I’ve just finished this book by prize-winning South African journalist Jonny Steinberg in less than a day, and I have to confess I’m stunned by its vision, intelligence and compassion. Marketed in South Africa as The Three-Letter Plague (a title I prefer), Sizwe’s Test is subtitled A Young Man’s Journey Through Africa’s AIDS Epidemic. What Steinberg does is to follow two people – spaza shop owner Sizwe Magadla and Médecins Sans Frontières (MSF) doctor Hermann Reuter – during a two-year period in which the former tries to decide whether to test for AIDS or not, and the latter does his utmost to provide AIDS testing and treatment in Lusikisiki, one of South Africa’s poorest and most remote districts. What Steinberg does so well is to empathise with both men and the adversity that they face, so that, as a reader, I understood both Sizwe’s intricate cultural difficulties with acknowledging AIDS and Hermann’s Herculean challenge in ensuring adequate services for the poverty-stricken people of Lusikisiki.
A third character who Steinberg encounters during his visits to the area is self-appointed community health worker Kate Marrandi. Unlike the two men, Kate is not young. She is not rich like Sizwe (he runs a small shop out of his two-roomed house and is considering buying a car, which makes him a wealthy man in his village), nor highly-educated like Hermann, but she is singled-handedly getting the people of her village who are HIV-positive onto antiretrovirals (ARVs) and watching them come back to life. Kate’s success is due, much like Hermann’s, to the fact that she is an outsider. She is a Zulu, not Xhosa, and has stayed behind in Lusikisiki to serve the people after her devout husband has returned to KwaZulu-Natal to proselytize for the Jehovah’s Witnesses.
Sizwe, on the other hand, is not an outsider. He grew up in the village where he now lives. For him to take an HIV test and to live with the potential outcome of that would be a threat to everything he is: a self-made man, a father, a husband, a son. Throughout the book, Sizwe’s intelligence shines through. Steinberg says of him:
His interest in me was neither watchful nor suspicious; I had arrived from a world he knew little about, and he wanted to imagine the place I had come from. By the time we reached his parents’ homestead I liked him. He possessed a curiosity both rare and distinctive; one recognizes it the moment one sees it. It is the curiosity of a person who has no interest in confusing the boundaries between himself and others, who does not identify or envy too much.
Sizwe’s curiosity takes him along on Steinberg’s journeys through the district, sometimes as translator and sometimes as observer. His understanding of the function of ARVs grows and yet he remains reluctant to test. By testing and potentially being found HIV-positive, Sizwe will have to acknowledge his promiscuous past, he believes he would lose his business and not be able to support his family, and thus never be able to pay the bride-price for his lover Nwabisa and give their son his own name. While Sizwe understands intellectually that ARVs can keep the sick alive for many years, his culture provides an impediment to his taking the test.
Steinberg shows how Sizwe sits on the cusp between old and new: he sits between the peasant society his parents grew up in and the modern new world where technology can save lives, between poverty and relative comfort, between the traditional requirements of manhood and a new, more enlightened way. At one point, Nwabisa has to give up work to stay home and care for their child, and Sizwe agrees to pay her the salary she has lost, plus an extra 15%. This is a world where women are changing too. Steinberg describes a support group meeting for people on ARVs where women discuss loudly and in public the nature of female desire, complaining that they may not always have condoms to hand when they are in the mood.
Hermann Reuter’s challenge, on the other hand, is to entrench the services he designs so that when he and MSF pull out and hand over to provincial government, they will continue. His goal is to show that if you provide decent treatment, people will come and get it. His triumph does come: a few months after he leaves, the South African government decides that nurses can dispense ARVs, which means that people can receive their treatment in community clinics and not at far-flung hospitals. At the end of the book Steinberg says his goal was tell a story of AIDS treatment, and that there is no reason to see Hermann Reuter as emblematic of the quest to heal a country of AIDS, nor to see Sizwe’s reactions as typical of ordinary people. However, he couldn’t help seeing the two allegorically – a doctor and a potential patient in the theatre of a battle against a pernicious epidemic.
Sizwe’s Test reads easily and well. It is intimate in its insights, but broad in its perspective. I would strongly recommend it for anyone wanting to see the human side of the AIDS epidemic. I also recommend it for Jonny Steinberg’s superbly strong writing. The dust jacket calls it a “tour de force of literary journalism”, and it is.