PINETOWN, South Africa -- The 35-year-old high school teacher named Bheki was lucky to be alive, thanks to the free antiretroviral pills that kept his HIV in check. He felt strong and had no side effects. Life was normal, as normal as it gets with an incurable disease.
Then in February, he ditched the pills and started taking a mystery potion sold here outside Durban. It is made by a former truck driver who says his late grandfather came to him in dreams with the recipe for an herbal drink that could reverse HIV's march to full-blown AIDS and death. Eager to banish from his body the virus that stalks one in five South African adults, Bheki instead found himself sicker than ever. Three months later, he begged his doctor to put him back on antiretrovirals, only to find that he has built up a resistance that makes the pills less effective.
The makers of the herbal remedy "said I was going to be cured," said a weak-voiced Bheki, who gave only his first name because of HIV's powerful stigma. "They're putting people's lives in misery."
Across Africa, untested and unregulated traditional therapies are flourishing even as Western medicine becomes more widely available. Despite the health risks, many people prefer the old ways for various reasons, such as suspicion of "white" science or evidence that some home-brewed tonics can alleviate some ailments.
And South Africa's government loudly champions such age-old practices that for decades were dismissed as witchcraft by the apartheid regime.
Nowhere are the stakes higher than with HIV/AIDS, which kills nearly 900 South Africans a day. Doctors say uBhejane, the herbal drink Bheki took and some 2,000 others still take, is the latest in a long line of alternative therapies.
When Bheki visited the uBhejane "clinic" tucked off a busy street, he said the staff warned him not to continue taking his antiretrovirals, or ARVs. "I have to stop using them and then use this stuff," he recalled being told.
"It's a horrible disservice," said his physician, Dr. George Chidi. Nine other patients of his, including a nurse, have taken the same path. Bheki's tuberculosis has come roaring back, and Chidi suspects that the uBhejane damaged his liver.
"He's quite ill now," Chidi said. "He restarted the treatment, but I don't think it's working."
When told about Chidi's 10 patients, the chief spokesman for South Africa's health minister expressed no concern. "As we have heard that story," said Sibani Mngadi, "we have also heard the stories to the opposite of that" - that is, success stories.
South African law does not regulate traditional health practitioners or the remedies they dispense, he said. And his boss, Health Minister Manto Tshabalala-Msimang, a physician, avidly supports natural remedies as "African solutions."
"We emphasize there needs to be choice," the spokesman said. "People who want to use antiretrovirals, let them use them. But those who think through consultation with their traditional health practitioner and feel they need to use traditional medicine, they have a right to do so."
Zeblon Gwala, who makes uBhejane and whose supporters include the mayor of Durban, defends his product. "You talk to the wrong people," he said when asked about Bheki. "All the results I got, I never find a negative." Citing confidentiality, he said he could not arrange a meeting with patients who have thrived.
Gwala says while people should not take both ARVs and uBhejane, he denies telling anyone that they should stop ARVs or that his product can eliminate HIV.
"I never say it is a cure; my staff would never say that. I say uBhejane is healing people who [cannot work]. I'm waiting for the result from scientific people to say what uBhejane does, a cure or whatever. People are suffering. They can choose, if they want, to take my concoction."
Treatment of HIV/AIDS has long been a touchy subject in South Africa, a land of 47 million. President Thabo Mbeki once asserted that HIV could not be the sole cause of AIDS. Today he seldom speaks of the disease that afflicts some 5.5 million South Africans - more than anywhere after India.
Critics of Tshabalala-Msimang, the health minister, have long claimed that she overstates the side effects of antiretrovials and the benefits of garlic, olive oil and other nutritional supplements. They have denounced her for voicing support for Matthias Rath, a German vitamin seller who calls ARVs "poison." At last week's Toronto AIDS conference, members of the Treatment Action Campaign vandalized the country's booth, with its display of garlic, lemon and beetroot, and chanted "Fire Mantow now," according to news reports.
Despite a belated rollout of ARVs that began two years ago, South Africa has pumped nearly $1 billion into treatment, though doctors say waiting lists are common for free drugs. Since fall 2004, the United States has devoted $162 million to help South Africa with drugs and support services. All health insurance plans here now must provide coverage for ARVs.
Doctors say widening availability is encouraging more people to get tested, reducing stigma - and keeping people alive. A recent study found that 93 percent of the HIV/AIDS sufferers on ARV medication were alive after a year.
Some physicians believe that traditional medicine can complement Western health practices. But several doctors said they could not put uBhejane in that category because Gwala will not reveal his ingredients. "It could be dishwater," said Dr. Dennis Sifris, an HIV specialist in Johannesburg. "We have no idea what's in it. It's magic. It's hocus-pocus."
Sifris is medical adviser to Lifesense Disease Management, which tracks 8,500 HIV-positive patients for health insurers. Every week, his staff gets four or five reports of someone leaving ARVs for uBhejane.
Sometimes patients die. Dr. Goodman Vilakazi had a 36-year-old male patient who was told to stop ARVs. Vilakazi wrote that "the patient took [uBhejane] for about two weeks, developed unknown complications and demised thereafter."
Without blaming uBhejane for the death, Vilakazi called it "a case of sadness, for the patient was doing extremely well on antiretroviral treatment, with his CD4 count raised from 24 to 384." The CD4 count gauges the body's ability to fight disease, and doctors here typically prescribe ARVs when it drops below 200.
In the United States, if a company falsely claims a product can cure or treat a medical condition, the Food and Drug Administration could issue a warning letter or conduct an inspection. Depending upon the claim, the agency could require the company to apply for approval to sell it, a long process requiring scientific studies.
In South Africa, the Parliament passed a law two years ago to regulate traditional medicine. But an interim council that was supposed to draw up standards has not been formed. And on Thursday, the Constitutional Court invalidated the law, ruling that Parliament did not allow enough public participation. The court gave lawmakers 18 months to seek more input.
Despite the Health Ministry's assertion that traditional medicine therefore remains unregulated, the main opposition political party claims that uBhejane violates the Medicines and Related Substances Control Act. The Democratic Alliance has sought an investigation, and the provincial prosecutor says a probe is underway.
Before he began selling uBhejane, Gwala, 49, drove trucks across Africa. At some point his grandfather, a traditional healer who died in 1969, began visiting his dreams, he says.
It took years for him to dream about all 89 herbs. In 1997, he began mixing the substance, and for years quietly sold uBhejane ("black rhino" in Zulu and pronounced OOH-buh-johnny) as word of mouth spread.
He calls his establishment the Nebza HIV & AIDS Clinic, and a sign outside says he is "Doctor Gwala." He has a staff of eight, himself and his wife. Five work at the small factory, the others at the office he calls the clinic.
All day customers stream to the window counter. Some ride in taxis, and others drive themselves. The two-liter jugs cost $25, a hefty sum, since a third of the population lives on less than $2 a day.
A batch of 1,000 jugs can sell out in two days.
One recent afternoon, Thuli Nxele traveled an hour to pick up a supply for her father. Though she does not know if he is on ARVs, she credits uBhejane with boosting his health. "He was sick before, and now he's working," she said, walking away with two unlabeled plastic jugs filled with liquid the color of cider.
When people start on uBhejane, Gwala says, they must take two types on alternate days, one to raise the CD4 count and one to lower the viral load. After two weeks, they are to take one jug weekly of the latter type for six months, or "until your viral load is untraceable; you can stop there."
Gwala says he explains this to new arrivals. But Lydia Mabaso bought four jugs for a cousin who lives hundreds of miles away in North West Province, and all she gave the receptionist was a bank deposit slip proving she paid $100.
"They don't ask me nothing," Mabaso said later of the receptionists. They did not even ask her cousin's name.
To that Gwala replied: "We try to collect data. It's not very important to us. What's important to me is saving lives of that victim."
Later that day, M.D. Sithole stopped to buy four jugs for his 33-year-old sister, whose CD4 count is not low enough to warrant ARVs. The liquid works "if you believe it," he said outside. "It's in your mind. It's worth trying. Nobody knows what's the cure. I know plenty of people taking it."
Gwala says he wants a clinical trial. Last year he approached the deputy dean of the University of KwaZulu-Natal medical school. But the dean felt it was too soon for clinical trials and urged lab tests. Those showed that uBhejane is not toxic to cells and kills or limits bacteria. He is testing uBhejane on HIV in the lab, but results have not been released.
Gwala also asked a Catholic-run AIDS hospice if he could do research on residents. He supplied free uBhejane even after nursing supervisor Sue Bloom explained that "we can't go giving substances to patients when we have no idea of the content."
For some, the mystery of the ingredients poses less concern than do antiretrovirals.
Despite their life-extending properties, the pills are sometimes scorned as poison because of their side effects.
Wanda Xaba, 25, recently started her 6-year-old son Mxolisi on uBhejane. The boy was diagnosed with HIV this year. His mother and father both have the virus; none are taking ARVs.
Although the pills cost less than uBhejane, Xaba said she would rather scrape together money for Gwala's product. She has no intention to seek free ARVs from a clinic.
"I won't because they say uBhejane is better than ARVs. ARVs kill people, and uBhejane makes people get well and healthy."