I saw something that astounded me when I visited a public hospital in a farming community.
There are empty beds. There are rows of black plastic-covered mattresses. Privacy curtains folded up over rails.
I have never seen a hospital like this before. Patients lay on a bed head-to-head when I last toured one 15 years ago. There is more on the floor. There are mats in the hallways. The patients had sunken cheeks and huge eyes. Hopelessness and suffering were hanging in the air.
The wards were silent, not just because of the recent wave. I asked Morton Zuze, the doctor, where everyone was as my voice bounced off the walls. He knew what I was talking about when I told him that I had last been here in the mid-2000s.
He said there are 200,000 people in this district and 20,000 of them are on ART. There were 20,000 people on treatment for H.I.V.
There was only one sign of H.I.V. that I saw in the capital city of Zambia, which was glossy billboards with the slogan "I'm ending AIDS with..." and some helpful strategy: testing regularly or taking treatment or using drugs to prevent infections.
The last H.I.V. epidemic to batter this region was at the height of my time as a correspondent. There were 28 million people living with the virus in Africa in the early 2000s, and about a third of young adults in the country were affected. More than two million Africans died of AIDS each year.
The price of antiretrovirals was still more than $10,000 per person per year, even though H.I.V. had become a treatable illness in wealthy nations. Absolutely, impossibly, impossible.
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The H.I.V. ward of the Hlabisa Hospital in Nongoma, South Africa, was built in 2001.
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AIDS activist, and Nelson Mandela in 2002.
I reported from villages in Eswatini, where I couldn't find many older people or children. I wrote about the day Nelson Mandela broke a taboo and told South Africans that his son had died of AIDS. I told the story of a woman named Regine Mamba, who was raising 12 children. The Treatment Action Campaign in South Africa was founded by a group of activists who were fighting with their lives to get access to treatment.
The fruits of what they fought for were on display, and a reminder of how much is possible at this moment as another Covid wave makes this epidemic seem endless.
Science, in the form of drugs that quelled the deadly virus, a network of fierce, brave activists, and coordinated international efforts, all combined to deliver the miracle of that empty hospital ward.
We know how to do this.
Linda-Gail Bekker, a renowned H.I.V. researcher, mentioned to me that longevity is back. The life expectancy of South Africans has risen steadily since treatment began to be delivered by the public health system, and will pass, according to the data she showed me.
25 years ago, when I began covering H.I.V. in Africa, I had a dozen interactions that I could not have imagined.
When people test positive for H.I.V., they are given their first pills to suppress the virus at the clinic where they work, according to a community health care worker I met in a public clinic in Soweto.
The number of positive cases was falling. She and her co-workers said that it was due to pre-exposure prophylactics. It has been used by gay men in the U.S. for years to keep them from being exposed to H.I.V. Young women who have older boyfriends who they can't trust, are the ones who come to her clinic.
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A community health care worker is in South Africa.
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Antiretroviral drugs and hand sanitizer will be distributed in 2020 at a clinic in South Africa.
It was fascinating to hear that Nelly talked about it casually, despite the fact that research shows that it isn't high in Africa yet. For a long time, the only thing that she and other AIDS counselors had in their arsenal was condoms.
I was in a clinic in the city where nurses were screening young women for a trial that could lead to the creation of a new drug to fight H.I.V.
I visited the Africa Health Research Institute the same day, where an infectious disease expert named Thumbi Ndung'u talked about the trial and other upcoming ones that represent real, strategic steps to a cure. He was describing a lot of work and I was emotional when I heard about it.
You think this is going to work, right? I asked Professor Ndung'u if he would test the hypothesis of inducing H.I.V. remission. His normal demeanor is somber, but he broke into a wide grin. He said it will be exciting if it works.
The H.I.V. treatment campaign is housed in a white bungalow in Lusaka. I wanted to interview Felix and Carol about the lessons they learned from the H.I.V. epidemic, and how they learned to take them.
Carol and Felix had more immediate concerns when I asked how they were. They talked about the challenges of late middle age, a loss of bone density, and the fact that there was little research into long-term use of antiretroviral drugs in African settings. When they ask their doctors if something is normal, they are most often met with a shrug.
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The Africa Health Research Institute in South Africa is led by Thumbi Ndung'u, an infectious disease expert.
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The Treatment Advocacy and Literacy Campaign has veteran activists Carol Nyirenda and Felix Mwanza.
It was a valid point and a source of concern. When I met Felix and Carol, no one imagined they would have the luxury of aging.
Carol was getting A.R.V.s from friends abroad. When they ran out of money and couldn't send the drugs, she "sat back and waited to die," ravaged by a Tuberculosis infection that her immune-suppressed body could not fight.
She wore a pink face mask for her daughter's bridal shower last month. Research has not kept up with the needs of people who have lived with H.I.V. for decades in places such as Zambia. It is the best kind of problem to have.
I had dinner with Ida and her family. I haven't seen Ida in 13 years. When we first met, she was a counselor at an H.I.V. clinic, known for her ability to handle tough cases, such as the men who threw their pregnant wives out of the house, or worse, when they were tested at the prenatal clinic and learned they were H
In 2006 Ida found out that her husband had a disease. There was no guarantee that she would survive until she had reliable access to treatment. I met her two daughters when they were small, wide-eyed girls, and Ida told me that she wanted to keep them in school so that they could never feel like they had to stay married to a violent, unfaithful man.
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The mobile H.I.V. testing laboratory was in Sikwaazwa, Zambia.
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Ida and her daughter, Teba, were at the bar on the day she was called.
The daughters came straight from work to join us for dinner. A woman of 25 years old is named Mwamba. She is saving for graduate school and has a degree in development. Teba was fresh from arguing her first case in front of the High Court.
The way the young women's lives have turned out is so different than what their mother was afraid of.
I saw a lot of what I saw 25 years ago. It was a long fight. The solutions were decades later than they should have been. We talked about the people who didn't survive as we sipped tea, like Carol and Ida.
AIDS is not over. Covid has disrupted testing, interrupted drug delivery and undermined livelihoods in ways that make people more vulnerable to the other virus. This year, an estimated 700,000 Africans were new to the disease.
H.I.V. has been defeated. The money that was poured into treatment was a credit to the former President. To brilliant scientists in South Africa. To activists like Ida, Felix and Carol.
The proof of human resilience and ingenuity that I saw in Chongwe, is a reminder that the battle with a virus is not as short as we would like it to be. It is possible to come out the other side, into a future we can't imagine.
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