Charlotte's Web

Blogging my world since 2006


World AIDS Day, 1 December 2013

The first time AIDS crossed my radar was in 1985, when I read this edition of Time magazine. People were dying of a virus and nobody knew why. It was terrifying; a plague. I had my first HIV test at university and then later in the UK when I was pregnant with my first child. I was, mercifully, HIV-free but for millions of people the experience of being tested has a different outcome.

Getting up the courage to have the test is one thing (brilliantly documented in Jonny Steinberg’s book Sizwe’s Test), but living with HIV – even in this world of anti-retrovirals – takes another kind of courage.

In his memoir Aidsafari, South African journalist Adam Levin talks about how, when he tested positive in 2003, he experienced life-threatening opportunistic infections and debilitating side-effects from the medication, was bedridden for months, tortured by nerve pains in his feet, lost his hair and teeth, required dentures at 35, had TB and cancer. It is a deeply moving book.

Imagine suffering as he did, but in poverty – in a home without electricity or running water and without access to medical care.

Despite having the world’s biggest HIV treatment programme in the world – 2.4 million people on drugs – South Africa is only treating a third of them. Four million people still don’t have access to treatment. At least one in five treatment facilities or clinics have run out of HIV or TB drugs.

AIDS has not gone away. We might be getting closer to a vaccine, but that is cold comfort to people already infected with the virus, who through poverty can’t access treatment or whose local clinic has run out of drugs.

The theme of World AIDS Day 2013 is Shared Responsibility: Strengthening Results for an AIDS-Free Generation. The virus began one person at a time, and we can end it one person at time. Let’s think about ways we can each take steps to stop HIV – we can find a local AIDS organisation and donate, we can talk about AIDS to our children, we can read up about HIV to beat the myth that it has been dealt with. I did a quiz and discovered that despite all my research into HIV/AIDS, I still know very little. Self-education helps!

In the name of learning more, I have collected some blog posts and news articles more eloquent than mine on the topic of HIV/AIDS:

We can end AIDS without a cure

Too many being left behind in AIDS fight

World AIDS Day: No time for complacency

Still here and still fighting – AmeriNZ blog for World AIDS Day

Thanksgiving and World AIDS Day

The sangoma who lives for science

If you have written a blog post to mark World AIDS Day 2013 or stumbled across a post you like, let me know and I will link to it from here.

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World AIDS Day: Some Things I Found

It’s World AIDS Day today. I come from South Africa, a country where 4.85% of adults are HIV positive and where 1.7 million people are on ARV treatment. There are 1.9 million AIDS orphans in South Africa.

My novel, Balthasar’s Gift, centres on the murder of an AIDS activist. While discrimination is receding, and people who need treatment are starting to get treatment, South Africa still has a long way to go.

I alway focus on World AIDS Day here at Charlotte’s Web. Here are some things I found that show the changing face of HIV/AIDS:

Dating when you’re HIV positive

Portraits of people with HIV

10 Things We’ve Learned about HIV/AIDS

Clinton Releases Blueprint for AIDS-free Generation

HIV: Film tells survivors’ stories

HIV prevalence falls in sub-Saharan Africa, but is still higher than anywhere else

Orphaned at the ages of 6 and 7, Tandeka and Njabulo have looked after each other for 10 years. Their teacher is also an AIDS orphan.

Mother to child transmission reduces in South Africa, but the costs are hard to cover

South Africa: From Crisis to Catastrophe

South Africa: HIV drugs increase life expectancy by five years

Story of a Survivor

When the need is so great, it is hard to choose where or how to help. I support the Noah Community, which empowers communities in South Africa with the knowledge, skills, strategies and self-confidence needed to create and run organisations that support the well-being of their vulnerable children. These organisations are networks, not buildings, although most do have a resource centre. These centres have staff and provide additional programmes for vulnerable children such as daycare, aftercare, child protection and bereavement counseling.

If you have a World AIDS Day post, let me know and I will link to it here.

Here are some of my previous World AIDS Day posts.


World AIDS Day 2011: Are There Any Good News Stories?

The theme of today’s World AIDS Day is ‘Getting to Zero’ (zero new infections; zero discrimination; zero AIDS-related deaths)’. While we all know that the statistics are devastating and sad, and that we are a long way from zero, we are slowly winning the fight against HIV/AIDS. I tried to hunt down some good news stories.

Here is a sample:

Masai Cricket Warriors integrate HIV/AIDS awareness into their coaching.

Sisters in science research an AIDS vaccine (see page 14)

UNAIDS report for 2011 showed fewer infections, fewer people dying of AIDS-related diseases, more people living with HIV/AIDS.

ARVs are getting cheaper, so that governments like South Africa’s can scale up their treatment campaigns.

Is the HIV/AIDS pandemic at the tipping point?

Longevity studies show that people with HIV/AIDS on courses of ARVs can live almost as long as people without HIV/AIDS.

South Africa launches an AIDS treatment plan that aims to raise the number of people on treatment from one to three million.

Play the Avert HIV/AIDS Challenge and find out how much you know about the virus. Let me know if you guessed the question about North America correctly or not – that one was a surprise.

Read my review of a beautiful book, The Gifts of the Body, about a home-care worker who visits and treats people with AIDS. This is the best story about AIDS that I have ever read. I first posted it for World AIDS Day 2008, but I am reposting it in honour of the millions of carers who work tirelessly with people with AIDS to make their lives better – the grandmothers whose children have died and who now find themselves parents to a second generation, the community workers, the children who nurse their dying parents. These are the unsung heroes of HIV/AIDS and I want to recognise them.

In order to do so, I have been collecting donations at work and today we will give €450 to Noah’s Orphans, a community organisation which cares for children orphaned by HIV/AIDS in my home province of KwaZulu-Natal, South Africa.

AIDS Day posts from around the world:

Johns Hopkins University, USA ‘We are all unprotected’

83 to infinity, Canada Will AIDS ever be a memory?

BBC World Service Trust, India Being the face of HIV in India

Age UK, HIV and older people

Reluctant Mom, South Africa Talking to your kids about HIV/AIDS

If you have a post in honour of World AIDS Day, let me know and I will link to it here.


Reading about AIDS

Today is World AIDS Day. Around the world, landmarks are being lit red, celebrities are turning off their Twitter streams and hundreds and thousands of people are renewing their commitment to universal access and human rights.

My home country, South Africa, has the highest number of people living with HIV/AIDS in the world. It seemed natural to me, when I started writing a novel three years ago, that I would somehow try to address this. So soon after we had achieved freedom from the ugly strictures of apartheid, we were struggling with a disease that seemed to target the poor – the very people who had suffered during apartheid.

During the process of writing Balthasar’s Gift, I did a lot of reading around the topic of HIV/AIDS and today, on World AIDS Day 2010, I’d like to recommend some of the books I read.

The shortest and most moving book was Rebecca Brown’s The Gifts of the Body, which I reviewed here. Brown is a former home-care worker and her compassion for the dying and unstinting generosity in meeting people’s needs was astonishing to experience. When reading about AIDS, we are beset by statistics that are huge and difficult to digest, and what Brown does is to take it down to the individual level. Her unstinting compassion shines through. I was inspired by this book to create two characters who are homecare workers and who understand the need to relate to people not as statistics but as whole human beings, who still feel, think and dream.

Another book that moved me deeply was Edwin Cameron’s Witness to AIDS, which I reviewed here. Cameron, a Constitutional Court judge in South Africa, is gay and living with HIV. In 1999, he went public with his HIV status – only a year after 36-year-old Gugu Dlamini was stoned and stabbed to death after publically declaring on Zulu-language radio that she had the virus. Witness to AIDS is part autobiography, part analysis and is gripping. AIDS disclosure is becoming less of an issue in South Africa, but in 2000, when my novel is set, it was still an incendiary issue and I centred the book around it.

I also read and reviewed Sizwe’s Test, by South African journalist Jonny Steinberg. 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. This book helped me to see how having HIV/AIDS is tightly tied  up with people’s ideas of masculinity, and that to test, and to admit HIV status was, and still is for some men, testament to undermining that masculinity.

These were my top three reads, and I can strongly recommend them. Four other excellent books were:

AIDSAFARI: A Memoir of My Journey with AIDS by Adam Levin. Levin is a South African journalist and his book takes us through the daily trials of living with AIDS. It is beautifully and amusingly written.

The Virus, Vitamins and Vegetables by Kerry Cullinan and Anso Thom. This takes the reader down the rabbit hole of AIDS denialism, thankfully now on the wane in South Africa. AIDS denialism is one of the themes of the novel and I used this book to understand why an entire administration could deny the link between HIV and AIDS and question the viability of antiretrovirals.

Illness as Metaphor and AIDS and Its Metaphors, by Susan Sonntag. Passionate and moving, these two great essays gave me insight into the mythology we create around disease, which can distort the truth about illness and isolate the patient.

When Bodies Remember by Didier Fassin. This is an academic book that sets out to demonstrate how the history of colonization, domination and segregation still vividly affects today’s South Africa, most specifically with regard to treatment or the lack of it.

Do you have a World AIDS post? If so, let me know I will link to it here.

For every comment I receive on this post today, I will be making a donation to AVERT, the international HIV and AIDS prevention charity. If you would like to make a donation yourself, just click on the blue and white  ‘Stop AIDS in Children’ button on my sidebar.


South Africa: Drugs for HIV+ Babies

According to a report from the BBC, South African president Jacob Zuma announced today, World AIDS Day, that his government would provide all HIV-positive babies under the age of one with antiretrovirals. He also promised that the drugs would become more widely available to children and pregnant women. Zuma said in his speech at the Pretoria Showgrounds that he was preparing to take an AIDS test himself. He urged everyone to test.

While this may seem a drop in the proverbial ocean, it is also an urgent and imperative about-face from a government that ignored AIDS for too long. A decade of denialism has cost hundreds of thousands of South Africans their lives. It is estimated that by 2015, 5.7 million children – a third of South Africa’s children – will have lost one or both parents to AIDS. There are currently 1.4 million AIDS orphans in the country. I read a blog run by orphan careworkers. Go and see the faces. These are the children who no longer have parents because the South African government acted too slowly to contain the epidemic.

Zuma’s announcement is a positive change, say AIDS activists Treatment Action Campaign. Let’s hope so. Let’s see the South African government save lives instead of waste them.

ETA: Times Live journalist, the very excellent Claire Keeton says World AIDS Day 2009 in South Africa was “an historic event”.


Breaking the Silence

One of South Africa’s most senior and eminent businesspeople, Clem Sunter, writes movingly of the AIDS crisis in News24:

We recently witnessed the huge coverage given to the Air France Airbus that crashed into the Atlantic Ocean. Two hundred and twenty-eight people perished in that disaster. Putting our Aids statistics into perspective, the equivalent is four airliners full of mostly young South Africans plunging into the sea every day of every month of every year. And yet silence accompanies their death because they die individually and the majority are from deprived backgrounds.

We should be ashamed and we should do everything to break the sound of silence. We should talk openly about ways to change sexual behaviour to minimise transmission of the virus. We should get the advertising agencies involved since it is their speciality to change behaviour. We should encourage people to get themselves tested and if they test positive seek the appropriate medical treatment. We should focus on compliance with the pill regimen and the fact that even when you feel better you can’t stop taking the pills.

Finally we should openly praise all those heroes and heroines who have dedicated their lives to caring for the victims of the epidemic. They deserve national medals for their bravery and compassion.

(My emphasis.)

Four planes a day crashing into the sea, four planes a day, filled with young people who should be economically active, taking care of their children and their parents and living life. It’s hard to stomach, which is why people don’t talk about it, but it is a tragedy on a giant scale – and one which will come to haunt the South African politicians who messed about for too long toying with dissident science and refusing to commit to providing people with the drugs.

It is easier to mourn one plane than many, as we harden ourselves to horror and stop hearing it. One of the things I’m trying to do in the book I’m writing is to show how AIDS has become a fact of life in South Africa, but how, at the same time, it is a deeply personal and excruciating tragedy for those who die and those who are left behind. Each story is worth telling.


Good News about AIDS

The BBC reports that HIV/AIDS in South Africa has “leveled off” in the age group two years and older. There are signs that the rate of infection in children and teens is falling. A study by Dr Olive Shishana, former Director General of the Health Department and who now heads up the SA Human Sciences and Research Council’s national research programme on the social aspects of HIV and AIDS, shows that increased condom use amongst the young has led to falling infection rates.

This indeed cause for cautious celebration.

But let’s not forget that those who are worst affected are women between the ages of 20 and 34. In this age range, 33% are HIV carriers. THIRTY-THREE PERCENT.

It’s time for the men of this generation to look to the teenagers, learn from them and start wearing condoms. Be a man; don’t spread HIV.


The Gifts of the Body

People who are dying are not statistics. People who are dying are loved ones; parents and children, family and friends. People who are dying have bodies, dying human bodies with needs identical to the needs of those of us with healthy bodies. We understand so much about AIDS now – how it transmits, how the virus cruelly mutates, how it takes over the immune system, how drugs can help, how if they come too late, they can’t. What very few of us understand, unless we are medical personnel or close to someone who is dying, is how people die. We understand that the body slowly gives up and that the basic functions fail, but we don’t understand how that feels. We don’t understand how hard it is to have our needs met when we are dying.

The Gifts of the Body is a small, spare book written from the perspective of a home-care worker who visits people with AIDS in their homes, and who helps them in their day-to-day care as they are dying. The unnamed narrator describes the basic care she gives – washing someone, making someone a meal, creaming someone’s sore-covered body with salve. She does not give you the individual stories, you do not know how or why people became infected, but she takes you into their bedrooms and shows you how people sustain life in the face of death. In doing so, she gives you their humanity.

In the chapter The Gift of Hunger, the narrator visits Connie who has received some Vermont maple syrup as a gift from her daughter. It is a symbolic gift of happier times, but Connie is desperate to eat it, so the narrator makes her pancakes to have with the syrup. Connie is so hungry that she asks her to make her an egg on the side too. After four painstaking bites, she can’t eat any more, but she is still hungry so she asks for some oatmeal. Connie manages one agonising mouthful of oatmeal before her body revolts and she must expel the food. The simple tragedy is that Connie is dying to eat. She is desperate for the taste, the flavours, the nourishing memories that food brings, but her body cannot tolerate it.

Another chapter I found moving was The Gift of Skin, in which the narrator describes bathing someone. It is so simple, and so beautiful:

I squeezed the cloth under the water then pulled it up his forearm to his elbow.

He took a deep breath, “Oh, that feels so nice.”

I cupped water in my hands and poured it down his arm. I washed his elbows and arms and toweled them dry. I washed the hollows of his armpits and his ribs. I washed his back and stomach and shoulders. When the water began to cool I filled the pan again with fresh warm waters and fresh clean oil. I did his neck and face. I washed his forehead and eyelids and around his beard and mouth. The air began to smell like oil, like mint or eucalyptus.

I sat on the floor and washed his feet. I poured the water over them.

He looked down at me. He touched my head. His face was full of kindness. “Thank you,” he said.

Other chapters include The Gift of Tears, when tear ducts fail and someone cannot cry no matter how much they want to; The Gift of Speech, when words fail and a person is too weak to talk; and The Gift of Sweat when a simple walk down the street to the bakery precipitates a visit to hospital. They are written without sentimentality, and yet they tore at my heart, because eating, crying, talking and walking are basic functions which I take for granted but which are, in fact, gifts not to be taken lightly.

The Gifts of the Body is the best book about AIDS I have ever read. The author, Rebecca Brown, is a former home-care worker and her compassion for the dying and unstinting generosity in meeting people’s needs is astonishing. It is not entirely clear to me if this is a work of fiction or non-fiction, but in the reading it begins not to matter. It just a book about one person helping others. The narrator sees people for who they are and she recognises what they need. It is a book about empathy.

On 1 December, World AIDS Day, and every day, empathy is what we need to have. After all, we are all human.


Further reading for World AIDS Day:

Natalian’s moving tribute to her manager J, who died of “TB” in Durban a few years ago.

Sharon from The Not So Secret Life of Us, writes about volunteering with AIDS babies at Nazareth House in Cape Town.

Julie Belle’s message of love.

Christopher’s review of the movie Longtime Companion.

John Self’s review of Adam Mars-Jones’ Monopolies of Loss, a book of short stories about AIDS.

Atherton Bartelby’s tribute to a beloved friend.

* If you have a World AIDS Day post, please let me know and I will link to it here.


Women, AIDS and Poverty

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?

  1. Women and girls will be expected to give up their jobs and schooling to tend the sick, thus fuelling a cycle of poverty.
  2. 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.
  3. There are also orphan-headed households, where the oldest child or oldest girl, takes care of the younger children.
  4. Society and customs do not allow women to abstain from sex or insist on condom use, so they are at heightened risk of infection.
  5. Women and girls in poverty are often forced to sell sex to survive, which opens them up to more risk of infection.
  6. Fear of abuse, or community retribution, discourage women from getting tested and seeking treatment.
  7. 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?


Sizwe’s Test

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.