In Africa, life after AIDS

But she was lucky enough to find a clinic that could give her antiretroviral drugs. She persuaded her husband, who is also HIV-positive, to get treatment. He stopped drinking as part of the treatment, and has stopped abusing her and sleeping around. Now she counsels pregnant women on how not to pass HIV on to their babies.

"For some, HIV brings death," she says. "For me, HIV brought life into my home."

You come to Southern Africa to visit AIDS hospitals, and you expect, or at least I expected, to find unrelieved sadness. But something positive has happened recently because of the confluence of three factors.

The first is the spread of antiretroviral treatment programmes. Second, some African governments have gone on the offensive against the disease. And third, the US and other countries are pouring in money to pay for treatments.So now you run across health workers who have been labouring for years and watching people die, but who suddenly have the means to offer life.

You have, amid the ocean of despair, this archipelago of hope, hospitals that are ramping up treatment programmes as fast as they can, even while bursting out of their walls.

In Namibia, for example, only 500 people were receiving treatment in January 2004. Now over 9,000 people are, and the number is rising rapidly.

Here in Windhoek, Namibia’s capital, you run into people like a six-year-old who was born to parents who were both HIV-positive.

They gave her the name Haunapawa, which reflected their mood at the time. It means, "There is no good in the world." But the parents are both still alive, and the girl, once racked by pneumonia, is thriving on the medicine.

You run into scenes like the one I saw at Oshakati Hospital in northern Namibia, by the Angolan border, where a young Zimbabwean doctor, Gram Mutandi, works at his clinic. Patients can wait for eight hours to receive treatment and counselling.

One woman, Josephina, had been dying of AIDS. Her mother had already died. So had her sister and brother-in-law, and she was looking after their children. Then she got on the treatment programme, and now she has the irrepressible joy of someone who has come back from death.

Next to her was a woman who showed a photograph of herself at the depths of her disease, frail and emaciated. With treatment, she’s robust now. "I want to thank Dr Mutandi," she said. "You saved my life."

You can imagine what this has done for the morale of the health workers. You can imagine how it has helped them in their efforts to get more people tested for HIV. Now a positive test is not a death sentence. Something can be done. Obviously there’s a long way to go. You can still go out and visit children in mud huts who are raising themselves because their parents, aunts and uncles are all dead. Only a small fraction of those who need treatment are getting it. At the Lutheran Hospital in Onandjokwe, Namibia, the staff tested 858 women in the first quarter of this year, but could get only five of their male partners to even come in for testing.

But there’s something perversely akin here to Silicon Valley in the early 1990’s. All these little treatment facilities are trying to get really big really fast. Thanks in part to American money, they’re building new wings and desperately scrounging for qualified staff.

They’re facing the problems start-ups face: how to offer treatment to hundreds when you have only one sink and one phone, how to use the survivors who suddenly have the rest of their lives to lead.

I came here expecting despair, but now realise that we should be redoubling our efforts out of a sense of opportunity.

I came here aware of controversies about abstinence versus condoms in AIDS prevention programmes, about US aid versus multilateral aid, and now realise that all that nonsense is irrelevant on the ground. This is a world of people trying everything, of doctors from Russia, Egypt, Cuba, Germany and Zimbabwe. Many are backed by money from the President’s Emergency Plan for AIDS Relief, finally doing the work they’ve always dreamed of doing.

We could be on the verge of a recovery boom.