Each year, it brings 71 billion rand* into the economy (including 21 million rand from business tourism) and provides 260,000 jobs for about six million rands in salaries. "It has been identified as a priority economic sector, in particular business tourism, which we are developing through international-class events like the "Salon Meetings Africa" that foster exchange and partnerships between specifiers both in the interior and internationally, to develop exports," continues Kate Rivette-Carnac, Director of Tourism for South Africa's Department of Industry and Research, whom we met at the Salon Meetings Africa 2006 organized by Thebe Exhibition & Events. For its second international meet, the salon meeting gathered 150 exhibitors and 2,500 visitors together. But all these efforts are being hindered by a huge obstacle: one out of every nine people is now infected with the AIDS virus. This alarming pandemic is made worse by the lack of health facilities and a lucid health strategy for combating and checking it.

*1 rand = 0.14 euro

South Africa's health sector blacklisted: urgent need to eradicate the raging AIDS pandemic

According to the United States, South Africa is the world's most AIDS-infected country. Nearly 20% of South Africans are HIV-positive, with nearly 1,700 new cases per day on average. Apparently, about 65% of the population from 15 to 19 years of age are infected, and one out of every two teenagers will not live beyond the age of thirty. A few years ago, we might have thought that the epidemic growth of the disease would level off. Unfortunately, this is not the case in South Africa, where nearly 24.5% of women seeking prenatal care in 2001 were infected with AIDS. UNAIDS is predicting that 70 million people in the 45 most affected countries could die over the next twenty years.

Jenny, a fifty-year-old nurse at Saint Augustine Hospital in Kwazulu-Natal, explains that "without political mobilization and permanent information campaigns everywhere in the country to raise the awareness of tribal chiefs on the need to use condoms and to change traditional mentalities, it is very difficult for women, who are often raped, to protect themselves from the virus. Most of the population have to pay for their own treatment, which often lasts a long time and is physically exhausting. The weakened patients are not capable of holding a permanent job, especially since they are treated like pariahs. The medicines sent by the NGOs arrive regularly by truck in isolated health clinics (one for every six villages.) People come to them on foot, travelling from 3 to 15 kilometres.") By 2010, the average life expectancy in South Africa will have decreased by 17 years. In many cases, the family is scattered when the parents die, the children sent to family members to be taken in charge. The loss of income, the expensive health care, and funeral costs plunge families even deeper into poverty. One of the most visible effects of the epidemic is the drop in school registration, and teachers have been considerably hit by AIDS deaths (increasing by 40% from 2000 to 2001). The direct medical costs of AIDS (not including retroviral treatments) are at least $30 per year and per inhabitant in countries where global health expenses are $10/year/inhabitant or less. (In the European Union, these costs are from $3,500 to $50,000, depending on the stage of the disease.) Pressure on the health system is increasing considerably, and especially on hospitals. As the demand increases, health workers, already understaffed and underqualified, are also succumbing to AIDS. High levels of absenteeism and death in the working population from 18 to 40 years of age are causing more and more labour disorganization, leading to a drop in productivity in companies and slowing down the economic activity. But not for everyone, however …

The pharmaceutical multinationals: an outrage

There are 10,935 pharmacists in South Africa (compared to 64,500 in France), for about 2,500 private pharmacies (source: IMS Health), 409 wholesale pharmacies and 500 hospital pharmacies. Fifty percent of the industry's sales go through the private pharmacies, which constitute one of the world's most expensive and profitable distribution channels.

In 1999, the ten largest pharmaceutical companies combined profits of 1,150 billion francs, according to Fortune magazine. This sector is the most profitable of all (legal) economic sectors. Its profits climb 16-18% each year, or three times faster than the average company. In 1998, the pharmaceutical industry spent $10.8 billion, or 475 billion francs, in advertising. In 1997, 3.3 billion francs were spent on lobbying. "In '99, North America, Europe and Japan, which represent 19.3% of the world's population, consumed 82.6% of the world's medicines. Africa and Asia, or 72.3% of the world's population, had to make do with 10.6%. And in the coming years, that gap is going to increase," accused VUB researcher Els Torreele back in 2001 at a Health and Globalization Conference organized by Medicine for the People in protest against the lawsuit filed by 39 of the largest multinational pharmaceutical companies, including Boehringer Ingelheim, Bristol-Myers Squibb, Glaxo Wellcome, Merck, and Roche, against the South African law passed in late 1997, which authorized the import of low-cost generic medicines and set up a price-control mechanism. The law aims to make medicines available to as many people as possible in the country the hardest hit by AIDS, but hasn't yet been implemented: that step was blocked in February 1998 as a result of pressure from the pharmaceutical companies. For information, one of the generic medicines used, Diflucan, is sold in Thailand for 2 rand ($0.25) per capsule, while in South African pharmacies it is sells for 120 rand ($15) per capsule.

The beginnings of change

According to the NGOs, 400,000 people have died in South Africa since the Pharmaceutical Manufacturers' Association (PMA) blocked the law - 85% of patients apparently not receiving the treatment they were entitled to. "The South African government could have saved 75,000 lives in 2005 if its anti-retroviral drug program had been set up as planned," said Cape Town University researcher Nicoli Natrassi at the AIDS 2006 - XVI International AIDS Conference that was held in Toronto, Canada at the end of August 2006. According to her, the Health Ministry's plan provided for the treatment of 453,650 people in the public health sector last March, but only 141,000 received the treatment (source: Mail & Guardian). There have been many protests, to no avail. The situation could change, however, at the instigation of the United States. "Out of all the African countries that I have been to in the past five years, I've never come across one where the government is as stubborn, amateurish and negligent about treatment as South Africa", snapped Stephen Lewis, the UN Envoy to Africa for AIDS, at the August 25th closing ceremony for the Toronto AIDS conference. Since his lapidary speech, the South African government has issued an irritated reply indicating that contraception is an integral part of the government's "ABC" program (abstinence, being faithful to one's partner, and using condoms). The objective for 2005-2006 is to distribute 3 million condoms compared to 2.6 million in 2004-2005. On the industrial side, South African researchers are looking into how gold could be introduced into medicine for AIDS, malaria and cancer. The South African mining research organization Mintek is working with the three largest gold-mining industries in the country (AngloGold Ashanti, Goldfields and Harmony) to lead research along these lines. At the Toronto conference, South African researcher Jita Ramjee announced that a new bactericide in gel form would be available by the end of 2007. This form of prevention will be an effective weapon against infection for women whose male partners refuse to use condoms. In South Africa, where women between the ages of 15 and 24 are four times as likely to be contaminated as men in the same age range, the gel will add to the range of preventive means. And in 2006, perhaps - aided by the government's program and the support of the international community - South Africa will be able to halt the process and gradually restore job security. The improvement in the economic situation during the last quarter of 2006, with 4.2% growth in the building, transport and service industries, is reason enough for hope!