Part One | Part Two

The Age of AIDS

Series Producer and Reporter
Renata Simone

Part Two

Produced and Directed by
Greg Barker

Written By
Greg Barker &
Renata Simone

DAVID HO, M.D., Cedars-Sinai Med. Center 1978-82: It was a great mystery to all of us.

ANNOUNCER: Before we knew what it was, it was already with us.

JIM CURRAN, M.D., M.P.H., Dir., CDC AIDS Division 1981-95: By the time the first cases of AIDS in the United States were diagnosed, 250,000 Americans were infected.

ANNOUNCER: Before we knew how to halt it, it was with the world.

AIDS EXPERT: By the time the first cases were diagnosed in South Africa, millions were infected.

ANNOUNCER: The story of AIDS is one of the most important stories of our age, the epic story of scientific battles-

AIDS EXPERT: It's as if this virus has nine heads. You cut off one, it still operates with the others.

ANNOUNCER: -political indifference-

AIDS EXPERT: Because of the stigma, because of the shame, we've seen world leaders unwilling to accept the fact that HIV is a real issue.

ANNOUNCER: -moral dilemmas-

JEFFREY SACHS, Economist, Columbia University: Even if these drugs were available at cost, poor countries couldn't afford them.

ANNOUNCER: -and the perseverance of the human spirit.

ZACKIE ACHMAT, AIDS Law Project: People unified in action can achieve things.

ANNOUNCER: Tonight, Part 2 of a special FRONTLINE series.

AIDS EXPERT: One day, the age of AIDS will be over. In the history books, we will be defined and described by how we did or did not respond to it.

NARRATOR: Africa in the 1980s. Men leave their homes and their countries for a chance to work. They head south, to a nation where they have no rights, to the gold mines near Johannesburg, the economic backbone of South Africa's white apartheid regime. Until now, South Africa has largely been free from AIDS, but many of the foreign miners come from countries where the epidemic is already out of control, and they work together with miners drawn from within South Africa itself. They all live side by side in crowded hostels, cut off from their families. Outside each mine is a small settlement, just a company store, and women for hire.

ZODWA MZAIDUME, HIV Prevention Worker: This is the path that's basically been used by mine workers from the hostel to go and buy their goodies from the concession store. Where we are going, it's the bushes where the women actually have their business of sex work. They have an area where they sit within these bushes, and they wait for their clients to come from the hostel, walking through to the shop.

These women, the sex workers, practically didn't have a clue about HIV and didn't even use condoms. And they had different partners. There was no knowledge at all.

NARRATOR: Away from the mines, apartheid was crumbling as black South Africans struggled for freedom. AIDS was someone else's problem.

MANDLA MAJOLO, Pan-African Congress: And at that time, it was something foreign. You see people on television dying of AIDS. It was as if it was happening overseas in America, you know, not here.

NARRATOR: In 1990, Nelson Mandela was released from prison. By then, nearly one percent of South African adults were HIV-positive.

ZACKIE ACHMAT, AIDS Law Project: Mandela was released, and a few months later, I discovered I had HIV. I'd been very active in politics, and our slogan was "Freedom in our lifetime." And here the possibility of freedom was beckoning, and what happened was, in fact, at that time, a death sentence.

NARRATOR: As in the West, gay activists were among the first to warn that aids was coming.

EDWIN CAMERON, AIDS Law Project: I got infected, as thousands, hundreds of thousands of comparable gay men in Sydney and San Francisco and elsewhere. But it was already plain at that stage that there was a heterosexual African epidemic, which was going to surpass the epidemic amongst people like myself.

ZACKIE ACHMAT: We started an HIV prevention program, trying to speak to people about it, trying to say to people to use condoms, and so on.

NARRATOR: In the black townships, the activists met resistance.

MANDLA MAJOLO: People from outside come into your community, telling you how to behave, especially if they are whites and you're black, and you can easily look at it as if they think that you are irresponsible sexually. And once you reach that feeling, you start to build walls.

NARRATOR: In pockets across the nation, like rural KwaZulu-Natal, people began to die from AIDS. Increasingly, they were women, infected by their husbands and lovers who'd worked in the mines.

D.E. NDWANDWE, Nurse, KwaZulu-Natal: We used to get more males than females, but eventually, there was a change and we got more female patients than males, you know, such a change that we actually had to change the accommodation at some stage, use the people who worked for females and use the other ward for males.

NARRATOR: For four years after Mandela's release, the apartheid leaders and the ANC were consumed with the transfer of power. In that political vacuum, an opportunity to stem the epidemic was slipping away.

SALIM ABDOOL KARIM, M.D., University of KwaZulu-Natal: In a way, the complex political transition, the lack of credibility of the apartheid government at that time, which was disintegrating, in effect, and the new government was yet to be installed- and the new government had all kinds of challenges, not least HIV.

NARRATOR: In poor, crowded townships like Soweto, the epidemic accelerated. doctors at the nation's largest hospital were soon overwhelmed.

GLENDA GRAY, M.D., Baragwanath Hospital, Soweto: It was just hemorrhaging. And we just watched this- this thing explode in our face.

NARRATOR: Babies were being infected by their mothers through childbirth and breast feeding.

Dr. GLENDA GRAY: As HIV became more frequent and more commonplace in children, and as they needed more and more care, the ICUs in the country also made decisions not to admit children with HIV into their ICUs because it was terminal, and we needed to keep the beds open for children who had better prognosis. HIV became the new apartheid in South Africa. You know, we discriminated not on race anymore, but on HIV status.

Nurses were burnt out. Doctors didn't care, as well, you know? "Why should I care when the government doesn't care?"

NARRATOR: In May 1994, when Nelson Mandela became South Africa's president, he saw his job as reconciliation, holding his fractured nation together. Activists hoped he would also make time for AIDS.

EDWIN CAMERON: At the time I chaired a national convention on AIDS, my co-chair and I made every effort we could to get an audience with President Mandela, and we didn't succeed. We got an audience instead with Deputy President de Klerk, and Deputy President Mbeki joined the meeting.

NARRATOR: Mandela delegated AIDS to his deputy, Thabo Mbeki.

EDWIN CAMERON: Our efforts, which were sustained and determined and insistent, to get President Mandela to involve himself personally in the epidemic were unsuccessful.

Uganda

NARRATOR: Eight years before, another African president had taken a very different approach. Uganda's Yoweri Museveni personally led a nationwide prevention campaign.

Pres. YOWERI MUSEVENI, Uganda: AIDS is a dangerous disease because it has no cure. But on the other hand, it is not so dangerous because it does not infect easily.

NARRATOR: Uganda was one of the first countries to bring AIDS under control.

NOERINE KALEEBA, AIDS Activist, Uganda: If the president has sent out a call, if you are seen working on the issue, it is politically correct. You know, on the contrary, there were other countries where if you were seen to be working on HIV and AIDS, you were immediately a subject of suspicion. "Are you saying that we have AIDS in this country?" So it was a very, very interesting contrast that I saw very early.

NARRATOR: This was a campaign South African experts wished they could emulate.

SALIM ABDOOL KARIM: It was largely a function of the credibility of the messages. It was largely a function of the way in which the state was willing to intervene, not just to have posters and pamphlets and billboards, but intervene in structural ways to try and impact on this epidemic. We just did not have that in this country.

NARRATOR: In his five years as South Africa's president, Nelson Mandela barely mentioned AIDS.

EDWIN CAMERON: The fact is that President Mandela had a huge job. He saved our country. He didn't do what we what we would have wanted on AIDS. Whether history will fault him, I'm not clear.

NARRATOR: Infections were doubling every year. South Africa's epidemic was on its way to becoming the world's largest.

Prof. ABDOOL KARIM: I felt that the window available to us to try and change the course of this epidemic was rapidly closing. And you know, what did we really have available to us? I mean, when you think about it, if you're going to fight this kind of battle, you want to be better armed, and we just weren't.

New Jersey October 1992

NARRATOR: In America, Bill Clinton ran for president saying he would provide new leadership on AIDS. Under his two predecessors, Ronald Reagan and George H.W. Bush, the epidemic at home had grown almost unchecked.

Pres. BILL CLINTON: Most of us have preferred to believe that AIDS is not our problem, that it only affects gay men and IV drug users. But the truth is, it is everybody's problem. We don't have a person to waste in our country, and viruses do not discriminate.

I had met with a lot of AIDS activists in the `92 campaign, and I was very much focused on the United States because we still had the biggest AIDS problem in the world, not Africa.

NARRATOR: AIDS had already killed 200,000 Americans. Another million-and-a-half were infected with the virus.

Pres. BILL CLINTON: When it comes to AIDS, there should be a Manhattan Project. One person should be in charge, one person who can cut across all the departments and agencies, who has the president's ear.

When I became president, first of all, we had the first AIDS czar. Then we had an AIDS Advisory Council. And we tripled funds for research and doubled funds for care. So we did a lot of work.

NARRATOR: But within weeks of taking office, Clinton broke a campaign promise to allow gays to serve openly in the military. Gay activists saw it as a betrayal.

ANTHONY FAUCI, M.D., National Institutes of Health: So I think that the expectations of people that now, because this was a more liberal administration, that a lot of things were going to happen that many of the constituency groups felt were going to be automatic. And then I think what they were faced with, that even though you have an administration that would ideologically feel a certain way and agree with you, it isn't all that easy, sometimes, to get it done.

PROTESTER: Slick Willy! The Republicans were right! We should have never have trusted you! You are doing nothing, while me and my community are dying in ever-increasing numbers, and all's you do is talk! A Manhattan Project on AIDS research- we need it now!

Pres. BILL CLINTON: It's all right. It's all right. Part of my job is to be a lightning rod. Part of my job is to lift the hopes and aspirations of the American people, knowing that as long as you're trying to lift hopes and lift aspirations, you can never fully close the gap between what you're reaching for and what you're actually doing, and knowing for sure that there's no way I can now keep everybody alive who already has AIDS.

PROTESTING MOTHER: It's very sad. My son was 41 years old. And I'm devastated!

PROTESTER: Right now, I feel like there's a war going on and that we're screaming and yelling and that no one is listening.

MARTIN MARKOWITZ, M.D., Aaron Diamond AIDS Research Ctr.: I don't think that people can understand what it was like to live in New York in the `80s and early `90s. The gay community here in New York was completely devastated by HIV infection, and being a member of that community, I was basically a doctor by day, a nurse by night, and a mourner on weekends. I mean, it was just unbelievable.

NARRATOR: Markowitz took a job with AIDS researcher David Ho, who was trying to unravel one of HIV's greatest mysteries: Why did the virus seem to lie dormant for years?

DAVID HO, M.D., Aaron Diamond AIDS Research Ctr.: Throughout the 1980s, we knew quite well that HIV could infect a person and not cause disease for many years- in fact, as long as a decade or more. And that lulled us into thinking that HIV wasn't so active.

NARRATOR: Dr. Ho and other researchers began using new technology to measure the amount of virus in a patient's blood. They discovered that the virus was never dormant. From the very moment of infection, HIV was at war with the body's immune system.

Dr. MARTIN MARKOWITZ: What was realized is that HIV is a very dynamic infection, not an infection that's latent.

NARRATOR: Scientists discovered that HIV replicated by the billions every day. And as it did, it mutated.

Dr. MARTIN MARKOWITZ: HIV is a virus that doesn't make copies of itself very well. It's sort of like a little child typing at typewriter, it makes lots of mistakes. And the combination of lots of mistakes and a high turnover rate made for a lot of mutations. You have a lot of mutations, then drug resistance is a big problem.

[www.pbs.org: HIV's life cycle]

NARRATOR: So far, the virus had developed resistance to every known drug, like AZT. Ho and his team were among those working on a radical new treatment.

Dr. DAVID HO: We came to the conclusion that it's inevitable for HIV to develop drug resistance if you give it one drug at a time. However, if you start to combine the drugs and try to force the virus into a corner using multiple drugs, it is exceedingly difficult for HIV to become resistant to all the drugs simultaneously.

NARRATOR: Three drugs, including the most advanced, called protease inhibitors, would attack the virus, boxing it in.

Dr. MARTIN MARKOWITZ: We knew from the get-go that these drugs were not perfect, but we were trying to see if we could really achieve something miraculous- you know, a cure. So we sat there and said, "What should we do now?" And we said, "Well," you know, "let's get a newly infected person," because, you know, that's the best- that's the best place to start.

WILLIAM W. DODGE IV, Clinical Trial Participant: I went to this really kind of strange place. And it's this absolutely beautiful laboratory. I felt like I was in the movie Andromeda Strain. It was just a beautiful movie studio lab. And I met this man, Martin Markowitz. And he drew my blood, and I'm, like, "What is this about?" And he goes, "We think you might be eligible for a pharmaceutical trial." And I'm, like, "Why?" And he goes, "To treat HIV." And I was, like, "But there are no treatments for HIV." He goes, "Yes, there are, that's what we're working on."

Dr. MARTIN MARKOWITZ: He let us biopsy his tonsils, do spinal taps, do pretty much anything that we wanted to do to understand what the limits were of what we could achieve with anti-viral therapy, he let us do.

WILLIAM W. DODGE IV: And I was given drugs, a lot of drugs, three different drugs, 20 pills that were phenomenally toxic. And I was a sick kid, really, really sick.

NARRATOR: The side effects of the first drugs were severe, but the virus seemed to be gone.

WILLIAM W. DODGE IV: When I was checking out the hospital, I was, like, "Well, how long will it take for me to go undetectable in viral load?" And he goes, "Oh, you've already gone undetectable. You went undetectable on day five or something." So fast results.

But yet I couldn't share it with friends because they were sick, and that probably wouldn't happen to me. And I was getting treated and they couldn't get treatments. Treatments weren't available to anyone else.

It was almost as if I was at the fulcrum of history. There was life there was there was the world of HIV prior to me and the world of HIV from my time forward, which was a different world.

NARRATOR: In 1996, at a global AIDS conference in Vancouver, researchers announced the results of their clinical trials to the world's media.

Dr. MARTIN MARKOWITZ: As we expected, with this triple regimen, we put out of the fire, in the sense that when we look in the blood for evidence of viral replication, we cannot find it.

Dr. DAVID HO: I think the experiments I talked about, the ones Marty Markowitz talked about are trying to determine the feasibility of eradication.

NARRATOR: It was called the triple cocktail. "Time" named David Ho "Man of the Year." With these new anti-retroviral drugs, HIV infection was no longer a death sentence.

Dr. MARTIN MARKOWITZ: The people who were on disability got out of bed and started looking for things to do. And you know, the funerals stopped and the inpatient units emptied out. It was a true miracle.

[www.pbs.org: Explore how the drugs work]

WILLIAM W. DODGE IV: Then there was- there was another job involved. It was- it was letting people understand that, "Yeah, go ahead and get tested, find out what your status is and do something about it because things now can be done," and also telling everyone I knew to get health insurance because I knew the drugs were crazy expensive.

NARRATOR: At Vancouver, the news had been about the scientific breakthrough, not what the drugs would eventually cost- as much as $16,000 per year. At the close, a Zambian mother addressed the delegates. She was dying of AIDS.

ZAMBIAN MOTHER: Thank you very much for providing my accommodations while in Vancouver, which costs the equivalent of three years rent for me.

Dr. DAVID HO: She posed it quite simply, that "What does this mean for us? Our fate is the same."

ZAMBIAN MOTHER: Thank you for my air ticket, the cost of which would feed my children from now until they reach adulthood, God willing. Thank you very much for listening.

NARRATOR: Scientists from South Africa were in the audience.

SALIM ABDOOL KARIM, M.D., University of KwaZulu-Natal: The theme was, I think, "One world, one hope," or something like that. And I tell you, at the end of that meeting, I just was quite dejected because we were anything but one world and we had anything but hope as we were preparing to head back. There was almost no opportunity to get anti-retroviral drugs, they were that expensive in this country.

NARRATOR: Edwin Cameron was now a high court judge.

EDWIN CAMERON, High Court Judge: On the salary of a judge, I could just afford it. It took a third of my income as a judge. I felt my life returning to me within two weeks of starting anti-retrovirals. It was an incontestably dramatic moment when I realized that my strength was returning. I could feel the virus stopping activity in my body. I could almost feel the gradual return of my immune system. And my energy levels returned.

At the same time, I knew that I was one of millions of Africans who just weeks before were feeling the lassitude, the terrible feeling of fungus in your mouth, of not being able to breathe because your lungs are beset by disease. And it was an experience that was pivotal to my subsequent involvement in the epidemic, that there was an iniquity here so large and so insurmountable, so morally insurmountable that it had to be addressed.

NARRATOR: The scale was overwhelming. By 1996, 20 million Africans were infected with HIV. A new agency of the United Nations had just been created to fight the epidemic. Dr. Peter Piot, who treated some of the first cases of AIDS in Zaire in the early 1980s, was asked to lead it.

PETER PIOT, M.D., Exec. Director, UNAIDS: I felt that the top priority was exactly to put AIDS on the political agenda. It has to be on the agenda of presidents, of prime ministers if it's a national emergency, a matter of national survival.

NARRATOR: The first U.N. effort had fallen apart. In the early `90s, the World Health Organization let its AIDS staff drop from 250 to 4.

Dr. PETER PIOT: AIDS program collapsed completely. There was no ownership. About $200 million was spent on AIDS in developing countries, in the poor countries. There's no way that you can stop such a complex epidemic worldwide with that kind of peanuts.

Washington, D.C. October 1996

NARRATOR: In America, the triple cocktail became widely available to patients with health care. Activists laid the AIDS quilt on the National Mall for what would be the last time.

CLEVE JONES, Founder, The AIDS Quilt: I remember, actually, when I got my lab results after I began on this combination, I was in the supermarket and I ran into- I saw a friend of mine down at the other end of the store, in the produce section. And I shouted at him across the store, "Jeff! Jeff! We're going to live! We're going to live!" You know?

I was strong and I was healthy again, and I remember walking on the quilt with President Clinton and telling him, you know, my friends are getting out of bed, my friends are going back to work.

Pres. BILL CLINTON: Just seeing the love and devotion that those sections of the quilt represented for all those people who died prematurely and knowing that they now, with the medicine, that they didn't have to die anymore, if we do the right things.

NARRATOR: Clinton had authorized emergency funds for treatment. But there were long delays, and not everyone would get the drugs.

Selma, Alabama

MEL PRINCE, Selma AIDS Info. and Referral: When I first started working with Selma AIR in `95, I didn't know what I had gotten myself into. The third day on the job, I went to a funeral. That's how tragic this disease was.

NARRATOR: Mel Prince worked for an AIDS clinic in Selma, Alabama. Across the rural south, the virus was spreading unseen.

MEL PRINCE: Certain parts of Alabama can still be lost in the Dark Ages where they think this is just a gay white male disease- "It doesn't happen in our neighborhood." But it's there.

NARRATOR: Half of all new infections in America were among minorities.

MEL PRINCE: Most of our patients did not want anybody to know. That's how primitive things were back in those days. We would hide, we would pick up people around the corner to get them to the doctor.

NARRATOR: To AIDS patients here, news of the triple cocktail seemed a world away.

MEL PRINCE: I had mixed feelings when the cocktail was first announced because there was nothing I could offer my patients. They were hearing about it, too. They was watching the TVs. They was listening to the radios. The clients felt defeated. They felt like the system always let them down, so what should be different about this? This is just one more frustration. They're used to it. And therefore, they just accepted it, as though they couldn't do anything about it.

NAIR SOARES DE BRITO, AIDS Activist, Brazil: [through interpreter] I was part of an international community of women living with HIV, and I started traveling around the world. And that was how I found out, "Wow, there are drugs?" So in addition to fighting for our human rights, I said, "Is it also possible to fight for drugs?" And everyone said no. "Why?" I asked. "Because those drugs are very expensive, and Brazil won't buy those drugs."

Sao Paulo, Brazil

NARRATOR: In Brazil, half a million people were HIV-positive, most of them in densely packed mega-cities where stigma and desperation flourished. Nair Brito was a school teacher. She'd been infected by a boyfriend.

NAIR SOARES DE BRITO: [through interpreter] I saw people dying, lots of them. I joined a theater group to speak to the people of Sao Paulo through theater about prejudice because the stigma of AIDS was very nasty.

NARRATOR: In poor neighborhoods, activist priests from the Catholic Church's liberal wing began to speak out about stigma and demand action on AIDS.

Fr. VALERIANO PAITONI, Our Lady of Fatima Church: [through interpreter] Dealing with this issue brought up all the great moral questions. Our duty was to understand deep down that being Christian meant we had to welcome those in need and go towards them, without making any distinction.

NARRATOR: The government built aids clinics in poor neighborhoods but said it couldn't afford to give patients the triple cocktail.

NAIR SOARES DE BRITO: [through interpreter] I had a CD4 count of 8, which means that the body has no defense. But I didn't give up the idea that I'd seen abroad, how people had a chance to live if they took those drugs. It was as if I was seeing some kind of magic happening- take the medicine and you'll live. And I wanted that magic to happen with me. I wanted to live.

NARRATOR: Brazil's new democratic constitution guaranteed health care for everyone.

NAIR SOARES DE BRITO: [through interpreter] So I spoke to a lawyer. "I'm a Brazilian citizen, and in our constitution, it says that health is the right of all, and I'm dying. I've got no way of staying alive."

NARRATOR: Nair Brito sued her government. As she lay in her hospital bed, a judge ruled she was entitled to the drugs immediately.

NAIR SOARES DE BRITO: [through interpreter] The lawyer came to the hospital with the drugs. I was full of tubes, so I just gave her a thumbs-up.

NARRATOR: She left the hospital with the new anti-retroviral drugs in hand.

Unlike most developing countries, Brazil had its own labs to make generic drugs. With this leverage, Brazil negotiated lower prices from the global pharmaceutical industry, which held the patents for the cocktail. Following the court decision, Brazil passed a new law on AIDS treatment.

PEDRO CHEQUER, M.D., Dir., Brazil National AIDS Program: [through interpreter] One of the secrets to our solution was dialogue between government and society. Another was the decision to strengthen the institutions of the state to respond to the epidemic. There was political determination, which was translated into a financial commitment.

NARRATOR: Brazil was the first country in the world to guarantee anti-retrovirals to all its citizens.

Pres. BILL CLINTON: All of us in the rich countries have to understand that our impact is going to be very limited unless the countries in question are really committed to doing something about it. If you look at the marvelous job done by Brazil, for example, where you had the commitment from government, from civil society, from the church, from everybody at the grass roots level to turn this around, and they did, that's what we have to have everywhere.

Pretoria, South Africa June, 1999

NARRATOR: In South Africa, the historic presidency of Nelson Mandela came to an end. His successor was his longtime deputy, Thabo Mbeki, who finally emerged from his mentor's shadow. On his lapel, Mbeki wore an AIDS ribbon-

Dr. SALIM ABDOOL KARIM: Mbeki came into power with a different message, a message of, "We've got a job to do, and we're going to deliver." And so I was quite hopeful.

NARRATOR: Mbeki promised African solutions to African problems, including AIDS.

EDWIN CAMERON: The real crisis eventuated six months after President Mbeki took office, when he rose to give a speech in the upper house of South Africa's parliament.

Pres. THABO MBEKI, South Africa: You see, when you ask the question, "Does HIV cause AIDS?" the question is, "Does a virus cause a syndrome?" How does a virus cause a syndrome? It can't. It really, truly- it's necessary- I've been saying to the honorable members, to the people of this country, it's necessary for people to study this question."

EDWIN CAMERON: it was clear from his speech that he'd had access to denialist literature on AIDS, denialist literature that queried whether HIV was, in fact, a virally caused condition, and that queried, most significantly, whether the anti-retroviral drugs were of any use in treating what the denialists claim is an environmental and social condition, not a viral condition.

NARRATOR: Mbeki had made contact with Peter Duesberg, a University of California biologist who claimed HIV had nothing to do with AIDS.

PETER DUESBERG: It's just a harmless retrovirus. There are hundreds of those around. Hundreds. Everywhere in- there's no animal around that doesn't have it. You know, it's not an infectious disease, it's not that virus.

NARRATOR: Duesberg's theories had been discredited for years.

Dr. DAVID HO: If HIV doesn't cause AIDS, then how would anti-HIV drugs lead to such dramatic improvement in one's wellbeing? And that's only one example. There are plenty of examples to do away with this ridiculous theory.

NARRATOR: Across South Africa, the president's skepticism reinforced local doubts about AIDS.

DOROTHY MAKSALITIBA: I used to hear about it from the TV and the newspapers, the radios, but then I wasn't interested in it because of I didn't believe that it existed. AIDS was just a diagnosis made up, just made up.

NARRATOR: One day as she came home from work, Dorothy Maksalitiba was attacked by four men and raped.

DOROTHY MAKSALITIBA: I was gang-raped by four men. There was blood all over me, and I didn't know what happened to me. I just passed out, and then I got gang-raped by these guys.

And it didn't come to my mind that I have to go to the clinic to be tested or anything. I didn't think of that. The only thing that was in my mind was that I have to get myself clean, I have to wash myself. Then I just went home and then took a cold bath, thinking that everything would just go away. But it didn't. It didn't.

NARRATOR: Most women didn't know they could pass the virus to their babies.

DOROTHY MAKSALITIBA: After I delivered my son, he was sick all the time, always going to the hospital, the doctors trying this and that, but nothing ever worked. Then I agreed that he be tested for HIV, and then I was also tested for HIV. And then the results came. After two weeks, the results came back positive both for me and him.

NARRATOR: On some pediatric wards, half of all children had the virus.

GLENDA GRAY, M.D., Baragwanath Hospital, Soweto: You just were diagnosing them, every other kid. You can imagine, you know, it's kind of "Eenie, meenie," this- you know, "Love you, love you not." You know, HIV-positive, HIV-negative, HIV-positive, HIV-negative.

The kids just streamed in. Sometimes when we would do ward rounds, and this kid had come in that's 3 months old, you know, has a respiratory infection, you know before you even do X-ray that this is PCP pneumonia. And the nurse would say, you know, "You know it's HIV, I know it's HIV. Let's just not test this baby. Let's just not tell the mother," you know? "When the mother comes back next time, we can do it. I just don't want to tell another mother that her child is dying from HIV."

NARRATOR: Mbeki was leading a nation with five million infections, more than any country in the world. He asked the denialists to advise his government.

Pres. THABO MBEKI: I'm somewhat embarrassed to say that I discovered that there'd been a controversy around these matters for quite some time. I honestly didn't know.

PETER DUESBERG: The first charge for us here is, Is there even a new epidemic? Is there anything new happening? You've got to first know what the cause is before you start treating it.

NARRATOR: Dr. Glenda Gray helped prove the drug AZT could block most cases of mother-to-child transmission.

Dr. GLENDA GRAY: We knew that AZT could prevent transmission, and we knew that these interventions were as cheap as measles vaccination. And if you can give measles vaccination, you can give this intervention.

NARRATOR: But on the advice of the denialists, President Mbeki banned AZT and the entire triple cocktail from government hospitals, claiming the drugs were too toxic.

PATRICIA DE LILLE, Leader, Independent Democrats: One question, Mr President. One of the reasons used by government for not providing anti-retroviral drugs is that it is too toxic. Now, why is it toxic only for the poor people of this country that cannot afford it, but it is not toxic for many members of Parliament who are using the same anti-retroviral drugs?

Pres. THABO MBEKI: Undoubtedly, Madam Speaker, if these drugs are toxic, they are toxic for everybody.

Dr. GLENDA GRAY: What we had was a president who was a dissident. We had lackeys in the health department that would do anything that their master said, and even if it meant not giving women interventions to save their children's lives.

DONNA SHALALA, Sec. of Health & Human Svces. 93-01: Thabo Mbeki- I do not believe he was in denial as much as he saw it as a conspiracy, a much more traditional African response. Both Vice President Gore and I argued with passion with him to move on this issue. And you know, we had polite responses.

INTERVIEWER: What did he say?

DONNA SHALALA: He simply listened politely and basically said to us, "We understand what we need to do in our country," and, "Thank you very much."

NARRATOR: By 1999, one in five South African adults had the virus.

MANDLA MAJOLO, Pan-African Congress: There are funerals of many black people who are dying from AIDS. And there are many people who are dying at a very young age. What could be the explanation of that? Why are the ANC leaders or ANC members who are coming from our community do not see what we see? And why are we the only people who are normal enough to understand what is happening, to see what is happening?

New York City

NARRATOR: In America, the epidemic among minorities continued to spread unchecked. In parts of New York, 25 percent of black men were HIV-positive. And as in so many other communities, the denial and stigma of AIDS ran deep-

PERNESSA SEELE, AIDS Activist, New York City: Unfortunately, we have not seen the response of the black community in crisis mode. At that time, there were over 350 churches in Harlem, and there was not one pastor, no one was coming to the bedsides of these people. And I was just shocked and disappointed in the lack of response of the church.

Rev. W. FRANKLIN RICHARDSON, Grace Baptist Church: African-American churches really resisted HIV and resisted discussions with it, resisted acknowledging that it was a reality. And people used to whisper when somebody died of HIV/AIDS. They'd go to a funeral, didn't treat it like any disease, always, like, whispered, was a hush.

PHILL WILSON, Director, Black AIDS Institute: After I'd talked about the disease and I asked the ministers for their help, one of the ministers stood up and said, you know "This is not our problem, and we're not going to let them blame this on us."

REV. W. FRANKLIN RICHARDSON: Bad Bible, is what I called it. We used to do bad Bible and make HIV some kind of plague that God had sent upon homosexuals. It was a terrible time for the church.

[www.pbs.org: A state-by-state breakdown]

NARRATOR: By the late `90s, new infections in America remained steady at 40,000 per year, but 80 percent were among minorities and this epidemic went largely unnoticed.

PERNESSA SEELE: I remember when the U.S. Centers for Disease Control predicted that the epidemic would be out of control. They said, you know, 1 in every 50 black men would be HIV-positive. And yet there was no real serious intervention from the public health perspective.

PROTESTER: This is a question of race and class. Take a look around you. The people who are injecting drugs, the people who dying from injecting drugs, the people who are dying from AIDS and HIV, are black and brown. And the people who control the money are white.

NARRATOR: The Clinton administration was under pressure to fund needle exchange programs to prevent more infections.

HELENE GAYLE, M.D., Centers for Disease Control: As a public health professional, my first concern is saving lives. There's a large group of people who are not prepared to stop injecting drugs. Should their penalty be automatic death? You know, I think not.

NARRATOR: Experience abroad and pilot projects at home clearly showed needle exchange worked. The idea even had the support of Clinton's own health secretary.

[www.pbs.org: More on needle exchange]

DONNA SHALALA: Forty percent of new AIDS infections came from IV drug use. I believed that we had an opportunity here for at least a narrow part of the campaign to eliminate new AIDS infections, to make a real contribution.

NARRATOR: But the Republicans who controlled Congress cast AIDS prevention in moral terms.

REP. DENNIS HASTERT (R), Illinois: If drugs are illegal in this country, and it's illegal to use cocaine or heroin or anything that's injectable, then you know, we shouldn't be handing out free utensils.

Pres. BILL CLINTON: The opposition to it was simply overwhelming.

Rep. MARK SOUDER (R), Indiana: -because you think the cause is right, to violate the law and enable people to violate the law-

Pres. BILL CLINTON: It was overwhelming in Congress and it was overwhelming within the drug control office of the administration, and it simply would have been reversed in the Congress if I'd done it. It just wasn't- politically, the country wasn't ready for it.

DONNA SHALALA: I believe the president made the wrong decision. I said so at the time. No one tried to debate with me what the science said or what the right thing to do was, there was simply a straight political decision that was made.

Tver, Russia

NARRATOR: Wherever people inject drugs, HIV follows. In Russia, the end of communism brought cheap heroin- and AIDS.

DRUG USER: [through interpreter] It came from the West. You saw it in the movies. The film Trainspotting really influenced me. If you wanted to be fashionable, you had to use drugs.

NARRATOR: Along busy highways, some drug users paid for their habit with sex.

WOMEN ALONG HIGHWAY: [subtitles] We get men of every stripe- drivers, long-distance drivers, businessmen. Yeah, every kind- foreigners, Finns, every kind.

NARRATOR: Men carried the virus home to their families. Soon nearly one million Russians were infected. In Moscow, the government did almost nothing.

VADIM POKROVSKY, M.D., Dir., Russian Federal AIDS Ctr.: [through interpreter] Part of the problem is that many officials, even in the health ministry, think it's best that we underplay the scale of the AIDS epidemic. Many of them intentionally tell our senior leaders that AIDS is basically non-existent in Russia.

NARRATOR: In the age of globalization, HIV thrived. Following sex and the drug trade, it spread across Eastern Europe, through Southeast Asia into India and China, the most populous countries on the planet.

DONNA SHALALA: I believed that it was going to be awful around the world. We had enough information on how AIDS was spreading in South Africa, in India, in China, in Russia. We were scared to death. Most of the countries of the world were in total denial. The health minister of China told me there wasn't a chance, because they were a closed society, for AIDS to spread in China.

Henan Province, China

NARRATOR: At the time, it was estimated China had nearly one million infections. In this village alone, 500 out of 800 residents had been infected when years before, a commercial blood plasma program became contaminated. A prominent doctor found out about it.

GUI XI'EN, M.D., Wuhan Univ. Hospital: [through interpreter] It was by coincidence that I came across so many AIDS patients in a rural village. It was heartbreaking. People needed help. I had a huge task in front of me.

NARRATOR: When Dr. Gui brought patients to the city, he was arrested. China wanted AIDS kept secret.

Pres. BILL CLINTON: AIDS is a hot political issue in the beginning, in a lot of places where people are uncomfortable talking about how it's communicated. They either don't want to admit they've got a drug problem or they think it violates their culture to talk about the sexual communication or it's embarrassing that blood transfusion equipment is contaminated and blood can't be tested. I mean, it's a downer talking about it. So a lot of people say, "Well, we aren't going to do this." But denial only makes it worse everywhere.

[www.pbs.org: Map of HIV's global spread]

NARRATOR: By the end of the `90s, AIDS had killed 20 million people. Even then, the international community itself was still in denial.

KOFI ANNAN, U.N. Secretary General: No one had an idea of how it was going to evolve or develop. But suddenly, we realized that it had a potential to decimate whole nations and people.

RICHARD HOLBROOKE, U.N. Ambassador, Clinton Admin.: I came up with the idea that we should hold a special session of the Security Council on HIV/AIDS. I was told by everyone, including my own staff, "You can't do this. It's not done. It's not in the U.N. charter." And I said, "But AIDS is a security issue because it's destroying the security, the stability of countries."

Vice Pres. AL GORE: I call to order this first meeting of the United Nations Security Council in the 21st Century. When 10 people in sub-Saharan Africa are infected every minute, when 11 million children have already-

PETER PIOT, M.D., Exec. Director, UNAIDS: It was the first time that the Security Council debated on something that was not, let's say, war and peace,

Vice Pres. AL GORE: -when a single disease threatens everything from economic strength to peacekeeping-

Dr. PETER PIOT: That was a breakthrough because it opened so many doors, and presidents, prime ministers say, "Oh, it was debated in the Security Council, this must be a serious problem," which was ridiculous, but I literally got that kind of reaction.

JEFFREY SACHS, Economist, Columbia University: The surprising thing is that there's lots of talk going on. And so you imagine with all that noise that there's actually some action. And you have to parse through all of the fog that's intentionally thrown up to find out there is nothing there. Officialdom doesn't exactly hold up a sign that says, "We're doing nothing." Essentially, this pandemic was running its complete natural course without any intervention from the rich world.

Durban, South Africa July 2000

NARRATOR: AIDS researchers decided to hold their biennial meeting in South Africa-

Dr. PETER PIOT: Up to then, no AIDS conference had happened in the developing world, and we really wanted to have it in Africa. It was a very difficult conference, but also I think a historic conference.

MARTIN MARKOWITZ, M.D., Aaron Diamond AIDS Research Ctr.: The turning point for me was the Durban meeting in 2000. That was a life-changing event, I think, I think for many people. It was my first trip to Africa, and it put a face onto the problem. And it was deeply disturbing. And even though you read about it and heard about it and thought about it, it didn't resonate as much as actually seeing it.

ANTHONY FAUCI, M.D., National Institutes of Health: And you go bed after bed after bed. To actually be there and make rounds on patients in which you can't do anything, that triggered in me this- not only frustration but absolute resolve that we can't accept this. This is just something that as human beings we can't accept.

NARRATOR: As delegates arrived, South African activists launched a new campaign to force their government out of its denial.

ZACKIE ACHMAT, AIDS Law Project: Comrades, today is a sad day for everyone!

NARRATOR: Zackie Achmat, who could afford the drugs himself, had stopped taking them until they were available to everyone.

ZACKIE ACHMAT: We decided to embark on a civil disobedience campaign to get government to treat people. It was critical for me that we win. It was critical for everyone that we win.

NARRATOR: Activists hoped that with the world watching, President Mbeki would respond.

ZACKIE ACHMAT: I want to believe that even Mbeki, if he actually visited people dying of AIDS and saw what was happening- even Mbeki would be willing to change.

NARRATOR: Mbeki agreed to give the opening speech. He even asked for more time.

SALIM ABDOOL KARIM, M.D., University of KwaZulu-Natal: So I was very hopeful. I mean, I thought he needed 25 minutes because he needed to explain what had happened and he needed to mark out a new path.

Pres. THABO MBEKI: There is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of HIV/AIDS. However, we remain convinced of the need for-

Dr. SALIM ABDOOL KARIM: Only when he actually was 10 minutes into his speech, I realized he was not going to make any drastic new announcement.

NARRATOR: Mbeki repeated the denialists' claim that AIDS in Africa was caused by poverty, not HIV.

Pres. THABO MBEKI: As I listened and heard the whole story told about our own country, it seemed to me that we could not blame everything on a single virus.

NARRATOR: His speech was met with stunned silence.

QUARRAISHA ABDOOL KARIM, M.D., AIDS Researcher: If only he said unequivocally that HIV causes AIDS and he made an announcement on reducing mother-to-child transmission, he would have seized the moral high ground. And he didn't. And you look around, the strong statement that all the delegates here are making, and they continue to go against all of that!

ZACKIE ACHMAT: There's nothing in the world that can explain it. There is nothing in the world that can explain it. To find out that a government does not care about the lives of poor people and the lives of black people and are prepared to consign us to the graveyard was actually quite shocking.

Dr. ANTHONY FAUCI: You're looking at it straight in the eye and you say, "What am I going to do?" And that was really crystallized by the activist movement that we saw in South Africa, and it was that impetus that led to the resolve to get treatment, care and prevention into the trenches in developing nations in whatever manner or form we can.

Washington, D.C.

PROTESTER: AIDS drugs for Africa!

NARRATOR: Activists in America picked up the cause, focusing on the price of the triple cocktail, which still cost $16,000 per year.

EDWIN CAMERON, High Court Judge, So. Africa: The pharmaceutical companies' policies, their practices, their insistence on patent enforcement were morally indefensible. And their attempts to evade the moral consequences of their position were threadbare and tawdry.

NARRATOR: The industry argued high prices paid for future research.

HARVEY BALE Jr., Pharm. Manufacturers Assn.: Certainly, one of the critical issues that continues to be debated is the provision of intellectual property protection for new inventions. Without that, there will certainly not be the kind of product development that I think we're all hoping for over the next 3, 5 and 10 years.

[www.pbs.org: The battle over drug pricing]

KOFI ANNAN: I met with the chairman and CEOs of the five pharmaceutical industries. They were determined to protect their intellectual property, but as I told them then, if you insist only on intellectual property and you do not take any measures to ensure that the poor have access to affordable medication, it will not be defensible.

NARRATOR: Under pressure, the companies finally dropped prices for developing countries to as low as $400 a year.

EDWIN CAMERON: To their credit, they responded to it, and the prices decreased dramatically after that.

NARRATOR: But for poor countries, it was still a problem.

JEFFREY SACHS: Even if these drugs were available at cost, as they were coming to be, poor countries couldn't afford them and poor people couldn't afford them. So one needed a financial strategy to translate the new technology into saving people.

NARRATOR: Economist Jeffrey Sachs looked at what it would cost to buy and deliver drugs to poor countries.

Prof. JEFFREY SACHS: I made a calculation that showed that for a few billion dollars a year, it would be possible to make a huge step in actually putting people on treatment. The proposition was that a fund would be established to buy the drugs at cost and make them available to the poorest people in the poorest countries, and I envisioned, of course, for free.

NARRATOR: Kofi Annan backed the plan, and called for a new multi-billion-dollar AIDS program.

KOFI ANNAN: I propose the creation of a global fund dedicated to the battle against HIV/AIDS and other infectious disease.

NARRATOR: George W. Bush had just taken office. Annan's fund would need American money, but Republicans had blocked many AIDS programs for nearly two decades.

Prof. JEFFREY SACHS: I came in to see Condoleezza Rice, to say, "We need to help treat people that are dying of AIDS. Here's a $3 billion-a-year plan." Condoleezza Rice said, "The president's interested in this," thank goodness, "and it's interesting to hear you discuss this, but our experts tell us that people can't be treated."

NARRATOR: Their experts didn't believe the triple cocktail was practical in poor countries.

ANDREW NATSIOS, U.S. Agency for Intl. Development: So the biggest problem, if you look at Kofi Annan's budget, half of the budget is for anti-retrovirals. If we had them today, we could not distribute them. We could not administer the program because we don't have the doctors. We don't have the roads. We don't have the cold chain. This sounds small - and some people, if you've travelled to rural Africa, you know this - this is not a criticism, it's just a different world. People do not know what watches and clocks are. They do not use Western means for telling the time, they use the sun.

COLIN POWELL, Secretary of State 2001-05: What he was saying was that it is difficult to administer anti-retroviral drugs in Africa, not because Africans are ignorant, but because of where they are located throughout the countryside, and the difficulty of reaching them.

NARRATOR: Early versions of the regimen involved up to 20 pills a day, close medical supervision, exact schedules, even refrigeration.

COLIN POWELL: How do you get it out there? There are no clinics out there. There are no doctors out there. There are no nurses out there.

NARRATOR: But the real obstacle in Washington was politics. Jesse Helms, the powerful Republican senator, had consistently opposed AIDS funding on moral grounds.

Sen. JESSE HELMS (R), North Carolina: Let's talk about who's causing this, who caused it from the very beginning. I never heard once in this chamber anybody say to the homosexuals, "Stop what you're doing."

Rev. FRANKLIN GRAHAM, Samaritan's Purse: Here was the most strongly conservative, anti-gay senator, who had- you know they call him "Senator No" because he was no this and no that.

Sen. JESSE HELMS: No federal funds can be used to encourage or promote homosexual sexual activity!

Rev. FRANKLIN GRAHAM: I think the reaction of many Christians was, "Well, this is a result of sin, this is the consequences of sin. And so therefore, you know, it doesn't concern us."

NARRATOR: Franklin Graham, the son of evangelist Billy Graham, ran a global missionary program. He'd seen the devastation of AIDS himself.

Rev. FRANKLIN GRAHAM: As I study the Scripture, Jesus Christ came to this earth for sinners. I'm a sinner. I'm no different, no better. I'm a sinner. And Jesus Christ came for me, and he came for each person that is infected with HIV/AIDS. God loves that person.

NARRATOR: In February 2002, Graham called evangelicals to a closed meeting in a Washington hotel. With Bush administration officials in the audience, he laid out his vision of the Christian response to AIDS.

Rev. FRANKLIN GRAHAM: The church of Jesus Christ needs to provide the leadership in this crisis- the infection rate increasing, 40 million people. We need an army of men and women who are willing to go into this battle.

NARRATOR: Graham then framed AIDS as a missionary opportunity.

Rev. FRANKLIN GRAHAM: I see 40 million dying men and women as 40 million souls that Jesus Christ shed his blood on Calvary's cross, 40 million people who may not know that Jesus Christ died for their sins, 40 million people that may end up in the flames and the fires of hell if someone doesn't tell them this wonderful news, this prescription for hope, the hope for our souls to spend eternity in the presence of almighty God!

NARRATOR: At the same time, evangelicals found an unexpected ally.

BONO, Lead Singer, U2: My name is Bono, and I am rock star.

NARRATOR: After campaigning for debt relief, Bono had turned his attention to AIDS.

BONO: This is the biggest health threat since the bubonic plague wiped out a third of Europe, and this is happening right now.

NARRATOR: Bono's activism was backed by his own Christian faith. Franklin Graham took notice.

Rev. FRANKLIN GRAHAM: Bono has a pretty significant level of biblical understanding. He's read the Bible. Not once, but I think he's read it many times.

BONO: I was offended to discover that the religiosity of this country was not available to the AIDS emergency, so I asked to meet as many church leaders as I could and used examples from the Scriptures. You know, "Isn't this the leprosy of the age," I argued. "Isn't this what," you know, "the Christ spent his time with?" And yet the church now is walking across the road and looking the other way.

NARRATOR: With Franklin Graham's support, Bono came to Washington to meet Jesse Helms.

BONO: Jesse Helms is a tough guy, but he's also rigorous, from his point of view. So you know, Christ only speaks of judgment once, and oddly enough, it's in regard to the poor. I think it's Matthew 23. It's the famous lines, "I was naked and you clothed me. I was a prisoner and you visited me.' And then they say to Christ, "What are you talking about? You weren't." "I was sick and you came to me." And he says, "No, no, I wasn't. But as much as you do this to the least of these, you do it unto me." And that's a very powerful piece of Scripture.

And he was very moved. Even emotionally, he kind of welled up. And as I was leaving the room, he said - big Southern- big, tall, Southern old boy, you know, just this amazing character- he said, "I want to give you a blessing." And he put his arms around me and then he gave me this blessing. And I take such- I take blessings pretty seriously. And I went out and of course told the assembled press what had happened, and they couldn't believe it.

I'm very humbled. I'm having my world turned upside down, and I'm surprised that people should be so generous in letting an obvious outsider in.

Sen. JESSE HELMS: You'll never be an outsider. You'll always be a friend.

Rev. FRANKLIN GRAHAM: He respected what Bono was telling him, and Senator Helms changed his position to where opposing funding for HIV/AIDS, he became an advocate for funding.

Pres. GEORGE W. BUSH: Thank you all. Bono, I appreciate your heart. Let me tell you what an influence you've had. Dick Cheney walked in the Oval Office, he said, "Jesse Helms wants us to listen to Bono's ideas." That's pretty-

BONO: And he was very well informed about it. I was surprised that he knew- you know, he knew as much as he did. And to be fair to President Bush, he really responded, and he responded in a way that no one could ever have imagined.

NARRATOR: Dr. Anthony Fauci, a top scientist from the NIH, was summoned to the White House. They wanted a plan on AIDS.

Dr. ANTHONY FAUCI: It was driven by the president. He said he wanted it to be feasible, he wanted it to be bold, and he wanted it to be accountable.

NARRATOR: Bush was also getting advice from Franklin Graham, one of his spiritual advisers.

Rev. FRANKLIN GRAHAM: I tried to encourage him to- first of all, in most of Africa, not only do you have a church, but there are church-related hospitals. And we need to enlist these churches in this fight against HIV/AIDS. And we don't need to be pouring this money into some of these governments, who are going to squander the money.

NARRATOR: A plan emerged. It would draw on both religious and government health services already in place.

Dr. ANTHONY FAUCI: Therapy prevention care for HIV can really work under these circumstances, if you do it the African way. Don't parachute in your own preconceived notion about how things can be done, do it the way the Africans feel that they can do it.

The White House staff said, "We believe you, Tony, but you're a white American who works for the federal government. We want to hear, is this thing feasible from people who are in the trenches."

NARRATOR: Fauci reached out to Uganda's leading AIDS specialist to convince the White House staff.

PETER MUGYENYI, M.D., Joint Clinical Research Ctr.: They were very skeptical that infrastructure would not support anti-retroviral therapy on the African continent. They even went to some extremes of saying that the continent do not even have clean water.

NARRATOR: In January 2003, the plan was still behind closed doors. With a looming war in Iraq, there were worries about the White House's priorities.

BONO: I said that to President Bush. You know, I said, "Look, paint them red, white and blue, if you want, but these drugs are the best advertisement you're going to get right now, and that might be important right now." And so, you know, above the moral imperatives comes the political imperative to some people. So fine, whatever brings you to the party.

NARRATOR: As the president arrived for his State of the Union speech, everyone expected him to issue an ultimatum to Saddam Hussein. They were not prepared for what came first.

Pres. GEORGE W. BUSH: Today, on the continent of Africa, nearly 30 million people have the AIDS virus, yet across that continent, only 50,000 AIDS victims - only 50,000 - are receiving the medicine they need. I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.

Dr. PETER MUGYENYI: That sounded like melodious music. From there onwards, things would never be the same. And that was victory for the people who were suffering and who were now going to have hope.

Geneva, Switzerland

NARRATOR: In Geneva, U.N. officials were stunned.

[www.pbs.org: More about the Bush plan]

Dr. PETER PIOT: I believe that President Bush's State of the Union speech really was a historic moment in the fight against AIDS. It put the debate on AIDS funding into another league. We moved from the M-word to the B-word, from millions to billions.

NARRATOR: But Bush had decided to sidestep Kofi Annan's Global Fund. It would receive only $1 billion of the $15 billion plan.

Dr. PETER PIOT: I was disappointed, indeed, that not more of the money went to the Global Fund. The Global Fund is extremely important because it works with all countries

NARRATOR: Piot believed the AIDS pandemic required a global response.

Dr. PETER PIOT: We are only at the beginning, from a historic perspective, and we are now entering into the true globalization phase of this epidemic. It's not only the West and Africa alone, it's the whole world now.

NARRATOR: The Global Fund was trying to cover 130 countries. Bush's program, known as the President's Emergency Plan for AIDS Relief, or PEPFAR, would target only 15.

COLIN POWELL: The president's emergency program focused on Africa and the Caribbean first, where the danger was the greatest and the need was the greatest.

NARRATOR: The Bush plan said little about the new epidemic spreading beyond Africa, across Asia and the former Soviet Union.

COLIN POWELL: Countries like Russia, like China and India, they don't need the president's emergency funds. They have resources and funds and assets of their own that they could throw into the job.

NARRATOR: All three countries still denied they even had an AIDS problem.

Guangdong Province, China

NARRATOR: Three months after Bush's speech, that began to change. SARS, a deadly infectious virus, shook the Chinese leadership. At first, Beijing tried to deny the disease. As panic increased, the economy seemed threatened, and then the full power of the communist state was mobilized to fight SARS.

Dr. DAVID HO: It took charge and had a dramatic turnaround. And I think it was a loud wake-up call for the country and it turned the attention of the leaders to health problems for the first time, I think.

NARRATOR: The AIDS researcher David Ho, who'd come to China to help them deal with SARS, saw an opportunity. He organized a conference on lessons learned and on AIDS.

Dr. DAVID HO: We brought former President Clinton to the table to speak to the audience and to speak to the Chinese leadership.

NARRATOR: Out of office, Clinton had made AIDS a personal cause.

Pres. BILL CLINTON: I was at Tsinghua University in Beijing, and I gave my speech on AIDS. There were three deputy ministers of the relevant government departments in China with me at the head table.

NARRATOR: A Chinese activist who was HIV-positive asked a question.

Pres. BILL CLINTON: And just on instinct, I said, "Come up here," because I knew it was being televised nationally. So he came up on the stage and I put my arm around him and hugged him and shook his hand, and I took him over and introduced him to the vice ministers. So they showed this man - he was a human being, a real person - shaking hands with these government ministers. None of them had ever shaken hands with anybody who was HIV-positive before. Within 10 days, the prime minister had 10 AIDS activists in his office, then before you knew it, he was out visiting hospitals of people who were HIV-positive.

WANG LONGDE, M.D., Vice Minister of Health: [through interpreter] With SARS, we came to realize that disease can affect economic and social development, even national stability. In the 1980s, some countries in southern Africa didn't have an AIDS problem, but now their adult prevalence rate is 30, even 40 percent, which is very destructive to national security. This was a great lesson to us.

NARRATOR: The government sent doctors into the countryside along its southern border, where the threat from AIDS was highest. The well-oiled levers of social control, including those used for China's "One child, one family" policy, were turned to AIDS.-

WANG KAIJING, M.D., Rural AIDS Project: [through interpreter] In the past, our birth control department preached about condoms for birth control. Now condoms are also used to help prevent AIDS, so we can continue to encourage the use of condoms and kill two birds with one stone, and it is easy for people to understand.

NARRATOR: For its prevention campaign, China took methods that had worked in other countries. Sex workers got free AIDS tests and learned how to use a female condom when clients refused to wear one. Heroin addicts got counseling, and free methadone so they wouldn't share needles. The government even promised to deliver the triple cocktail.

And the same doctor who was once arrested for helping AIDS patients was made a local hero. But he would find the state's promise of treatment had limits.

GUI XI'EN, M.D., Wuhan Univ. Hospital: [through interpreter] We have 600 patients who are receiving the free drugs. I sympathize with them immensely.

NARRATOR: Dr. Gui could offer only the most basic versions of the cocktail. And since the virus continued to mutate, the drugs could stop working.

Dr. GUI XI'EN: [through interpreter] The problem is that only six drugs are available free. Sometimes, because of side effects, a patient needs an alternative. I've heard that in America, they have 24 different drugs for treating HIV.

NARRATOR: Even with the best health care in the world, the triple cocktail still had to be taken for life.

WILLIAM W. DODGE IV, Clinical trial Participant: I've never missed a dose. I mean, one pill I've missed in all these years. And I treat it like a job. It's my primary job. I have a job to make money, but my real career, my real job is taking these drugs.

NARRATOR: Scientists had realized that HIV never disappeared from a patient's body.

Dr. ANTHONY FAUCI: And then the proof of the pudding was a very depressing experiment we did in which we discontinued drug, and in essentially every one of the individuals, the virus rebounded right back to where it was in the beginning, saying that you could suppress it but you couldn't eradicate it.

NARRATOR: The implications were staggering. To stay alive, patients would need a continual supply of ever more sophisticated and expensive drugs.

Dr. DAVID HO: There is an impression that life could be extended indefinitely, but that's with the best therapeutic options available. In the developing countries, it's quite different. You need your entire therapeutic arsenal that we have available here but they don't in the developing countries.

Pres. GEORGE W. BUSH: Every day in our world, 8,000 lives are lost to the AIDS pandemic. We are fighting one of the great tragedies of human history. We really don't care if it takes a bicycle or a moped to get anti-retrovirals out of these big cities, but that's what we're going to do.

NARRATOR: But delivering the drugs to countries with little or no health care was daunting.

Addis Ababa, Ethiopia

In Ethiopia, one of the world's poorest nations, a military band marked National AIDS Day. The country was about to receive over $200 million from America and the Global Fund. Bureaucrats in the government AIDS office didn't share George Bush's sense of urgency and insisted on control.

NEGATU MEREKE, Dir., Nat'l. AIDS Office: This drug, we should look at it cautiously, and that's why there are a lot of things that could be done before, implementation, before we start implementing. One, we have to have guidelines on how to implement this drug. And two, we have to be able to identify sites-

NARRATOR: Ethiopia had just 2,000 doctors for 70 million people. Only the luckiest AIDS patients could get a bed in this regional hospital. Many thought their lives were about to be saved by free drugs from America.

DANIEL BISETEGNE, M.D., Director, Dire Dawa Hospital: That has been announced on the media, so many people come to us and ask us, "When is this drug going to be available?" Many people come and ask us this question. so the information is there, but the amount of drug that is available for free use is very small compared to the demand.

NARRATOR: When the first drugs finally did arrive, they were locked away while the government refined its guidelines.

BONO: So I had another meeting with President Bush, where I had to complain to him about the speed. And I had said, "Look, you talked about getting the drugs on bicycles and motorcycles, and where are they?" And it got quite heated, and he was saying, "This is very difficult. You do not want to do this wrong." He said, "We're doing this right. And I'm telling you, we are going to do it." And I'm going, "Well, let's see it then."

[www.pbs.org: Read Bono's extended interview]

NARRATOR: In the absence of treatment, prevention is the only option. It made up 20 percent of Bush's AIDS plan. He said one country had shown how a simple prevention message could work.

Pres. GEORGE W. BUSH: You're leading the way here in Uganda. President Museveni and Uganda have pursued a direct and comprehensive anti-AIDS strategy. They're implementing the strategy for the whole world to see, and the results have been magnificent.

NARRATOR: Bush visited Uganda's leading AIDS prevention group.

NOERINE KALEEBA, The AIDS Support Organization: I have met President Bush personally twice, and he strikes me as a very, very passionate and very caring person.

Pres. GEORGE W. BUSH: I believe God has called us into action. I believe we have a responsibility. My country has got a responsibility. We are a great nation. We're a wealthy nation. We have a responsibility to help a neighbor in need.

NOERINE KALEEBA: But when I contrast the President Bush that I have met with the policies and practices that are coming out of the United States, I can't reconcile the two.

NARRATOR: Uganda's program had always included direct and practical messages about sex, and especially condoms. That made many in Washington uncomfortable.

NOERINE KALEEBA: The message that the U.S. is sending out with regard to prevention, the ABC, "Abstinence and Be faithful," and there is- there is some kind of a campaign to be quiet on the condom discussion, which is a disaster.

Sen. SAM BROWNBACK (R), Kansas: We had the ABC proposal, which is the Ugandan model- Abstinence, Be faithful, and then if that doesn't work- it's really AB, and if that fails, Condom distribution as a third part of it. But we even specifically said that 30 percent of the funding needed to go for abstinence-based training because this we know works.

NOERINE KALEEBA: Yes, abstinence works for some people, for some time. But you can't say that abstinence works for everybody all the time.

NARRATOR: Washington set aside a billion dollars to teach abstinence. Franklin Graham's group was one of 11 missionary organizations to receive a total of $100 million.

Rev. FRANKLIN GRAHAM: I want to warn people. I don't want to be prevented from warning them. I don't think I should be handicapped from warning them because my message isn't politically correct with some other group that wants another way to cure AIDS. They want condoms.

NARRATOR: Even President Museveni began to dilute his message. His government began to emphasize abstinence over condoms.

NOERINE KALEEBA: This debate of condom or no condom really makes me angry because I know for a fact my husband had HIV. I don't have HIV. If you ask me to put it on record what actually protected me from his infection, it was a condom.

Rio de Janeiro, Brazil

NARRATOR: In Brazil, the government had instituted a forthright prevention campaign. But when it applied for some of America's AIDS money, it found there were strings attached.

PEDRO CHEQUER, M.D., Dir., Brazil National AIDS Program: [through interpreter] They made one particular demand that we found unacceptable, about prostitutes. Any Brazilian organization that accepted American money was to be forbidden from advocating the legalization of prostitution. Prostitutes are our partners. We could never exclude such an important group. Today it's prostitutes, tomorrow it may be homosexuals.

NARRATOR: In protest, Brazil rejected the American money, over $40 million.

Sen. SAM BROWNBACK: If the Brazilians decide they want to go on another model, God bless them. Go after that model. The United States Congress has thoroughly debated this. We have decided on this. We have articulated a policy, and if you choose not to participate in that, that's fine.

Dr. PEDRO CHEQUER: [through interpreter] We are appealing to other countries to bring pressure on the American government to rely on science. With the large amount of money it is offering to fight the epidemic, the United States can do a great service to humanity, but it must follow the scientific method.

Rethabisans, South Africa

NARRATOR: In South Africa, the science of AIDS had been officially ignored for years.

DOROTHY MAKSALITIBA: And it was very depressing for me because of seeing people dying of HIV and AIDS, knowing that I'm HIV-positive is very hard. It's really- it's really hard.

I was very skinny. I was coughing all the time. I was getting weaker by the day. I was worried that if I die now, what's going to happen to my two sons? What am I going to do? Because I'll be dead. Who's going to take care of them?

NARRATOR: Dorothy Maksalitiba checked into a nearby Catholic hospice, where AIDS patients came to die.

NETTIE MASILELA, Nurse, St. Joseph's Care Center: Dorothy was very sick at some stage, and we were so scared that should Dorothy die, what about these children? The children would be orphans, and who was going to look well after these children?

NARRATOR: South Africa was to be one of the biggest recipients of the global treatment programs, but President Thabo Mbeki had banned the triple cocktail. Activists sued the government, forcing Mbeki's health minister to appear before the high court.

ZACKIE ACHMAT, Treatment Action Campaign: The money had been allocated, the science was clear, the health profession was ready, the country was ready. The only obstacle was the minister of health and the president.

NARRATOR: The court ruled unanimously that the government could not deny AIDS treatment to its citizens.

ZACKIE ACHMAT: It broke the dam wall. It broke the dam wall, in the sense that the country realized, A, that government's denialism is not invincible, and that people unified in action can achieve things.

NARRATOR: Reluctantly, the government began to cooperate with the treatment programs. In late 2004, drugs from the Bush fund arrived at this Catholic hospice, where one of the patients was Dorothy Maksalitiba.

PHARMACIST: One in the morning and one at night.

DOROTHY MAKSALITIBA: OK.

Then I began taking the drugs, and then I saw some improvement on my face, on my feet. And I was gaining weight. I've gained a lot of weight.

SALIM ABDOOL KARIM, M.D., University of KwaZulu-Natal: The wishes and the hopes started being realized. And I can just tell you from my own experience working in a rural poor community, I mean. when we first started working there, our patients were dying and we just- there was nothing we could do. We just couldn't afford it. And we now have all these patients on treatment, and now all you hear about is the patients who are suddenly gaining weight, they're going back to work, and they're encouraging others to get tested. It's changed the whole nature of the discourse.

NARRATOR: But the vast majority of patients had to rely on state-run hospitals, where although the Global Fund paid for the cocktail, the health ministry set priorities.

GLENDA GRAY, M.D., Baragwanath Hospital, Soweto: This country only has 40,000 people on treatment. We have almost 5 million people that are HIV-infected in South Africa- 40,000, that's like a drop in the ocean. You know, if we really are going to turn this epidemic around, we have to march out anti-retroviral therapy. You know, we need a military operation. We need a state of emergency in this country.

Sao Paulo, Brazil

NARRATOR: A decade earlier, Brazil had done exactly that when it promised treatment to every AIDS patient. But the drugs themselves had been a mixed blessing to the woman whose lawsuit had made anti-retrovirals a human right.

NAIR SOARES DE BRITO, AIDS Activist, Brazil: [through interpreter] Terrible. The effects were terrible. I used to think that the medication was going to kill me. There were 10 years of changing medication, getting ill, getting well, with several rare diseases, 10 years of health and illness and changing of medicine.

NARRATOR: Nair Brito's difficulties showed up some of the limits of the drug therapy. Brazil was finding that patients on the cocktail lived, on average, an extra eight years.

PEDRO CHEQUER, M.D., Dir., Brazil National AIDS Program: [through interpreter] Today, the average survival time is most probably over 100 months. That definitely means that patients are now living longer without being absent from work, without having to retire early, with quality of life, and with hope.

NARRATOR: Brazil now spends a fifth of its health budget on AIDS.

DAVID HO, M.D., Aaron Diamond AIDS Research Ctr.: Brazil is much better off than most developing countries. And the way I see it, the therapeutic option at times is only one. You have your frontline regimen, which is typically quite simple, with three drugs, but there is no backup. So when you fail that frontline regimen, you have no other options.

DOROTHY MAKSALITIBA: I'm just praying that they can be available for the rest of my life. I'm just praying to be available until, until.

INTERVIEWER: You believe they will be?

DOROTHY MAKSALITIBA: Yeah, I have to believe that because if I don't believe that, then I'm going to- my health is going to go down back again.

NARRATOR: In KwaZulu-Natal, a nurse and a social worker take half a day to reach the home of Nkhonzeni Ndwandwe. He once spent six years in the gold mines near Johannesburg, and came home to die from AIDS. He now gets free drugs from the Bush plan. But both that plan and the Global Fund will run out of money in 2008.

BONO: I hope these leaders understand that when they make a commitment to a family, a man, woman, child with AIDS, that it's a long-term commitment because if budget cuts bite too hard, you will have the most preposterous sight of people being taken off anti-retroviral drugs. If that happens, it will blow up. It will set fire to any good any of us have been working towards.

NARRATOR: Ninety-five percent of all new infections are in poor countries. In the absence of aggressive prevention programs, it's estimated there will be at least 40 million more infections over the next decade. Treatment programs will never keep pace.

Dr. DAVID HO: I still admire the compassion . I still commend the effort to treat. But we live in a world of limited resources. We have to bear in mind that during the years when this concerted treatment effort took place, approximately 2 million were treated. But during those years, another 15 million or so got newly infected.

RICHARD HOLBROOKE: What we've got here is a tortoise and a hare, in which the tortoise will never catch the hare. The hare is the spread of AIDS, the tortoise is the slow-moving treatment programs. We have to attack HIV/AIDS as we've attacked every other infectious disease in the last century-and-a-half. We have to attack it as it spreads, before it spreads.

Mumbai, India

NARRATOR: India already has over 5 million infections. A conservative country where sexual behavior is hidden, the virus has spread most quickly via sex workers and their male clients, like long-distance truckers.

ARUPA SHUKLA, Population Services Intl.: Truckers tend to live away from home for a very long duration, you know, and there is no other source of recreation, so they tend to, you know, work out that, "This is the only recreation that we have in life."

NARRATOR: India's challenge is to get ahead of the disease now.

ARUPA SHUKLA: We don't want to go the way African countries have gone. Some of the countries, as you know, are completely- you know, have lost their productive population. In the case of India, where the infrastructure is also equally poor, you know, to meet up with such kind of thing would be the saddest thing.

NARRATOR: Back in 2000, the Clinton administration gave a five-year grant to this project, which teaches safe sex to truckers.

SEX ED WORKER: [subtitles] Here is a question for that gentleman. When a man has sex with another man, is there a danger of HIV?

TRUCKER: [subtitles] I don't know.

SEX ED WORKER: [subtitles] You can get the answer from this table.

NARRATOR: While on the road, many truckers have sex with other men.

SEX ED WORKER: [subtitles] When a man penetrates another's anus, it can get wounded, so HIV can penetrate into the other man.

TRUCKER: [subtitles] Nobody told us this before.

NARRATOR: In 2006, a major study showed that as a result of projects like this, infection rates among high-risk groups in south India had fallen by a third.

ARUPA SHUKLA: Our entire aim is that if we can reduce the incidence of HIV, it will be a big achievement for us.

NARRATOR: The project is unsure of its continuing funding. When it came up for renewal, the Bush administration gave it just a one-year extension.

Nearby, in the world's largest red light district, another group found more secure money. The Bill and Melinda Gates Foundation pays retired sex workers to take prevention directly into the cramped brothels.

ASHOK ALEXANDER, Gates Foundation: We don't take a moral stance because we don't think that that's an effective route to intervention. Commercial sex work has been there, will be there. There are factors that drive it. And our effort is to make commercial sex work safe.

I've asked the question, "Why do you do this when your life is at risk?" I've had a commercial sex worker tell me, "Look, I do it when my kid's got a high fever and may not be alive tomorrow morning, and I need the 50 rupees for milk or medicine." What's morality got to do with that? It's all about vulnerability. It's all about poverty. And that woman is doing it because she has to do it.

SEX WORKER: [subtitles] I didn't come here willingly, I was brought here by force.

HELENE GAYLE, M.D., Gates Foundation: More and more, we're seeing the face of HIV is a woman who may be monogamous and may even be married, who's at risk for HIV because of her husband's behavior. If we're serious about saving lives, we need to face the realities and meet people with options that are realistic for their life circumstances.

NARRATOR: A major scientific effort could offer real hope for prevention. Researchers are developing a gel to kill the virus on contact. This microbicide would protect women whose partners refuse to wear a condom.

Dr. HELEN GAYLE: There are a variety of different ways in which a microbicide might actually work, but at the core of it, it would be a product that women could use that would protect themselves from HIV.

Dr. ANTHONY FAUCI: There are a lot of good things about microbicides, if we can get one that works, probably the most important of which is that it empowers women be able to have a mechanism whereby they can protect themselves without their male partner knowing. It would be very important.

[www.pbs.org: More on microbicides]

NARRATOR: Five microbicides are now in advanced clinical trials-

Pres. BILL CLINTON: This is, after all, a disease that's 100 percent preventable. We're all in a race to get ahead of this thing. And it's a challenging endeavor because of the way the AIDS virus, in effect, invades the cell, reconfigures the DNA. I don't know if there'll be a cure in my lifetime, but I think there will be an effective vaccine.

NARRATOR: But the scientists who've devoted their lives to the study of the virus are cautious. A vaccine remains elusive.

Dr. DAVID HO: There are 40-some million people with the virus at the moment. We know the rate of increase is approximately 5 million new cases per year. We still don't have a vaccine. We have drugs that are very helpful, but we don't have a cure.

Dr. ANTHONY FAUCI: With vaccine, we've really been stymied, and that is due to the very special nature of this virus. It's really unprecedented in what it can do, the rapidity with which it can multiply or replicate, how it can change.

[www.pbs.org: The quest for a vaccine]

Dr. DAVID HO: Even if we come up with a cure or vaccine tomorrow, just think about the time that would be needed to implement all these measures widely throughout the world. So to me, it's clear that I'm not going to see the end of this epidemic. And it's also pretty clear that my children won't see the end of this epidemic. I think we've won a few battles. I think most of the time, HIV wins.

MEL PRINCE, Selma AIDS Info. and Referral: We are still putting ourselves at risk. And I say ourselves- I'm an African-American woman. It's happening. We want to turn our backs and pretend it's not happening, but it is. It's happening every day, and there are people spreading it and not thinking anything of it

WILLIAM W. DODGE, IV, Clinical trial participant: The younger generation don't know what an 80-pound purple-spotted man looks like. I mean, the visuals of AIDS in the `80s and early `90s were quite startling. We don't have that anymore. But there's also something that I'm seeing that's really, really disturbing. I'm seeing friends of mine who got on these drugs, did wonderfully, so now they want to be party kids and they want to not use condoms anymore and do crystal meth and do all sorts of crazy drugs. And they're throwing it away, and that's really, really sad.

NAIR SOARES DE BRITO, AIDS Activist, Brazil: [through interpreter] My focus now is to work with women, poor women who in their daily lives encounter violence and inequality. All of this generates vulnerability. No medication can take care of hunger, physical violence, moral violence, and the poverty that surrounds them.

ZACKIE ACHMAT: We can't win anymore. There's no way we can win. The death toll is already at a high, even in our country. But what we can do is, we can mitigate the disaster because through mitigating the disaster, we can show our humanity. Beating HIV? HIV's going to be with us for a generation or more.

NARRATOR: The numbers are staggering: 30 million people have already died. HIV has found its way into every country, into every stratum of society, even into the family of a president. Recently, Nelson Mandela's son died of AIDS.

Dr. PETER PIOT: When you think of it, that in, let's say, 25 years, roughly, that about 70 million people have become infected with this virus, probably coming from one at some point, it's mind-blowing. All these people are connected with each other by definition because they had sex with each other, they shared needles, they got a blood transfusion from someone who got it, or their mother had it. That's it. There are no other ways of transmission.

It's incredibly well adapted to us. It's a very- let's say a human virus, a very human epidemic. It touches right to the heart of our existence.

Dr. GLENDA GRAY: Do you have any questions you want to ask me?

LITTLE GIRL: Yes.

Dr. GLENDA GRAY: Yes? What do you want to ask me?

LITTLE GIRL: Why am I positive?

Dr. GLENDA GRAY: Hmm?

LITTLE GIRL: Why am I positive?

Dr. GLENDA GRAY: Why are you positive? OK. You've got a virus in your blood, OK, which makes you HIV-positive. So that's why you're positive, OK? You've got the virus. I don't know if your mum told you where she got the virus from.

Did you explain to her?

MOTHER: No.

Dr. GLENDA GRAY: OK. Well, one day when you're bigger, she'll explain how you got the virus. But at the moment, if you take your medicine, the medicine stops the virus.

 

THE AGE OF AIDS

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Part Two
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ANNOUNCER: This report continues on FRONTLINE's Web site. Explore how HIV crossed species to infect humans and how it destroys the body, a global map showing the staggering numbers of infections and deaths and how nations have responded, a multi-media timeline of breakthroughs and setbacks in fighting the pandemic, special reports on where the money is going to fight AIDS, the pharmaceutical industry's response and the controversial issue of making HIV testing widespread, plus interviews with top scientists, officials and others on the front lines, first-person accounts of what it's like to live with HIV, and the chance to watch the program again on line. Then join the discussion at pbs.org.

Next time on FRONTLINE: These women have a difficult decision.

TERRI HERRING, Pres., Pro-Life Mississippi: It should be uncomfortable to kill your unborn baby.

ANNOUNCER: The law says it's their right-

WOMAN: This is between me and God.

ANNOUNCER: -but in parts of America, it's almost impossible to get an abortion.

TERRI HERRING: The last abortion clinic cannot stand on earth.

ANNOUNCER: Does Roe v. Wade still matter?

BETTY THOMPSON, Jackson Women's Health Organization: The law is going to be on the books, but nobody will be able to access the service.

ANNOUNCER: The Last Abortion Clinic on FRONTLINE.

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