On Retirement

Man, it only feels like yesterday when I first created this rambling, nonsensical blog, but sadly it's come time to retire this thing. If anyone is still reading this thing (which if you are, why?), I want to say thanks for sticking with me while I was in South Africa. I know I wasn't the best blogger out there, but I hope you found that some of the stuff I did and went through was interesting.

I've been slow to close up on this blog because I think my experience living and working in South Africa was so compelling, so absolutely life changing, that I felt I couldn't sum it up in one final entry. After a lot of delaying, I've decided to not even try. If you want to talk to me about it, or if you have any thoughts, I'd be happy to talk to you about it over email.

Thanks for reading, and well, goodbye, I guess.

Nupe

This is a shot of beautiful Hout Bay just outside of Cape Town at sunset. When I said it was the most beautiful city in the world, yo, I wasn't kidding.

On Politics and AIDS

So the final reason why I think the AIDS epidemic is so prevalent in South Africa has to do with politics. The first group to blame is obvious. For 50 years the apartheid government systematically oppressed and subjugated 90% of the population (see previous entries ranting about these idiots). In an effort to divide and rule, in 1950 the National Party instituted the Group Areas act, which restricted the Bantu (black Africans) to certain areas in cities. Entire populations of free, working blacks were moved into areas where they didn’t speak the language or share the same customs. The Group Areas act was followed up by the Land Act as well as the Bantu Homelands Act of 1970 which restricted 90% of people to 20% of the land (the worst, non-farmable land in the country). Living on crap land, surrounded by other sick people, and lacking the freedom to move, it’s no wonder that Homelands were breeding grounds for AIDS. If you look at where HIV prevalence is concentrated now, you’ll find it’s in urban areas with high rates of migration (see previous entry) and in the former Homelands (Transkei, Ciskei, Venda, Ndabele, Zululand, etc).

During the fall of apartheid, politically things got worse – in Zulu areas for example, there was significant infighting among different black political groups, which in the midst of a burgeoning epidemic can’t be a good thing. Kwa-Zulu Natal Province, the region most affected in the turmoil leading to the fall Apartheid, not surprisingly also has the highest prevalence of HIV.

The post-Apartheid government doesn’t exactly have a great track record, either. Nelson Mandela, despite the amazing work he did with keeping the country out of civil war, didn’t really recognize the AIDS epidemic until recently. After his son’s death, he has been very vocal, but acknowledges that HIV was his biggest failure in office. Thabo Mbeki, the current president, didn’t (maybe even still doesn’t) believe that HIV caused AIDS and refuted UNAIDS statistics vehemently until 2004 when he capitulated in providing ARVs in government clinics. Finally, the queen of poor leadership and stupidity is the Minister of Health, my homegirl Manto Tshabalala-Msimang. She continues, despite mounting evidence to the contrary, to say that ARVs don’t work and her concoction of beet root, garlic, and olive oil is the panacea to South Africa’s AIDS crisis.

This lack of high level leadership would be fine in the US, where we call Dubya an idiot all the time, but here in South Africa, political leaders have much more clout with the people. So when Manto says, HIV is not a big deal, people listen (and may even change their behavior). The common thread among these three examples is that instability and the resultant upheaval leads to an insecure population that then engages in risky sexual practices. Well, at least that’s my theory.

Beautiful single-roomed church in the middle of nowhere. There might not be running water, but you better believe they've got Jesus.

On Migration and AIDS

South Africa’s economy has long been dependent on mineral resources such as gold, platinum, and diamonds. In fact, the world’s most famous diamond monopoly, DeBeers is based in Johannesburg, a city whose nickname, Egoli, literally means “Gold City.” If you travel around Joburg now, you’ll see huge hills of golden, sometimes glittering dirt dug up fand deposited on what used to be completely flat land.

During the fifty years of Apartheid rule, the mines were fueled by migrant African workers plucked from rural parts of South Africa and housed in large barracks on the mine grounds. These men (they were always men) worked for six months straight followed by two weeks of vacation time when they went back to their individual homelands. Families were not allowed to join the men on the Despite the bad working conditions, mineworkers were pretty well off. They were unionized, they were given healthcare and food, and most importantly, it was one of the only ways to get money to send home. Naturally, and perhaps inevitably, a sub-economy of prostitution and drugs sprang up to entertain the nearly 100,000 men who were away from home. Given this environment, it’s no wonder that HIV spread rapidly and was transmitted to spouses when the men returned home. Ship workers, truck drivers, police, and generally anyone looking for better opportunities were all affected during these periods of mass migration followed by returns home.

The fracturing of the family unit continues even when people are allowed to freely move around. For example, the district manager in Umkhanyakude (northern Kwa Zulu Natal) lives four hours away from her husband and family. I’m not sure why the family didn’t move with her, but this kind of thing - husbands and wives being separated – is so routine that I don’t think people think it’s strange. One of the people we work with in that area, Victor Fredlund, has an interesting solution to solving the AIDS crisis. Get people to have more sex and enjoy it. If people had frequent, enjoyable sex with their spouses, he contends, people would be less likely to leave their families and also not engage in higher-risk activities. Not a bad idea, I think. Here’s a slogan: “Screw more. Save lives.” Or what about, “Got sex?” Your thoughts?

Eastern Cape, with all it's problems, has this one really nice cloud (photo courtesy of Porter Mason photo courtesy service)

Flynn drinking a gallon of Mqomboti, frothy fermented wheat based beer served in the Townships that tastes vaguely like grass. Alcohol content? 1.2% This means you have to drink this gallon to get one beer's worth of booze. Cost? 1 rand for all you can drink. Crazy, eh?

On AIDS and Women’s Empowerment

The first reason why I think AIDS is so much more pervasive in South Africa is the long-standing poor treatment of women. At almost every HIV clinic in the country, you see long queues of women with very few men. But why does HIV disproportionately affect women? This is a very complex question to answer, but some reasons are because women are more likely to seek medical attention, the men are working in the cities, one man tends to infect many women, or the men have already died. Ultimately I think it has to do with women’s rights and the ability of women to exert control in sexual relationships.

In most rural communities, the role of women has not changed in 300 years. They are the predominant child-bearers, keepers of the home, and water-fetchers. What I found interesting is they are also predominantly the ones who tend to the crops and watch the livestock. The issue of childbearing is also interesting. I just finished reading Jeff Sachs’ book which shows that educational level correlates very strongly with the number of children per woman. In rural South Africa, average family size is between 5 and 6 children with most mothers not making it past the 10^th grade. This gets to the idea of power dynamics in (even monogamous) relationships. Men exerting control, especially with regards to condom use, over disenfranchised women leads to increased family sizes and ultimately increased HIV prevalence.

Domestic violence is also rampant in South Africa and plays a strong role in persistent HIV transmission. If you fear physical abuse to you or your children, are you about to force your boyfriend to use a condom? With few police in rural communities to act as guardians of women’s rights, the cycle of violence and increased disease communication endures. Men also tend to engage with multiple (3-4) sexual partners whereas women tend to have 1-2 sexual partners. In South Africa, the labels of promiscuous male as “stud” and promiscuous female as “slut” are taken to an extreme, with women regularly chased out of communities. Naturally, with men taking many sexual partners, HIV distributes towards women.

So what can be done about this? “Women’s empowerment” has become a buzz-word in South African AIDS awareness campaigns, but all I’ve found are thin education measures aimed at teenage girls. If you’ve seen the Love Life campaign, you’ll agree with me that the “Get Attitude” slogan makes no sense and does little to improve the power dynamic within relationships. In my mind the biggest revolution will be economic and educational. As women enter the workforce and are less dependent on men for subsistence, the will tend to have fewer children and be able to advocate for stable monogamous relationships. I’m also appalled by the lack of female condoms in this country. If women had the choice of when to use condoms, wouldn’t some of the decision-making influence shift towards women? At the moment, clinics around the country are piloting availability of female condoms but for most women these remain out of reach. There certainly isn’t a silver bullet for solving women’s rights issues, but it will take much more than lukewarm empowerment campaigns to improve the AIDS crisis.

On Why is AIDS Worsening in South Africa?

I pose the subject as a question because honestly there isn’t a good answer. HIV prevalence is certainly growing in South Africa whereas it’s leveled off or declined in a lot of places (Uganda, Thailand, Brazil, Vietnam). Take a look at the numbers. In 1990, the antenatal seroprevalence, which is the % of woman who are positive at routine pregnancy visits, was around 0.8%. In the past 15 years, that number has skyrocketed to 39.6%, and continues to rise year after year.

There are a lot of theories about why SA continues to falter in the fight against HIV. Black Africans have more sex, they are uneducated and don’t know about HIV, they don’t care if they die, there is something unique about African biology that makes them more likely to contract HIV; the list goes on and on. All of these are of course unfounded. African sexual practices are no different in terms of sexual frequency than other racial or ethnic groups. People, even in very rural areas, have good knowledge of HIV and DO want to prevent contracting the virus. Finally, concentrations of HIV are the same in blood, seminal fluid, and vaginal secretions between blacks and all other ethnic groups.

In this next set of blog entries, I’ll talk about the reasons why I think the AIDS epidemic is worsening in South Africa and other parts of especially southern Africa.

Anya showing a group of youths the correct way to put on a condom. Please note that the fake phallus is bright, nay flourescent, white.

Me and Anya doing some really groovy surfer-action on top of Table Mountain

On Teaching People About HIV

So, as you know, I’ve spent a lot of time in Coffee Bay, notably at the main hostel there called the Coffee Shack. Well, after many visits, resplendent with (at the time, at least) meaningful conversations about the devastating effects of HIV in the country, the owners asked me to come do an HIV/AIDS awareness training for the staff and their families.

I agreed and recruited Anya to come along to be my “co-facilitator.” Note to my male readers: it’s usually not good to refer to your girlfriend as “co-facilitator” instead of “girlfriend,” or “partner” or “shining light,” but hey, I was trying to be professional. Anyway, when we got there, we also met with Nurse Thandi who was to serve as our translator and fill in the gaps when people weren’t getting what we were talking about. The session started off very well. The headman and chief of the village were there, we had a pretty big turnout, and the weather was absolutely perfect.

Things were going well, I was explaining what HIV does in the body comparing CD4 cells to soldiers and germs as the enemy, when I finally got to the part about spreading HIV and preventing its transmission. Everyone perked up at this point, and people started asking tons of questions. I got the typical ones about kissing, sharing toothbrushes, and oral sex (at which point the headman left). My favorite question, though is one that I’d like to share with you.

Audience Member: “Hey, Nupe,”
Me: “Yes, sir.”
AM: “OK. Let’s say you have blood on a toilet from a woman.”
M: “Uh. Alright.”
AM: “And you have a cut on your butt and you sit on the bloody toilet.”
M: “Is the blood still wet, or is it dry by now?”
AM: “It’s still wet.”
(pause)
M: “Sir, I think the real question is why haven’t you cleaned up the bloody toilet? I mean who sits on fresh blood? You really should take care of that.”
(Laughter erupts. I feel very guilty for making fun of the question)
M: “Sorry sir, you’re right, though. If there is an open wound with fresh blood there is a high chance of HIV transmission. The point is if you see fresh blood, you should use universal precautions like we discussed earlier and try to clean with bleach.”

What was interesting to me about this whole day was how eager people were to learn more about HIV and its transmission. There are so many rumors flying around about the disease that people are really starved for more information – I just hope that what we were able to provide was helpful.

This is the Cape of Good Hope, which despite popular opinion is not the southernmost point in Africa, which is Cape Agulhas. Alas. It is however, really pretty. If you look closely you can see the lighthouse, which is very wee considering how important this spot is.

The Mehta Family on top of Table Mountain. Awwww.

On the Cape Town Paradox

Cape Town, on the west coast of South Africa has often been described as the most beautiful city in the world. After my two times visiting there I may have to agree. It’s at least the most beautiful city I’ve ever been to. Cape Town has this amazing combination of gorgeous beaches backed by the sheer face of Table Mountain, so that no matter where you are in the city, you have this really cool view. Mix in amazing restaurants, vibey bars, wine country, and a feeling that everyone is on vacation, and you have, well, San Francisco on steroids.

But amidst all this beauty lies a dark (no pun intended) secret. You see, Cape Town is also the whitest city in the country, and when you’re walking around some parts, like the waterfront, you can go a fairly long time without seeing Blacks, Indians, or Coloreds. Once a bastion of Afrikaner nationalism, statues of apartheid era “patriots” still dot the cobble stoned streets, and you still hear Afrikaans spoken nearly everywhere.

The biggest stain on Cape Town’s history was the systematic destruction of what was known as District Six. In the early 20^th century, immigrants from all over the world landed in Cape Town in search of greener pastures. Literally, these new Capetonians walked off the docks and created a vibrant community in the heart of the city. For almost 50 years at the start of the century, District Six housed Blacks, Malays, Indians, Jews, Coloreds and Whites who lived together in harmony. Given it’s proximity to the city’s center, however, the Apartheid government decided that it wanted to develop white military housing here, and over the next 16 years, basically moved everyone out to the townships miles outside of the center.

Presently Cape Town remains fragmented. Whites live in the city bordered by Table Mountain, the beach, and the harbor, while Coloreds and Blacks live in the townships of Khayelitsha, Langa, and Guguletu. Interestingly, District Six, despite its ideal position, is an undeveloped grassy field with a small technical college on one end. Some people say it’s cursed, that to build there now would bring bad luck. Others are simply wary of the land claims that are still outstanding on the land. In any case, Cape Town, for all its beauty, makes you realize that despite the strides made in the last 10 years South Africa has a long way to go before every place is like the District Six of the past.