Treatment, employment and art - tools in the battle against HIV/Aids in South Africa

It all began five years ago with a chance conversation over dinner during a relaxed holiday in the Eastern Cape. The publisher John Brown, who made his name and fortune through Viz magazine, was on holiday with his family, staying with friends in the small and disarmingly beautiful town of Hamburg.

He spent a relaxed week, walking on the beach, swimming and eating at the beach-shack restaurant Dorrigo's, a laid-back sort of place run by a Portuguese from Mozambique. Setting up an Aids charity was not on his agenda. But midway through his stay, he and his wife, Claudia, had a meal with a remarkable couple, Carol and Justas Hofmeyr.

Mr and Mrs Hofmeyr are doctors and they had moved to the seaside town the previous year from Johannesburg. Mr Hofmeyr was working during the week as head of obstetrics at East London Hospital. His wife had retired to Hamburg to pursue her other passion in life - art. She had a fine arts as well as a medical degree and, in her late-50s, had decided to paint, and to set up a local arts project. But she found it impossible to turn away from medicine. Aids cases were reaching pandemic levels in the region, one of the poorest in South Africa. So Mrs Hofmeyr had started treating HIV patients and dispensing drugs and advice.

She told Mr Brown that despite the rising rates of infection she saw glimmers of hope. She had come to know a woman called Eunice Mangwane, who had family in Hamburg, and had been trained in HIV/Aids counselling in Cape Town. Ms Mangwane, was a potential saviour, she said, a warm, intelligent, charismatic can-do woman who had spent the previous few weeks educating the women of Hamburg in HIV awareness and prevention. If only she could stay on. Mr Brown was intrigued, "How much would it cost to sponsor Eunice?" he asked. Around £6,000 a year he was told. The money was found.

Ms Mangwane, who had been thinking along the same lines, was delighted. She would start with Hamburg and then go to the villages in the region, talking to the elders, then holding meetings for the women: telling them the truth about HIV/Aids, and arranging, as far as she could, for medical treatment. At the time, the South African government was in denial about HIV/Aids: there was no official information.

Within a few weeks, the team were sourcing antiretroviral (ARV) drugs from abroad. Within months, they had set up a clinic in Hamburg, where patients would be brought in from the villages, given ARVs and nursed back to health. Within a year, Ms Mangwane had trained the first of her "adherence monitors" - village women, often HIV-positive themselves, who would identify HIV patients, accompany them to the clinic, and return home with them, after treatment, and visit them daily to make sure they were taking the ARVs.

I came across the scheme six years on, recruited by John Brown, along with 25 of his friends, to make a fundraising trip. "Come and see the place," he enthused. "It will be one of the most important things you ever do. And you can raise £3,000. That's what everyone else has promised to do." Nothing could have prepared us for the reception in Hamburg. The whole town had turned out, singing our way in, with hymns and anthems.

Over the next couple of days it became clear how much Mrs Hofmeyr and Ms Mangwane and their adherence monitors and network of volunteers had achieved. We began with a visit to the Keiskamma clinic, a building so palpably well-run, that you would be glad to find it in any country in the world. We met patients and cooks and drivers, who ferry villagers in makeshift "ambulance" saloons, and saw the beautifully decorated new nursery.

Something I had not grasped about HIV/Aids before visiting Hamburg, and talking to the Hofmeyrs, is just how effective ARVs (which are now made in South Africa and provided by the state) have become.

And if children are put on ARVs, before any complicating illnesses take hold (TB is the biggest killer of Aids patients in South Africa), their prognosis for life is good. Even more important, ARVs are crucial in preventing babies from being born with HIV. A pregnant woman with HIV has a 23 per cent chance of having an HIV-positive baby, but if she is on ARVs that probability is reduced to less than 1 per cent.

Rural South Africans often have an extremely poor diet, which compounds their health problems. So teaching the patients how to cultivate green vegetables, to add to the routine mielies (corn) and meat, was all integral to the Keiskamma plan.

And there was food of a different kind down the road, where we were greeted by the Keiskamma art workshop. Even if there were no Aids treatment centre in Hamburg, this would be a remarkable story. Staffed by volunteers, the workshop provides employment for up to 80 women, who learn and practise skills of embroidery, felt-making and other crafts. They produce bold and brilliant designs, often drawing on the local Xhosa culture of cattle herding, to decorate cushions and bags and cloths, which are then sold around the country. And it is hard to overstate how important (and how hard) it is to provide village employment where there is, literally, none.

But the really extraordinary achievement of the Keiskamma workshop is its public art projects. These have involved more than 100 women and men in the village, and have provided self-respect and a sense of pride, belonging - and an acceptance of Aids and the battle to live with and overcome it. The first project, initiated by Mrs Hofmeyr, was the Keiskamma Altarpiece - a huge work with multiple panels, composed of embroidery, appliqué, beadwork and photographs. It was inspired by Mrs Hofmeyr's interest in Mattias Grunewald's medieval Issenheim Altarpiece, which was completed in celebration of the end of plague. But the Keiskamma imagery is entirely local, showing Aids patients and funerals, the strength of grandmothers rearing young children, and a message of hope and redemption in the face of Aids. It is currently on extended tour in American churches, where it is used to raise money for Keiskamma projects.

Keiskamma's second public art project was even more ambitious: a local version of the Bayeux Tapestry. This time, Mrs Hofmeyr involved not just Hamburg but a number of outlying villages, whose women created embroidered panels representing their Xhosa culture and the history of the Eastern Cape. When stitched together, it turned out to be 120 metres long.

The Aids clinic, the gardens, the workshop, the art are fantastic achievements: humbling, and utterly inspiring. Those of us who were privileged to visit the town this spring will help to support the projects for as long as it is needed - but the scale of help that is required stretches to a distant horizon.

For more information, visit www.keiskamma.org

Mark Ellingham is founder of the Rough Guides travel book series