In South Africa where AIDS each year kills 350,000, mostly poor people, many South Africans remain uninformed about the disease and how it might affect their lives. But this year the AIDS death of her children's minder has transformed a young suburban mother into an outspoken treatment activist. Delia Robertson reports from Johannesburg.
Last Christmas Teri Welsh was happily holidaying in Mauritius with her husband Craig, two children, and Pumla, their friend and child minder to 9-year-old Jay, and 2-year-old Kiera.
Within 10 weeks Pumla was ill, and a week after that was admitted to hospital and diagnosed with tuberculosis; eight weeks later, on May 18, an emaciated shadow of her voluptuous Christmas-holiday figure, Pumla died of AIDS-complications.
Teri Welsh is a 32-two-year-old businesswoman, and an attractive brunette who says she is a little vain. She and Pumla loved pretty clothes and driving together singing the songs of popular musician Mandoza.
AIDS was something she warned her son Jay about, urging him to be careful later when, in her words, "he would become a 16-year-old whose behavior would be governed by his hormones."
But she says, her knowledge of the disease was limited.
"I didn't really know anything about it, I knew that it couldn't be cured," she said " and I knew that it was a bad thing to get, but I really didn't know much about it, at all. I didn't realize the extent of the problem, I knew there was a problem but I had no idea on what level the problem existed."
When Pumla was diagnosed, Welsh was overcome with grief for her friend, but she says, certain that help was close at hand.
"I was expecting her to breeze into any old government clinic, be handed a couple of bottles of ARVs [anti-retroviral drugs]; I wasn't really sure what the ARVs were going to do, I pretty much reckoned they would keep her alive; but yes, that is what I expected. I expected - so you are positive, its really bad news, but there is treatment and we will all carry on, it is going to be fine," she said.
But Welsh says Pumla was was not convinced.
"But the day that they gave her results she just became very, very quiet - almost as if she knew something that I did not know, she knew that there was no help," she recalled. "And the day that she was given the news, she was given a death sentence, and she didn't even flinch - it was almost as if she might have just as well have died on that day. I was the one who was saying, no, no there is treatment, there are things we can do. And she was looking at me, she just seemed to know more than I did, that it wasn't going to happen."
South Africa has the second-highest incidence of HIV, the virus that causes AIDS, in the world. The South African Actuarial Society says 11 percent of the population, or nearly 4.5 million people are infected.
The Actuarial Society reports that in June 230,000 people were receiving anti-retroviral drugs but that another 540,000 who needed the drugs were not getting them.
The government, in particular Health Minister Manto Tshabala-Msimang, has been severely criticised for slow implementation and even undermining its own plan to treat AIDs patients with anti-retroviral drugs.
Anti-retroviral drugs do not cure AIDS but do reduce the HIV levels in the system, patients become stronger and healthier and can live indefinitely.
Welsh says that there had been so much publicity in the media about AIDS and treatment, that she could not grasp why Pumla was not immediately admitted to a treatment program.
"Originally I wasn't sure if there was a miscommunication between her and the clinic. And so I kept saying to her, go back and get the stuff," she said.
"And eventually, she said, 'You don't understand, I can't get it, they have put me on a five month waiting list'; and I said to her, your CD4 count is 13, you can't be on a waiting list. And she said, 'I know, but they have sent me away to die'. And she almost accepted that they had sent her away to die. And I couldn't accept that," she added.
The CD4 count reflects the number of T-cells which fight infection in the blood. A normal CD4 count is between five and 15,00 per milliliter of blood. AIDS treatment professionals say that a patient whose CD4 count is below 200 is fully sick with AIDS and should be treated with anti-retroviral drugs.
By the time the friends learned of Pumla's dangerously low CD4 count of 13, they had exhausted all the avenues they knew to find treatment. Pumla seemed resigned but Welsh clung to hope until Pumla was rushed back to hospital on May 15.
When Welsh saw her the next day, she barely recognized the emaciated, whispering figure in the bed. That same day, Welsh learned for the first time that Pumla had been pregnant and had miscarried the day before, something that may have explained her rapid decline.
"And her baby girl was six months gestation, and was still born, so obviously had to do with the fact that she was pregnant that I didn't know," explained Welsh, "and that the baby was essentially taking the nutrients that her body needed to keep her alive, and as the baby got bigger and was taking more from the mommy, the mommy started getting weaker and weaker and weaker and ultimately neither of them survived.
Her friend's death has transformed Welsh into a vocal AIDS treatment activist, armed with new knowledge and consumed with finding treatment for people who need it. And she needs to find a lot, because not only has she since learned that two more employees are sick with AIDS; but she is now inundated with calls from strangers to help them too.
Welsh asks these people to get the information she needs to help.
"I want you to get a viral load from them and a get CD4 count; and if she is coughing have them to do a sputum test for TB. And then you let me know what the results are, and here is my cell phone number and you phone me with those, and I will try and help you," she said.
Welsh now has a string of contacts from hospitals to clinics to the organization providing treatment under President George Bush's PEPFAR program, and she does whatever it takes to persuade them to include people in their treatment programs.
"But I am not going to surrender, I am not going to . . . if your number is on the board, your number is on the board. But I am not going to let her number be written on the board, if I have an eraser I'm going to try and get it off there," she said. "And that is what I am currently doing, I am just trying to get her name off the board. I need to get the drugs. Just give me the drugs."
Welsh describes herself as passionate and cheeky, characteristics that are helping her in her relentless battle to prevent as many deaths from AIDS as one woman can.
