I've been thinking a lot lately about the differences and similarities about AIDS in South Africa versus America. The program I'm in through Peace Corps is CHOP (Community HIV/AIDS Outreach Project). Most of my group is based at Home-Based Care (HBC) organizations. In rural South Africa, AIDS touches a lot of people and there are OI (Opportunistic Infections), including TB, that people with HIV/AIDS get more easily because of their depressed immune systems. The HBCs work with those types of folks to get them proper medication and assess other needs.
I should put the disclaimer that all of the information I'm about to write about is from personal experience, reading books about HIV/AIDS in South Africa, talking with South Africans and Peace Corps sources. There are certainly people who know more about all of this than me. I just think it's interesting to take a look at some factors as to why South Africa has the highest incidence rates of HIV than any other country worldwide and how it differs from AIDS in the U.S.
Learners, youth and everyone hear a lot more about AIDS than in the U.S. It's everywhere. AIDS messaging is on the radio, TV, on posters in community buildings, in churches, etc. I've spoken with some South Africans who say that the constant messaging is fatiguing and that people tune out the messages about safe sex. It becomes background noise at a point. I read a story about a young girl who was diagnosed at 19 and she said she learned about HIV in school but thought it would never happen to her, that she tuned out the information because it was like, yah, yah, heard that before.
Multiple partners are really common and some have dubbed this concurrent partnering the HIV Superhighway. And, along with this comes cheating too. My friend said she read in a South African magazine that only 6% of relationships in South Africa are faithful. Six percet! Now I don't know who they polled, but wow! That's just crazy. And lots of this cheating is unprotected sex where the cheating partner goes back to the original relationship and then they have unprotected sex, thus continuing the superhighway.
Stigma. While stigma tends to be huge in any area, in rural villages of South Africa where everyone knows everyone's name and surname and where they live, etc., there's little confidentiality. Someone could get tested at the local clinic, but (and it's sometimes a big but) how far is the clinic? 5K, 10K, another village even? There's no quick, easy or reliable transport to get there. Sure, these big taxis called kumbis exist, but they cost money.
The person working at the clinic likely knows that person coming to get tested too. The registers where patients sign-in for testing is in plain sight to be viewed by anyone. In communities this small, it's difficult for anyone to keep anything a secret. Now, of course, not every village pushes out their HIV+ community members, some will even protect those among them who are 'different' from the rest. I've even heard of a village where there was a young biological boy living as a girl and the community protected her. I think that's pretty powerful for small community culture.
ARVs (or Anti-Retrovirals) are supposed to be provided at no cost to the public to people who are HIV+. However, the ARVs that are used here are ones that the U.S. hasn't used for years. The most recent development for an ARV used in South Africa is 1994, I believe. Med-adherence is also a big factor. Those HBCs I mentioned earlier have care workers who are supposed to go visit their clients and make sure they are taking their meds. There are lots of potential issues with HBCs, including no funding, fatigued staff, lack of transport to remote areas as well as many others. But I have a feeling I shouldn't discuss those on this blog since I'm working under Peace Corps. Let's just say there's theory ... and there's practice.
"We don't need to worry about HIV anymore, right? There's a pill." Not even kidding, this is what my former host mother said to me. I was aghast. Coming in as an outsider, looking at how South Africa's HIV rates are raging but people in the country seem to be immune to the panic that people outside South Africa are feeling. I'm not sure how frequently these words are uttered by other South Africans, but it scares me.
Before moving to South Africa, I worked for Caracole, an HIV+ transitional living community in Cincinnati (check them out, maybe even make a donation!) so I could get more experience with HIV/AIDS. I learned a lot about the HIV med system (those ARVs I mentioned earlier). Because HIV is such a clever virus, it's constantly mutating and if a person just took one pill, HIV would find a way around it and become stronger. That's why when a person goes on ARVs, they take a therapy of three pills so it's more difficult for HIV to mutate.
Poverty. Living in and visiting impoverished communities has given me a whole new perspective on poverty, but this post isn't about that. It's about lack of access to necessary resources. Most villages in South Africa seem to have electricity (so people can heat meat and kill viruses) and some source of water (which people can boil to kill parasites and use to clean themselves) but often times, access to nutritional food is lacking. Mealies or mealie pap which is basically corn, cornmeal or something similar is very common. People eat pap up to three times a day. You can tell which meal it is by the way it's cooked (thinner for breakfast, like porridge, or thicker for dinner).
When people have HIV/AIDS, nutrition is vital. People in rural areas have a limited diet of pap, maybe some meat and maybe some veggies. Oh, and also, all the mini-shoppes in the villages have chips and lots of soda. I would love to see a study done on how much soda is consumed here. It's crazy. Which brings me to sugar. Thanks to English influence, most people observe tea time. To make the tea taste good (b/c flavored tea is fancy and hard to come by) people will seriously sugar-up their tea. Like 4-6 heaping teaspoons. And for dinner? Rather than spices for flavor, a lot of families use salt. Eish, so much salt! I dare to even put a measurement on how much. My training village host mother made me eggs once and seriously all I could taste was the salt! So, beyond HIV/AIDS, illnesses like diabetes and hypertension are becoming increasingly common.
Those are some of the big factors. There are others like men just not wanting to wear condoms and women not being empowered enough to negotiate safe sex. And re-infection, where two HIV+ partners have sex and think it doesn't matter because they're both +. But it does matter, but they can re-infect each other with different strains. I suppose in some kind of a closing, the HIV/AIDS scene in South Africa is very complicated with many systems involved. This is just scratching the surface.
On a personal note, I'm still without a site, but my Peace Corps supervisor is back and I'll be meeting with her when I get back from Cape Town week after next. (Yay!) I really want to go cage-diving with the great whites, but I think back to this IMAX show I saw as a kid where my mom and I rooted for the shark... There might be some weird foreshadowing in that, so I'll keep my distance : )