A Woman's Work

How HIV Caught Fire in South Africa: Part Two

Hlabisa, South Africa— Handsome, soft-spoken Bongani is one of 3.6 million people infected with HIV in South Africa, which has one of the world's fastest-growing AIDS epidemics. As a gold miner working 300 miles from his rural home, he is also part of a vast and entrenched system of migrant labor epit-omized by the country's gold mines, where workers live in all-male barracks called hostels, visit their wives or girlfriends only a few times a year, and so often resort to prostitutes or casual relationships. Sitting in the mining hostel, and speaking on condition that his real name not be used, Bongani says that he told both of his two girlfriends that he's infected, and that one of them stopped seeing him because of the news.

But back home, that's not the tale told by the girlfriend who's still with him, a 19-year-old woman who on her last test was still HIV-negative. Holding their baby, she says Bongani assured her that he is notinfected. What the couple agree on is that Bongani suggested they start using condoms— but that he doesn't always stick to his suggestion. "When the urge is too strong," he says, "there's no time to think about condoms."

Bongani personifies the simple notion of how migration fuels the epidemic: lonely men far from home contract the virus and then endanger their partners. That certainly happens. But in preliminary data gathered by Mark Lurie, an AIDS researcher studying migration, a revealing fact has emerged. Among couples where the man is a migrant laborer, are many cases in which one partner is HIV-positive and the other is negative. But in fully half of those cases, the positive partner is the woman. "Clearly," says Lurie, "she's not getting the virus from her migrant husband."

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.

In Lurie's focus groups, rural women who are partnered with migrant men frequently complain about what happens when their man gets a "town wife," a steady girlfriend in the place where he works. Taken with his new romance, the man returns to his rural home less frequently and often sends back less money. Back on the homestead, or kraal, the woman grows lonely, and she almost always has children to feed. With unemployment at 37 percent nationwide, and with women profoundly subordinate to men, landing a formal job is usually impossible. Commercial sex as it is usually defined— money handed over for a specific sexual encounter— certainly happens, but often a subtler transaction takes place. The woman gets an ishende, Zulu for a man on the side who brings her food or a little money.

Men, of course, are happy to oblige. Polygamy was part of many African cultures, and, notes Sy Elhadj of the United Nations Joint Programme on Aids (UNAIDS),"When you discuss with people why men are having a number of sexual partners, they say, 'It's our culture.' " But in the traditional polygamy of many southern African cultures, a man was required to pay a lobolafor each wife, a kind of dowry that might take years to accumulate. This, as well as close-knit rural communities, limited the number of sexual partners a man could have, and he was expected to take responsibility for all of his wives.

Colonialism didn't simply destroy this system. It forced Africans to live in an increasingly hollow parody of it. South Africa's "homelands" were reservations that purported to allow Africans to continue their traditional cultures. But in fact, the homelands were devised not only to pacify blacks politically but also to coerce large numbers of African men to "choose" to work in white-owned farms and mines. The homelands were small tracts of South Africa's least fertile land, and white rulers, says University of Natal sociologist David Ginsburg, "understood quite clearly that if they took away the best farmland, blacks would be forced to survive on wage labor. It was a brutal system from the outset."

Migrant labor survives in post-apartheid South Africa because it is so deeply entrenched in the economy. And because massive unemployment places lobolasout of reach for millions of men, and because Western television preaches a radically different sexual ethic, polygamy often survives in caricature form in outright prostitution or sugar-daddy relationships that offer women far less stability.

On the urban side of the migration pendulum, black women in Carletonville have an outlook that's not much brighter than their rural counterparts. Many urban women also depend on men for basic subsistence. But city anonymity makes sexual mixing easier, so many town women who are poor, or whose husbands are unemployed, or who see some sex workers making more money than women in formal jobs, seek affairs that include the man bringing them gifts.

The result, says AIDS educator Yodwa Mzaidume, is that miners and permanent residents of the town are "all rotating in one circle." Indeed, Williams has found that fully half the 25-year-old women in Carletonville's black township, Khutsong, are infected with the virus. Overall, 20 to 30 percent of Khutsong adults are HIV-positive. Clearly, migrant labor isn't just scattering the virus. Wherever it forms a significant feature of the economy, whether in towns or in the countryside, it rends the social fabric and opens countless new opportunities for HIV.

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.

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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