In his 2003 State of the Union address, Bush announced an unprecedented $15 billion emergency plan for AIDS relief that targets two Caribbean and 12 African nations, including the hardest-hit countries of Botswana, Namibia and South Africa. However, funding for the initiative, authorized with discretionary funds and signed into law by the president last May, spreads the money out over five years and must be approved by Congress each year. Critics also contend that the initiative, which circumvents the delivery structures already in place, relies on slow-paced U.S. agencies mired in administrative overhead and conservative approaches to AIDS interventions.

Today, only $2.4 billion of the original $15 billon pledge has been appropriated by Congress for emergency AIDS services -even though the original measure called for $3 billion in its first year - and has not been distributed to the countries yet. By contrast, the war in Iraq is bankrolled at $4 billion per month.

Mtshali is hoping that when the elusive funds finally show up, the intervention strategy moves beyond the A-B-C plan endorsed by Bush, and is fine-tuned to confront African realities. A for abstinence is the primary message under the plan. But, says Mtshali, when you're raped at 13 or paid for in marriage, abstinence for young girls is not an option. The B is for "be" faithful to one partner, but social custom encourages men to take more than one partner, and myths - such as the belief that sex with a virgin cures HIV -is rampant. The C - for condom use - means little for women in Mandeni, or much of Southern Africa, because wearing a condom can't be negotiated with men, as CeIe can attest.

"We have to be concerned about these issues," says Mtshali. "Any program or funding must be inclusive to save lives."

A POISONED PAST

In South Africa, needs are as complex as solutions. Apartheid poisoned this place, says Mathebula. Researchers said HIV showed up in South Africa more than 20 years ago. It was mostly present among Black mine workers outside of Johannesburg.

Indeed, researchers have long suggested that South Africa's migrant labor system, in which Black male workers live in remote hostels and boarder towns miles away from their wives and families, fueled the public health catastrophe by spawning the explosive rise of brothels staffed by poor African women desperate for food and income.

By the early 1990s, mining camps, squatter towns and industrial zones were the national hubs of South Africa's AIDS crisis. They became breeding grounds for rampant, untreated sexually transmitted diseases and teeming harbors for HIV, which male workers carried back to wives and lovers during home visits.

In January 2001, the U.S. Agency for International Development reported on Carletonville, a gold mining area near Johannesburg, where 60 percent of 88,000 miners had come from other parts of South Africa or from the neighboring countries of Lesotho, Malawi and Mozambique. One out of five miners were found to be HIV positive, as were three-fourths of the 400 to 500 sex workers who serviced the miners.

It should come as no surprise that the nine African nations with the highest HIV infection rates are those with the largest mining industries: Botswana, Swaziland, Zimbabwe, Lesotho, Zambia, Namibia, Democratic Republic of Congo, Malawi and South Africa.

When he took office in 1994 as the nation's first Black president, Nelson Mandela inherited a raging public health crisis both fueled and ignored by the White apartheid regime. Today, as South Africa, the world's leading miner of gold and platinum and a major producer of coal and base metals, grapples with an alarmingly high number of people infected with HIV, the historic flashpoint of the epidemic is all but forgotten.

But in Mandeni, a young industrial town established in 1971 out of the infectious cauldron of apartheid, poverty and migratory labor, the social and political origin of the epidemic remains a daily reality.

A PRESCIPTION FOR HOPE

If dealing with the continuing fallout from apartheid isn't bad enough, politics and racism color the availability and distribution of anti-retroviral (ARV) medicine, a regimen of drugs that improves health outcomes for people living with HIV.

South Africa's long-awaited roll out of free anti-retroviral drugs under a new governmental program announced in September is still in the planning stages. The publicly funded program, which aims to serve 50,000 patients in its first year, is ultimately designed to save nearly 2 million lives.

But activists say that for years, access to needed drugs was hampered as president Thabo Mbeki and other key South African leaders challenged the Western scientific view that HIV causes AIDS, subscribing instead to the conviction that AIDS in Africa is largely the consequence of poverty.

Access was also road-blocked by big drug companies in the United States and Europe, that refused to release their grip on drug patents - their "intellectual property rights" - which disallowed the manufacturing or production of cheaper generic versions of their drugs.

Some pharmaceutical researchers and company executives have also speculated that African patients would not be able to adhere to dosage regimens according to Western-based guidelines and that lack of compliance would potentially create mutant strains of HIV resistant to treatment. But at the 2002 International AIDS Conference in Barcelona, researchers from Doctors Without Borders presented contradicting data from pilot projects conducted in seven African nations, including Kenya, Malawi, Cameroon and South Africa. The researchers showed that after six months of taking the drugs, 95 percent of patients were taking their treatment properly.

Last October, it was announced that former President Clinton brokered a deal with four pharmaceutical companies - Aspen Pharmacare, Cipla, Ranbaxy Laboratories and Matrix Laboratories - to cut prices by at least 45 percent for hard-hit 12 Caribbean nations and four African countries, including South Africa. More recently, pharmaceutical giants GlaxoSmithKline and Boehringer Ingelheim have agreed to permit the production and import of lowcost generic versions of their patented AIDS drugs in South Africa, including GlaxoSmithKline's popular AZT and Ingelheim's Nevirapine, the drug used to prevent transmission of the virus from mother to child.

After countless bouts of wrestling and negotiating with drug manufacturers reluctant to release their tight corporate grip on drug patents and profits, the latest figures show the government can purchase a full regimen of ARVs for 36 cents per day.

Blessed Gerard's hospice will be one of the first five health institutions in South Africa to begin rolling out ARVs. The initiative is funded through the South African Catholic Bishops Conference and several private international donors. But many fear that attention to the anli-retroviral campaign will eclipse government efforts to provide clean water and better housing, or halt the spread of tuberculosis - a serious health problem faced even by those who are not HIV-infected.

Still, while HIV activists have hailed the fledgling initiative as a prevention breakthrough, the cash-strapped South African government now fears it doesn't have enough money to get the drugs into a community like Mandeni in a timely manner. It is estimated the medicines will cost $1.3 billion by next year.

Social developers say, however, working to end these issues stands to lift more people into better health, including people living with AIDS, especially women.

HOME ALONE

There are more HIV/AIDS orphans in sub-Saharan Africa than there are people in New York City: 11 million children younger than age 15 have lost at least one parent to AIDS. In South Africa alone, the epidemic has left some 600,000 orphans. The United Nations AIDS program estimates that by next year there will be 1 million children orphaned by AIDS in South Africa. There are no official statistics on the numbers of orphans in Mandeni. But as kinship circles - moms, dads, aunts and uncles - are decimated, many children are left to fend for themselves.

In many cases, girls will have children because they can't afford the $10 some local clinics charge to end a pregnancy. By striking women in their prime childbearing years, ages 17 to 24, the transmission of HIV to children through breastfeeding is more likely. (Once the ARVs are available, if taken during pregnancy, the risk of HIV transmission through breastfeeding is only about 3 percent.) When the babies are born, some are abandoned. If they're lucky, says Lagleder, those who are found can end up at places like Blessed Gerard's children's home, another charitable project of the Brotherhood of Blessed Gerard.

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