I’m standing with my hands up and my feet on the snake . In my opinion the virus look like a snake . You can’t see it and it’s moving in the secret ways and dark ways. Inkanyamba , a big snake that lives in the water, a destroyer like a hurricane that destroys everything on the earth and makes houses and trees fall down and kills people. But you see I am standing on the snake . With ARVs I destroy this virus too.
Namawethu, Body Maps Participant
I’m home now, on a gray North Carolina winter’s day, trying not to let the subequatorial South African homesick blues take over. I’ve heard of culture shock, but this is more like climate shock. An early morning walk (I’m still getting up on Africa time, around 5:30am) with Booker and some serious house organizing are helping keep the blues at bay, and, I figure, as long as I keep moving I’ll be alright. I told myself I’d be able to detach from the trip easily but I’m finding it difficult today, another Sunday with a busy week (classes starting) looming. If, at the end of the day, I’ve accomplished all I set out to do I think I’ll be moderately satisfied, which is a tolerable condition this time of year.
My last two days in South Africa I spent in Johannesburg where I met up with my sister’s friend Kogie Thangavelu. Kogie is a long time resident of the city and she gave me an excellent tour of Soweto, taking me to the Hector Pieterson Memorial Museum in Orlando West and to Walter Sisulu Dedication Square in Kliptown. I’d been to Johannesburg in the 80’s, but had never seen this side of it. Both areas we went to on that first day are symbolic of the changes in South Africa since the time of apartheid, demonstrating pride in the struggle against government oppression which could never be displayed this openly before the 1990s.
This is especially true of the Hector Pieterson Memorial. The museum commemorates the events of the 1976 Soweto uprising which acted as a catalyst for student protest all over South Africa, lasting well into the 1980s. Sam Nzima’s photograph of Mbuyisa Makhubo carrying Pieterson’s lifeless body in his arms while the boy’s sister Antoinette runs beside them became an icon of the protest movement. A monument to this event, just a stone’s throw from the residences of Walter Sisulu, Desmond Tutu, and the former residence of Nelson Mandela, would have been inconceivable during the time I lived in South Africa. Now I was witnessing change in the form of government sanctioned symbolic memorials paying tribute to those who risked their lives in the struggle against apartheid. By visiting these locations I finally felt I had truly come in contact with the “new” South Africa.
This feeling was reinforced on the second day with Kogie when she took me to Constitution Hill, home of the Constitutional Court, South Africa’s highest judiciary body. Built on the former site of The Old Fort Prison complex known as Number Four, the court is now the primary interpreter of South Africa’s new constitution. The architecture and design are highly symbolic, representing a tree, traditionally the place of gathering when deciding important matters of the community. The entrance hall displays a wide variety of South African art in paintings and sculpture, and Kogie pointed out a series of works called “Body Maps”, a group of paintings based on the stories of HIV positive South Africans. I spent a good amount of time reading the stories and looking at the art which, like the memorials and museums, was also full of symbolic meaning, this time on a more personal level. The stories of these individual’s experiences when facing the physical and emotional aspects of the illness along with the reaction of the community—which is often discriminatory and unsympathetic—brought home some of the issues I had discussed with Jenny McConnachie at the Itipini clinic in Mthatha. Jenny made clear the difficulties these patients face: the threat to their employment by less-than-understanding employers, the chastisement from the community once the symptoms start to show, the debilitating byproducts of a weakened immune system, and the general stigma of living with a potentially fatal sexually transmitted disease. The Body Maps exhibit brings individual voices to the HIV pandemic in sub-Saharan Africa where some estimates of those infected reach upwards of 90 million.
The quote I used at the beginning of this piece by the woman named Nomawethu is also reinforcement for what Jenny told me at Itipini. The introduction of antiretroviral drugs into the health care system of South Africa has been, in Jenny’s words, “Revolutionary.” This and the new rapid test, a near-immediate test for the presence of HIV in the blood stream, along with high-strength vitamin “cocktails” and a coordinated regimen of visits to the clinics, all combine to dispel the earlier notion that a positive result for HIV was a certain death sentence.
As encouraging as this news is, there are still many obstacles facing the medical workers and patients on the front-lines of the pandemic. Some of the stigma attached to HIV and AIDS is eroding, but in an enduring patriarchal culture the attitude toward certain sexual practices remains rooted in tradition, reinforcing a need to keep an individual’s sexual choices hidden. The misconceptions and prejudices attached to HIV remain one of the true stumbling blocks to the better care of infected patients, as many of those infected try to keep their condition from the community for fear of being ostracized. But as more-and-more African lives are touched personally by the HIV pandemic, there seems to be a widening acceptance of the realities of the disease as communities realize how nondiscriminatory the virus is. Jenny sees this as a positive change but acknowledges there is still a long way to go until people really understand the disease and dispel the misconceptions and prejudices associated with it.
Another problem in treatment is motivating HIV patients to follow through on the regimen of antiretroviral drugs and doctor visits. In the case of Itipini, a community living in conditions of often the severest poverty, the strict schedule of pill-taking and visits to the clinic is much more of an obstacle than western minds might be able to comprehend. A disease that weakens the body of someone trying to scrape together an existence under extremely adverse conditions may also prevent that person from walking the distance to the clinic to take their prescribed drugs. This, combined with long waits at overextended clinics which might cause one to miss a days work or risk of exposure to one’s employer, all make the regimen of treatment precarious at best. These are some of the factors that worry Jenny, but the effects of ARVs continue to give her hope. The difference between what she’s seeing now and what she experienced just two years ago is dramatic. She’s seen people at the very worst stages of the disease make it back to a reasonable healthy state through ARV treatment, highlighting possibly the best development to occur at the Itipini clinic.
The trip to Constitution Hill for me was all about change. I wrote an article some twenty years ago for the UNCG newspaper about my 18 months in South Africa under apartheid. In it I all but predicted a bloody civil war because, at the time, things looked just that bad. With the release of Nelson Mandela only a few years later, and the peaceful turn-over of power into the hands of the ANC, my prediction, thankfully, missed the mark by a mile. But after the political crisis ended a new crisis appeared in South Africa involving the health of millions of people. Now, somewhat like the political situation, an uncertain truce has been made with Nomawethu’s snake. As the climate of the political landscape shifts and evolves in postcolonial South Africa so does the climate surrounding HIV, aided by revolutionary drugs and a slow wearing down of stigmatization. As with any revolution there is still a chance for the wheel to shift backwards and the snake to come free, but those at the front line continue to pursue advancements in an effort to put the worst days of the virus behind us.
For a brief summery of the HIV statistics at Itipini go to Jesse’s link. Please pay heed to Jesse’s assertion that the numbers are somewhay misleading, but these are the figures for a community estimated at about 2,500 to 3,000.
|Percent of Overall||35.56||38.64||24.39||30.26||27.09||30.86|
|Male Percent Positive||43.75||11.76||25.00||41.30||33.82||80.00|
|Percent of Overall||64.44||61.36||75.61||69.74||72.91||69.14|
|Female Percent Positive||44.83||18.52||37.10||47.17||34.97||33.93|
|Percent of Overall||29.66||35.42||48.04||41.57||32.60|
|Male Percent Positive||45.71||32.35||22.45||24.32||38.44|
|Percent of Overall||69.49||64.58||52.94||58.43||67.40|
|Female Percent Positive||36.59||25.81||31.48||26.92||35.11|