A Woman's Work

How HIV Caught Fire in South Africa: Part Two

When Shuffle Selo came to the mines in 1977, he was barracked in a room with 27 men originally designed for 18. Today he's a hostel manager, and he's seen how mining conditions have improved. Layoffs have left tens of thousands jobless, but for those who remain, the hostels are less overcrowded. It used to be that miners weren't allowed home during their 10-month stints even if there was a death in the family. Now most go home for three days every other month.

But the basic structure of migration hasn't changed for the simple reason that building family houses for all the mine's 10,000 workers would be too expensive. Mining companies have invested in AIDS education and STD treatment, but, says Selo, "So long as we have migrant labor on the mines we won't stop the spread of AIDS in this country."

Mzaidume is trying to prove him wrong. Under a leafy tree with gnarled roots big enough to be used as benches, she and five peer educators sing, role-play, and exhibit color flip charts of diseased penises and vaginas. The goal: to convince the women at this squatter camp, almost all of whom are sex workers, to use condoms.

Bonisile Ngema's family was plunged into poverty when her son died of AIDS. "We feel like orphans," she says.
Bonisile Ngema's family was plunged into poverty when her son died of AIDS. "We feel like orphans," she says.

But what happens when a man refuses to put on a rubber? Mimi Nhlapo, one of the peer educators who says she serviced three customers before this morning's education session, uses the flip charts. "I show them these pictures and say, 'This is what condoms protect against.' Then they say, 'Okay.' " Later, the group chuckles over one of their favorite strategies. When a man won't put on a condom, the women arouse him until he's hot for release, then refuse to continue until he rubbers up. "Once he has an erection," says one sex worker, "then we are in control."

The peer-education project, called Mothusimpilo, has clearly made a difference. Nhlapo says she started using condoms only last year, when the intensive, one-on-one efforts of Mothusimpilo made her understand the dangers of STDs and HIV. What's more, sex workers say STDs are down among the women who use condoms. Yet the project also highlights the daunting challenges of HIV education: Some men will offer as much as five times the going rate for unsheathed, flesh-to-flesh sex. And there is the threat of despair: At a recent Mothusimpilo staff meeting, the first 20 minutes are devoted to discussing a burial insurance plan. Three peer educators have already died; Mzaidume took each of the bodies home, one all the way to Zimbabwe.

Projects like Mothusimpilo can prevent new cases, but they can't save the millions already infected. Bonisile Ngema never went to school and she doesn't even know how old she is— she remembers someone telling her she is 52. But when she walked into her son's hospital room in Chris Hani Baragwanath hospital in Soweto, she knew she needed to take him home. Lying in bed with AIDS, "he was changed all over," she says. "Even his hair was changed. He was so thin, his mouth had sores all over." The doctors told her that her son, Bhekinkosi, was suffering from TB and diarrhea that wouldn't stop; there was little they could do. So at seven one morning she and her son climbed into one of the crowded, careening van-taxis that carry poor South Africans all over the country, and for the entire 10-hour ride back home, her wasted and rail-thin son "sat on my lap, because it was too hard for him to sit on his own."

It's been a year and a half since he died, and in addition to the grief, Ngema, like so many other mothers in southern Africa, has been plunged in destitute poverty. She went into debt to buy a coffin. Her husband died five years ago, and her two other sons are in Johannesburg but have not been able to find jobs, and so can't send her money. She was supported by Bhekinkosi, the son that died, who also supported her mother and her granddaughter, a six-year-old girl whose mother also died of AIDS. Ngema tries to sell potatoes to pensioners, and when that doesn't work the family survives on handouts. "It used to be that when the calendar ran up to the 25th or 26th and we were short on money, my son would always send something," she says. "But now when the calendar runs up we feel like orphans."

Research assistance: Tien-Shun Lee and Reetpaul Rana

This is the second of Schoof's series on HIV in South Africa.

Read part one: All That Glitters.

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