As South Africa prepares to lose more than 4 million people to Aids over the next decade, its universities appear to be the country's best hope for survival. Karen MacGregor reports.

Like Banquo's ghost, HIV wrought devastation in South Africa while most of its citizens were unaware of its existence. But, with 4.7 million now infected and tens of thousands dead or dying, the disease's true face has been revealed and people are being forced to face its terrible reality. Indeed, this unwelcome guest has taken a seat at the head of the table and is making its presence felt in every corner of South African life.

For years HIV-Aids was placed on a back-burner by a government reluctant to accept its threat and preoccupied with pressing demands for change in a new democracy. But now it pervades home and work, morality and the media, the economy and development, law and justice, the church, health and education, and personal and sexual relations.

In ÖйúAƬ, too, the challenges thrown up by HIV-Aids are urgent, multiple and monumental. The South African University Vice-Chancellors' Association is at last drafting a national plan against the disease, aimed at encouraging existing initiatives, devoting more resources to Aids-related work, building capacity to respond to the crisis and encouraging cooperation with other African universities.

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While university departments are producing reams of research about the disease, they are also morally bound to help prevent infection among students and staff, to accommodate those who are infected, and to produce graduates equipped to manage the pandemic. Among those rising to these challenges, the University of Pretoria is leading the way.

"Several universities have made really good HIV-Aids statements, but are, as yet, unable to back them up with any more than a few limited initiatives," says Mary Crewe, director of Pretoria's two-year-old Centre for the Study of Aids. Crewe, originally an education lecturer, went from theory to practice by running the Greater Johannesburg Aids Project for the Metro Council before launching the Pretoria centre.

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"The difference here is a highly complex response to Aids that starts with total commitment from rector Johan van Zyl and senior management, and with an intellectual understanding that the university will have to fundamentally change in order to respond adequately to the epidemic - that includes everything from the way we teach and learn to student recruitment and support."

Crewe is coordinating a flurry of projects, ranging from prevention campaigns and a volunteer corps of students working against Aids, to support for the infected, staff training in Aids management and inserting Aids into curricula at all levels.

One example is the multidisciplinary development by students of a kit for the home care of people with Aids: medical students are investigating medications that could be included; law students are compiling material explaining the rights of sufferers and sociology students are investigating ways of positively changing attitudes towards those with Aids.

Government statistics published in March show that South Africa has one of the highest HIV rates in the world. By last year, one in four pregnant women, and one in nine people in a country of 42 million were carrying the virus, a 12 per cent rise on the previous year.

Conservative estimates suggest that more than 4 million South Africans will die from Aids-related illness over the next decade. The Development Bank of Southern Africa calculates that the country's population will begin to contract by 2016, when the number of Aids-related deaths will exceed births, while the South African Institute for Race Relations predicts that average life expectancy among black people will drop from nearly 55 years to 47.2 years in the next ten to 15 years, before it rises again.

Like all major problems facing the developing world, the HIV-Aids epidemic is so massive as to seem unconquerable. It is easy to be overwhelmed during a stroll around any campus by recalling that as many as one in four of the fresh-faced undergraduates passing by is, according to estimates, infected by the virus and will die young.

But what is the best way to respond to the pandemic - to break down the different problems it throws up into manageable elements, or to approach it from some different perspective?

Crewe supports the latter approach, because Aids in South Africa, a society in transition with a traumatic recent history, has its own particular make-up. "In a sense, we need to see what good can come out of this epidemic. We must convince students that, although there will be unparalleled suffering, although the epidemic will be brutal and millions will die, our response does not have to be defensive. There are different ways of seeing what its impact will be on families and communities, on the economy and the delivery of services. Universities and students can find new ways of looking at democracy and society, of using Aids to foster a new South Africanism rather than letting it tear us apart."

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She also argues that universities have to take into account the economic and moral impact of the virus.

First, South Africa needs to ensure that it will survive HIV-Aids. "Aside from generating crucial research, for us the challenge is to produce graduates who understand the epidemic and are trained to help manage it. Also, universities must survive the epidemic in terms of enrolments, funding and the economic impact.

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"The moral imperative is to try and prevent infection among staff and students, and to ensure that those who are already infected feel that the university is a nurturing environment. We are trying to create mainstream Aids-awareness through everything the university does."

Work on HIV-Aids in this huge institution, with 30,000 full-time students and 20,000 on satellite campuses, is coordinated through Crewe's Aids centre and an inter-faculty committee of senior academics.

Pretoria has a large student HIV-Aids outreach project. Volunteers each receive 20 hours of training on HIV-Aids and then elect what they want to do, be it putting up posters, working in the campus health clinic, providing counselling, working on media development or working in hospitals and the community.

The centre also runs extensive staff training programmes covering everything from how to deal with Aids in the workplace to human rights, employment equity laws and providing support and counselling for infected people. Union representatives are being trained to be responsible for members who become ill.

There is also intensive Aids-in-the-workplace training for selected students, while faculties are responsible for inserting HIV-Aids into curricula. This has been highly successful, largely because it has the full support of the deans.

"We know that we are preparing our graduates well because employers tell us that their HIV-Aids understanding is having an impact in the workplace," Crewe says. "We have achieved an amazing amount, given that we are only three people. I believe we are the only university in the world that has made a total commitment to changing the way it looks at itself in terms of HIV-Aids and to graduating students who are properly equipped to deal with the epidemic," Crewe says.

Nobody knows exactly what the impact of HIV-Aids on the sector will be. Most people think that students will be through ÖйúAƬ before they become sick, and that HIV-Aids will thus not affect the way universities operate.

"While this is largely true, people are being infected younger and many are already quite ill when they become students. Universities need to think about difficult issues, such as how they invest in treatment and who they recruit into postgraduate programmes."

Crewe believes that South African institutions have focused on scientific research into HIV-Aids while neglecting the need for social scientific understanding of many issues, such as how sexual and cultural practices impact on the epidemic.

The University of Pretoria is hoping to draw on the work and experience of other institutions to fill this and other gaps in its knowledge of HIV-Aids.

It is cooperating with universities in South Africa, Namibia, Botswana and Lesotho, and hopes soon to finalise a collaborative project for social science research into HIV-Aids with three overseas institutions - the University of New South Wales, the University of Toronto and the Thomas Coram Research Unit, part of the Institute of Education at London University.

"The three foreign institutions have extensive knowledge of managing groups and individuals with HIV-Aids, while we offer experience of a major evolving epidemic and, because of our circumstances, of dealing with HIV-Aids from a different perspective. This collaboration has yet to be formally approved by the institutions involved," Crewe says, "but we believe it will be a powerful project."

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