A drug intended to treat HIV and AIDS is sweeping the townships of KwaZulu-Natal, South Africa. It is cheap and powerfully addictive.
"Nightline" witnessed the drug's effects upclose on a 17-year-old addict we're calling Joshua to protect his identity. A high school junior from a middle-class neighborhood in Durban, he said his parents would kick him out of the house if they knew. And yet he smokes the drug every day before and after class, despite his dreams of becoming a doctor.
"Once you've first started there's no turning back," he said, adding that he wants to stop using but can't.
When he uses, "it feels like you got no problem at all. Like yesterday if you killed a person and you smoked this thing you wouldn't remember that you killed a person yesterday."
The drug Joshua and his friends are abusing is the anti-retroviral Efavirenz. When taken properly, it's part of a lifesaving treatment for HIV patients. When crushed and smoked, it's a cheap high with no medical benefit.
When the teenagers finished smoking, they didn't have to hide. Everyone in the neighborhood seems to be aware of what they're doing, and they say the same was true when they went to purchase the drug.
South Africa has one of the highest HIV infection rates in the world and KwaZulu-Natal province has the highest rate in South Africa -- 40 percent. For the infected, anti-retroviral drugs, or ARVs, are the only things standing between life and a painful death.
The drug is so cheap and plentiful, thanks in part to a well-meaning effort by the American government to distribute ARV', a program that has helped extend the lives of more than 500,000 AIDS patients.
But as the medical director of one U.S.-funded clinic said, ARV abuse is threatening to turn an HIV success story into a health crisis.
"It's extremely frustrating," said Dr. Njabulo Masabo, from the AIDS Healthcare Foundation. "It's extremely, you know, discouraging because on one end you're trying to fight this epidemic that has ravaged the world so much ... the results are catastrophic."
Drug Dealer: 'They Shouldn't Blame Me'
How ARV abuse began is uncertain. Taken as prescribed, Efavirenz can cause vivid dreams. Someone -- possibly an HIV patient experimenting -- discovered that smoking the drug greatly enhances those hallucinations.
Today, some of the illegal drugs come from HIV patients selling their own lifesaving medication for profit. Others are stolen from patients or pharmacies.
Pharmacies in the townships have banklike security. The drugs are kept behind vault doors, because they have an enormous black market value. Just one container of the ARVs is worth $60, and a whole shelf is worth $3,000.
Driving through the townships, a local AIDS health worker named Zola Shezi showed us the extent of the black market in ARVs. She saw drug dens everywhere; one she identified had children playing right outside.
"Just here, the man he owns the house, he built all these rooms … one, there's one room where his customers stay and crush and do things."
The few police we saw did nothing.
In just three years, ARVs have grown from a niche drug abused by a small number of HIV patients into a widespread addiction, increasingly among young people.
Many ARV abusers are young students, and in a neighborhood like the one we visited you'll find dealers on almost every street, selling to students during school hours and just after.
In his house that doubles as a drug den, we met one of the dealers face-to-face. Dinda -- he gave us a false name to hide his identity -- said he earns many times what he could make, if he could find a job.
He acknowledged that the drugs are meant for people with HIV, but said "nobody can give me that money while I'm sitting at home; I have to go and do something for money."
Recounting a story that's not unusual in the area, he said he's the only one of eight siblings still alive. His siblings were all victims of HIV or gang violence, leaving him to take care of a large, extended family.
"I'm unemployed, four of these years I am not working, if I can stop this we can all suffer," he said. "So they shouldn't blame me for what I'm trying to make a living out of."
HIV Could Build Resistance to Medication
For families of abusers, it's a very different story. ARVs are powerful enough to turn even young people into violent addicts. We met Dudu, who told us her 21-year-old son steals from her to pay for his habit.
"Sometimes if I said I'm going to call the police he said he going to kill me," she said. "I believe him."
Now, South Africa may soon face a deadly consequence of ARV addiction. By smoking the drug, abusers are in effect giving HIV a small taste of anti-retroviral medication -- not enough to kill the virus, but enough for it to potentially develop resistance to the drug.
It's like "educating the HIV," said Masabo. "And so you'll find that we have a second epidemic emerging, an epidemic that we cannot control with the current drug that we have."
Back in the drug den, the teenage addict Joshua told us what happens to HIV patients isn't his problem.
"I feel guilty sometimes, but hey. I know what I'm doing is wrong, but what I've started I must carry on."
The cemeteries of South Africa are already crowded with victims of HIV. Now, a new danger is threatening to put the country's best defense up in smoke.