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JOHANNESBURG — Doctors and activists say AIDS patients aren't getting treated because of a nationwide civil service strike in South Africa, the country with the most people infected with the virus that causes AIDS.
Dr. Ashraf Coovadia said Wednesday his HIV and AIDS clinic at a Johannesburg hospital usually sees 60 to 80 patients daily, but that has dropped to 20 to 30 since the strike began a week ago. He said patients may believe the government hospital has been closed down by the strike, or fear getting caught in violence that has flared between police and health workers on the picket line.
Coovadia, who works at a government hospital, is among the non-strikers. He said his staff is calling patients who are nearly out of AIDS drugs to urge them to come in. The drugs are usually dispensed in amounts meant to last three months. He said he has had to negotiate with strikers and security guards to ensure patients can enter the clinic safely.
"The situation is quite volatile," he said.
In the short term, patients who miss a few days of medication can develop drug resistance, making future treatment difficult. It is a concern for both AIDS patients and patients with tuberculosis. Tuberculosis has seen a resurgence in South Africa because of AIDS — those whose immune systems are weakened are susceptible to TB.
"This is affecting hundreds of thousands of patients across the country," Coovadia said.
South Africa, a country of some 50 million, has an estimated 5.7 million people infected with HIV, the virus that causes AIDS, more than in any other country.
Sizwe Pamla, spokesman for a union that represents health workers, said it had planned before the strike for skeleton staffs to care for South Africans with AIDS and other critical patients, including those brought to emergency rooms. But Pamla said relations with the government had deteriorated to such an extent it was difficult to keep his members from the picket lines.
Pamla said the government could resolve the crisis by granting workers' demands for an 8.6 percent wage increase and a 1,000 rand ($137) housing allowance. The government is offering a 7 percent increase plus 700 rand ($96) for housing, and insisting it cannot afford to offer more.
"This country has got millions of people with HIV who need care," Pamla acknowledged. "It's sad that we are sitting here blaming each other."
At the Hillbrow Community Health Centre in an impoverished, densely populated central Johannesburg neighborhood, patients arrived to find the doors closed and hallways darkened Wednesday.
Jack Bloom, a local politician who specializes in health issues, said trouble at Hillbrow started when strikers forced a doctor to stop treating patients last week. Bloom said Hillbrow was one of the busiest AIDS clinics in the country.
In rural areas, poor patients who have to save up money for long journeys to clinics are arriving to find them closed, said Marige Versteeg of the Rural Doctors of Southern Africa organization.
"For rural patients, it's quite a disaster," she said.
The strike comes as the government has begun rolling out a campaign meant to make up for years of official denial and delay. A key component to the campaign is a testing drive, aimed at reaching 15 million people.
"I doubt there's very much testing going on during the strike," said AIDS activist Mark Heywood. "The health care service has basically broken down in large parts of the country."
Heywood said he supports the call for better wages that has led nurses and doctors as well as teachers, court clerks and other government workers to strike. But Heywood said he was trying to persuade unions to help ensure AIDS patients are cared for during the strike.
A public service strike in 2007 lasted a month.
Now, the two sides appear deadlocked. Unions who haven't yet joined the strike have threatened to do so, and major marches are planned Thursday in a show of labor's strength. The government has brought in military medics and volunteers to try to keep hospitals running.
