Putting Lives in Peril
Aiming to Be 'Very, Very Sick'
By MICHAEL M. PHILLIPS
April 7, 2006; Page A1 Wall Street Journal
DURBAN, South Africa

Zolile, a 25-year-old single mother, is one of the lucky few here who receive advanced anti-AIDS drugs free from the government. The pills work just the way they're supposed to, boosting her immune system, relieving her symptoms and restoring her health as long as she takes them twice a day.

That's why she stopped taking them a month ago.

Her decision represents an unexpected twist in South Africa's AIDS crisis. The South African government gives Zolile antiretroviral "cocktails" to make her healthier. It will also give her a $130-a-month disability grant -- but only if she gets sicker than she is now. And if she takes the drugs, she probably won't get sick enough to qualify for the cash.

For Zolile, the right choice was painful but clear. "I want to get sick so the doctor will give me a grant, and my children will have healthy food," she says, speaking on condition that her family name not be used. "Even if I die, my children will be better taken care of."

Medical workers, activists and academics in South Africa have been startled to discover that a number of impoverished AIDS patients are making the same decision, risking death in order to secure welfare assistance.

"Poverty and hunger are capable of driving people to do the unthinkable," says Suzanne Leclerc-Madlala, head of the anthropology department at Durban's University of KwaZulu-Natal, who has studied the issue.

Why are people shocked? We have known for centuries that the way we treat human behavior will cause rewarded acts to get stronger and punished acts to get weaker. South Africa is rewarding sickness and punishing health yet they are "shocked" when people follow the rewards.

Common sense tells us that this will usually happen so we need to devise ways to offer quick rewards for those who act responsibility. The personal motivation to get better is more important than any miracle drug or heroic doctor. This, along with the positive support of family and friends is essential to good health.