Naledi arrives at our cottage, early. Tumelo has not turned up. She sent him a message at 6am, has called him since, but his phone is switched to voicemail. We postulate all sorts of things - traffic, he has lost his phone, an accident. A neighbour saw him leave the house. Naledi says that if he has decided not to come, she will be very angry. As she says he was “a dead man“ when she took him in hand, slowly persuading him to get an HIV test, and then treatment. She nursed him back to life, feeding him (he could eat very little) and slowly slowly, persuading him that he could work a little, and finding him a part time gardening job. I am impressed by her clarity. She is not frightened to be angry, and she is very articulate. Treatment is overshadowed by worry about Tumelo. I am concerned for his safety, especially given Naledi‘s recent experience with workmen. Her township is not a very nice place (her words). It used to be nicer. She owns her own house. This will be small, possibly not much more than a shack, one or two rooms, and it has a value. She bought it so that she had something to leave to her son when she died. Hopefully, we have now extended that time, and her son, being well-educated, will be able to get a job. She thinks that to be safer, she would have to move, but whilst some areas are safer than others, my fear is that with the amount of poverty, lack of employment, alcohol and drug use, HIV infection, and hopelessness, and poor policing, crime is pretty much inevitable. I had thought that much poverty arose because weakness caused by HIV infection made it impossible for people to work. It is true that in some rural areas it is really difficult to find workers for the farms and other industries because so many workers have died or are too ill to work. And there is a problem with unemployment which is far greater. South Africa needs to create employment, needs to find a way for its people to recover self-esteem, so that alcohol and drug use subside.
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| Woman and child in a township near Cape Town |
I am really struck by how HIV/AIDS damages spirit. How men would are meant to be proud and strong and spirited become skinny, angry, resentful, demanding, and how women who should know that they are beautiful are harrowed and anxious. How both can forget their children, and how, whether or not they are forgotten, those children are often left abandoned. South Africa has, according to different estimates, between 1.4 and 2 million AIDS orphans. Often, dumped on the street. Some orphanages have places ( a kind of hole in the wall) where babies can be left anonymously. They are well used. See Michaela’s film, The Starfish Principle, available from the charity, Life Stride, which looks at some of the wonderful ways in which people help.
And yet, anti-retroviral drugs are available here. South Africa is a rich country. There is aid. Charities pour in huge amounts. Mother to baby transmission of HIV is completely preventable Why is it so bad? A mix of lack of education, unhelpful beliefs, suspicion of whites, the limited range of ARVs available and lack of skilled medical staff meaning that ARV side effects often being perceived as worse than the infection itself, and the perceived lack of a real solution. In the west, and here, amongst the well-informed with resources, ARVs have transformed HIV infection into a manageable chronic condition, like diabetes or heart disease. But not amongst the poor here, and certainly not amongst the rural poor. They describe ARVs being made available on a “take it or leave it” basis. “Here they are, take them religiously every 12 hours whether you have food in your belly to make them tolerable or not, pick them up every two weeks, or die” .
It does not seem surprising to me that people deny the existence of a problem when there seems to be no solution.
I want the HIVEX equipment, which is portable, and can be used simply once it is set up to treat large groups without side effects to be used in rural communities. In church halls, even, sitting around a tree, outside. It is very complex equipment, expensive to build, and once built, its operation is simple. Since its safety is accepted (it is very low power, and can be powered off a generator or an ordinary power socket) I think that whole communities could be treated - without the testing that puts off so many; without the stigma; poorly people, old people, men women, children and babies. HIVEX has run trials on groups of upo 25 people, but it seems that it should be possible to treat groups of 100 people at a time, since the field created by the equipment penetrates for around 5m in each direction.
We keep calling Tumelo. Naledi will go to her house this evening to see what has happened to him. That night, Michaela receives a text (sms) from Naledi. Tumelo is OK. He was angry with her because she talked about her own experiences of rape. These preceded her acquaintance of Tumelo. His English is not great, and he has had the impression that sometimes, when she has been talking about herself, she has been talking about him. We are not to call, please.
Alaena is astounded, outraged. How could he not come to treatment, when he is so near the end? What could be more important that his health, his life? How could he do something so unreasonable? But I think that there are other things that are more important to us than life, than survival. That our sense of identity is pretty important, that our sense of security, doing the same things we have always done, even if they are damaging us, is strong, and that fear can get in the way of all change… I imagine that Tumelo might feel ashamed of Naledi’s rape, even though he did not know her then - maybe that she is less because of it, or ashamed somehow that, as a man, he failed to protect his woman. We are not logical. I often find myself feeling things that I have no right to feel.
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