I am writing a novel about AIDS in South Africa. God knows if it will ever sell, because it’s very depressing, but it’s also about love, hope and ridiculous self-belief so maybe there’s a small chance. The thing that angers me most about the AIDS epidemic in South Africa is that it affects the poorest, the most vulnerable, the least educated and of this group, the largest proportion is women. It’s as if for them, apartheid is happening all over again, but it’s an apartheid of rich versus poor, of haves versus have-nots, of those with sexual power and those without.
So, to mark this year’s Blog Action Day – which has poverty as its main theme – I want to talk about the place where poverty collides with gender inequality, and how both affect the AIDS epidemic in South Africa. When Thabo Mbeki became South Africa’s ex-president a few weeks ago, the one thing that stood out for me in the reams of press copy I read was this:
First his culpability in the death of hundreds of thousands of people in South Africa with HIV/Aids cannot be underestimated and its impact will be felt for generations. Death certification by Stats SA shows more than 1,5-million deaths in the ages 0-49 and more than two million new infections during his rule. The long-overdue roll-out of a comprehensive antiretroviral programme, compounded by state-sponsored pseudo-science, has left 524 000 people desperately in need of the life-saving treatment unable to access it. As a direct result life expectancy has dropped every year Mbeki has been in office.
(Zackie Achmat of the Treatment Action Campaign (TAC), writing in the M&G, 27 September. Whole article here.)
That’s 1,5 million people – children and their young, economically active parents – who are now dead. That’s another two million who have become infected, of whom a quarter cannot access the life-enhancing drugs. Of these people most were, and are, poor. What a legacy, Mr Mbeki. According to the TAC’s website, most of the people who are infected live in informal settlements. There are more women infected than men, and most of those infected are black South Africans.
As part of my research for my novel, I have read a book by Edwin Cameron, a judge who sits on South Africa’s Supreme Court and who is living with HIV. Called Witness to AIDS, the book is part autobiography, part analysis and it is gripping. In it he describes the guilt he feels in being able to afford, just barely, the anti-retroviral treatment he needs to stay alive when so many millions in the country were being denied access. Cameron also bravely decided to go public with his HIV status in 1999, in order to begin to counteract the negative stereotypes of people with AIDS. He says:
The external manifestations of stigma are horrific enough. At Christmastime 1998, a 36-year-old South African woman, Gugu Dlamini, was stoned and stabbed to death. The horror of her death has never been fully investigated, because her murderers were never held to account. The prosecution brought charges, but dropped them for lack of evidence. What is clear is that shortly before her death Gugu told Zulu-language radio listeners that she was living with HIV. Three weeks later, members of her own neighbourhood rounded on her. Her attackers accused her of shaming her community by announcing her HIV status … Three months after Gugu died I decided to announce publically that I was living with HIV.
One of the main topics in Witness to AIDS, and of vital importance to non-governmental organisations (NGOs) like the TAC is access to drugs. There are two types of patients in South Africa: those who are privately insured and who acquire their drugs from dispensing doctors or pharmacies, and those who use the public health system. Here they can expect long queues and inconsistent service. Also, they have to get there. If you are poor and sick with AIDS and live in a rural village, you still need to find someone to help get you to the clinic in order to get your drugs. Poverty impedes people from getting treatment.
So, how do AIDS/HIV and poverty affect women specifically?
- Women and girls will be expected to give up their jobs and schooling to tend the sick, thus fuelling a cycle of poverty.
- The poorest households are mostly female-headed. Very often grandmothers, having nursed and buried their children, are left to raise their grandchildren, many of whom are also ill.
- There are also orphan-headed households, where the oldest child or oldest girl, takes care of the younger children.
- Society and customs do not allow women to abstain from sex or insist on condom use, so they are at heightened risk of infection.
- Women and girls in poverty are often forced to sell sex to survive, which opens them up to more risk of infection.
- Fear of abuse, or community retribution, discourage women from getting tested and seeking treatment.
- Lack of respect, and the custom of seeing women as commodities, means they are at risk of sexual abuse, rape and thus infection.
According to a paper by the HIV and Development Programme on poverty and AIDS in sub-Saharan Africa, the HIV epidemic has its origins in African poverty and unless and until poverty is reduced there will be little progress either with reducing transmission of the virus or an enhanced capacity to cope with its socio-economic consequences (my emphasis).
And the that question remains, for those who care, is what to do? There are many small ways to help make a difference:
1. Donate to Oxfam or another reputable NGO.
2. Join the Stop AIDS in Children campaign (see my side-bar).
3. Join a global volunteer programme.
4. Volunteer your professional services (I edit for an NGO in South Africa, and am about to start doing the same for one in Kenya).
5. Become a fan of The Girl Effect and spread the word that girls are the future.
6. Help a family affected by AIDS. PACSA is an NGO in the heart of the South African AIDS epidemic. I can put you in touch with the director, Danielle Gennrich. Through her, I am sending money to the widow and children of Tony Shelembe, an AIDS worker who died last year.
Edited to add: Following the wonderful example of LadyFi, I will make a donation for every comment on this post today to Global Giving’s project to Fight HIV/AIDS and build lives in South Africa. Why don’t you go and have a look at the amazing work they are doing?