“Do you still see the father of the child?” MaMarrandi asked.
Sizwe sat next to me and translated quietly.
“Yes, I do. But we do not have sex.”
“Did he test?”
“Yes. He is negative.”
MaMarrandi raised her eyebrows and looked at her patient skeptically.
“Your white blood cells are protected by the ARVs,” she said. “If you have sex with someone positive, their infection is maybe a little different from your infection and it will come and attack your cells. When it comes time to test your viral load, the nurses will find that the virus is there and they will say you have not been taking your ARVs. It will be because of what happens to your body when you have sex with your boyfriend. It will be difficult for you to survive.
“My advice: either your boyfriend must wear a condom every single time, or you must forget about sex for the meanwhile. Rather do something else: do something that will amaze you. You left school when you fell pregnant. Go back to school. Get your matric [high school diploma]. Your mother can look after your child in the mornings. Do something for yourself.”
“You are right,” the girl said. “I have stopped and started school too many times.”
Her tone is bland and unsuggestive. It is difficult to know whether her agreement is just an acknowledgment of MaMarrandi’s authority, or something more substantial.
MaMarrandi turned to Sizwe and me. “Do you have any questions for the patient?”
“Do people in Nomvalo know your status?” I asked.
“People on this side of the village know.”
“How does that feel?”
She pointed to the door as she answered, a gesture to the world outside.
“I don’t feel bad. I tell them myself. When they ask what is wrong I say amagama mathathu.” “Three letters”—H-I-V.
“Some people are ashamed for others to know. You are not.”
She shook her head earnestly, almost stubbornly.
“No, I am not. Because those who believe they are negative, how many of them have tested? They know in themselves that maybe the only difference between us is that I have tested.”
“Some people in Nomvalo say that there is more than one way of getting AIDS. There is sex, and there are traditional ways.”
“Yes,” she replied. “Some say they get it from bewitchment. Others say sex.”
“Do you believe it is possible to get it both ways?”
She glanced furtively at MaMarrandi.
“I do not agree with the way of the wizards. It is from sex.” She paused, and when she began speaking again it was MaMarrandi she addressed. “What’s difficult for me is that even old ladies are HIV-positive. I don’t know why.”
MaMarrandi took off her reading glasses, folded them carefully, and put them in her breast pocket.
“Maybe I should explain,” she said. “The pensioners, the men, after pension day, when they have money in their pockets, they sleep with young girls. They give them money and then they sleep with them. They come back to their wives with the disease. Also, there is a way the old women get the virus themselves. You have, just for example, an old lady with a shebeen [unlicensed tavern]. When the young boys come and drink, she watches for the one with a lot of money. He calls her magriza. She doesn’t like that. She does not like being seen as a granny. She will propose love to him to show she is not a magriza and she will get the disease from him.”
The girl persisted. “But there are other cases that are even more difficult to explain,” she said. “I know a child who is five years old and HIV-positive, but the mother is negative. What happened? Even the mother asked the nurses at the hospital how it could be that her child had the three letters.”
“Yes,” MaMarrandi said. “There are children as young as five or six who have sex. The little one maybe had sex with someone who is HIV-positive. There is a story about my own granddaughter. Her mother was heating some water to bathe her. She was eighteen months old. Two little ones came: a boy of three, a girl of seven. They came and took my granddaughter. When the water was ready for her bath, they brought her back. She was crying terribly. I checked the child. There was something wrong with her private parts. They were damaged. I called the little boy. I offered him food. We talked nicely.
“‘Who did it?’ I asked him.
“He said the girl did it. She put a stick in my granddaughter’s vagina. The girl denied it. We took the baby to a doctor. He shouted at us. ‘Why do you not care for your own kids?’
“Kids are naughty when they are alone.”
“That’s strange,” the young woman replied. “At the hospital they said maybe a healer used an old blade to cut the child, a blade used on an HIV-positive person. Or they said maybe a careless nurse used an old needle.”
WE LEFT THE young woman and her child, and on the village paths I caught up with MaMarrandi and walked in stride with her. I listened to the sound of her steady footfalls, and of the cotton on her arms brushing the cotton at her sides. Occasionally I glanced sideways at her impassive face, covered now in a thin film of sweat.
In all the hours I had watched her working with the ill, she had betrayed nothing. She appeared to have emptied herself of all save for a silent and limitless compassion. She had answered all my questions about herself so frugally that I soon gave up. It was as if she had decided long ago that to do this job in this village she must become a blank unit of care.
Back in the hut with the teenaged girl she had revealed a sliver of her vantage point for the first time. It seemed to be that of an exasperated woman, of conservative Christian morality, who believed the world to have become unhinged: the very old sleeping with the very young, the children running amok as soon as the adults turn their backs, an orgiastic anarchy spreading this epidemic into every second home.
“When you were growing up,” I asked her, “was there much less sex than now?”
Her face remained impassive and her gait steady, but she began to speak and did not stop for a long time.
“You can’t compare that time with this time,” she began. “They do not listen today. When we were growing, we grew up in groups—young adult girls, middle girls, and young girls. The oldest group had their boyfriends who were about to ask them to get married. They looked out for each other, and they cared for the middle group: they made sure that the middle group does not do wrong things. The young adult girls would watch the girls in the middle group closely and when they noticed that one of them is maturing to a certain stage they would approach her and tell her it is time for her to have a boyfriend. They would sit her down and tell her what to do. They explain that you must not have sexual intercourse. The boys as well, they had adult boys teaching them how to behave. When they reached the point they got married, they knew it is time now to have intercourse in order to give birth.
“Today, they are not listening. There is something called freedom that is confusing them. If you tell them it should not be like this, it should be like that, they tell you that you are abusing them. And so we have a generation of AIDS.”
We walked in silence for a long time. Her soliloquy was so thick with irony it muted me. She is the one in this village on the side of reason and simplicity. She is the one whose work is to drag the virus from the mire of treachery it inspires, to wash off the resentment and the envy and the bile, to wrap the afflicted in a plain garment of medicine and empathy. Yet her own moral imagination had suspended some of the medical knowledge she has learned. She is as aware as anyone that children neither ejaculate semen nor secrete vaginal fluid. So what is it that passes between them? How do they infect one another with AIDS? It is surely the sex itself, the surfeit of sex that has spilled over the boundaries of orderly categories. As if corrupt human practices are quite literally diseased.
It struck me that what I had been thinking of as her limitless compassion is in fact something else, something more admirable, perhaps. It is forgiveness. For the epidemic she ha
s given over her life to fighting is an epidemic of excess and perversity.
I wracked my brain for its thin and rusty knowledge of the New Testament. “What do you think of the Book of Luke?” I asked her. “Did you know it well when you were a child? Was it among your father’s favorites when he read to you?”
She laughed. It was more a query than an expression of amusement. “Why do you ask me that?”
“I am thinking of Jesus on the cross. When he says, ‘For they know not what they do.’”
“That is not a passage I think of often,” she replied. “Actually, when I was a child, my favorite story was from the Old Testament: the story of Samson. It made me feel very strong when I heard it. It shows that even when you think you have nothing, you actually have all the strength you need to accomplish your task. Whatever that task may be.”
We were approaching the car. She asked for a lift to Lusikisiki.
“I have to deposit money for my son,” she explained. “His college fees are due today.”
“How do you manage to pay for your son’s college?” I asked. “You live in a house built from mud and trees. You earn five hundred rand a month. Your husband has also done Christian work his whole life…”
By now, MaMarrandi was laughing heartily. “Jonny! Jonny! Jonny!” she exclaimed between bouts of laughter. Sizwe began to laugh, and then I did, too, reflexively, because there was no choice.
“It is easy,” she said. “It is so easy. Five hundred rand a month? A person can live from a fifth of that, from one hundred, and still be fat and healthy.”
Support Group
Kate Marrandi’s difficulties, as Hermann Reuter pointed out, are the symptom of an unlucky geography. Nomvalo is close enough to decent AIDS medicine to sniff it, but no more. The village institution most responsive to the anguish of the HIV-positive is not the local clinic but the Zionist church.
How would the story of Kate’s work have been told had Nomvalo been uprooted and put down within walking distance of a Lusikisiki clinic?
Finding out is, of course, a simple matter. Over the course of a three-month period in mid-2006, I sit in on several HIV support group meetings at Lusikisiki clinics. Sometimes Sizwe accompanies me. Sometimes I go with activists from the Treatment Action Campaign and watch them work.
By mid-2006, the youngest of the clinic support groups is more than two years old. In theory, each of the twelve clinics has two support groups: one for HIV-positive people, another for those on, or about to initiate, ARV treatment. Some are chaired by Médecins Sans Frontières adherence counselors, others by Treatment Action Campaign activists, still others by long-standing support group members. Each is held in the outdoors on clinic grounds, under a tree or against a clinic wall, the bum of every member on government-issue plastic chairs that were borrowed from the packed clinic waiting rooms. That they are conducted out in the open, in full view of passersby, is both their signature and an emblem of their most urgent aspiration: to take the virus and those it afflicts from their secret places of shame.
The most eccentric feature of the support groups is their cosmopolitanism. An odd observation, perhaps, in the context of a rural town in the depths of the old Transkei; but Lusikisiki is about as unequal and diverse a place as you will find in any countryside anywhere in the world. Around the town center are tiny suburbs of four- or five-room houses with satellite dishes, a complete range of household appliances, and a good car or two in the driveway. Twenty miles away is MaMagadla, Sizwe’s mother, who fetches water from the river and firewood from the forest, has never seen a working television or attended a day of school, or traveled any farther than the one-horse town of Kokstad.
The support groups assembled on their plastic chairs under the trees make for an unlikely sight: a cross-section of Lusikisiki, right through, from one side to the other. There are the adherence counselors and the Treatment Action Campaign activists, young, clever, testing the limits of a new identity and a new confidence. Some wear jeans and TAC t-shirts, others crisply pressed, button-down shirts and chinos. Among them are women in baggy trousers, cropped haircuts, and cloth caps, who carry in their body language and their faces the universal signature of an out-of-the-closet dyke; the TAC has been the catalyst for the unlikely emergence of a lesbian subculture in Lusikisiki.
Alongside the dykes are middle-aged, buxom women from the villages in their starched skirts, their hair wrapped in brightly-colored cloth, the accoutrements of their excursions to town in supermarket bags at their sides. Next to them, middle-aged gold miners returned to their home villages when they fell ill; young, unemployed men living on their grandparents’ pensions; men and women cast out of their homes because of their illness and living in a tin shack settlement to the north of town.
From this motley jigsaw of Lusikisiki’s people comes the most remarkable talk. Men and women who, under other circumstances, would have come no closer than to brush against one another on the town’s main street, here exchange views on clitoral orgasms, and semen, and anal sex; proper conduct in matters of love, marriage, parenthood and nutrition; and, of course, drugs. There has surely been nothing remotely like this in Pondoland’s history.
When a batch of people who have freshly tested positive join the support group, the discussion explodes into shards that disperse across every aspect of life.
A shy, middle-aged man in a red-and-black checked shirt clears his throat, tentatively tests his voice, and begins to speak: “If I stay with my child,” he asks, “is my baby safe? Can we still live in the same house?”
A hefty woman, her head wrapped in bright orange cloth, stands up and replies: “That depends. Is this baby your girlfriend or your offspring? Because some men refer to their girlfriends as their babies, and I need some clarity on exactly what you’re talking about before I can give you useful information.”
“I’m talking about my son,” he says with indignation. “He is fourteen months old.”
A TAC activist named Akona joins the discussion: “The virus lives inside your body,” she says, “mainly in your semen and in your blood. You cannot infect your child. You can cook for him and bathe him and do everything a parent does.”
“But when I cook for him, can I taste the food before I give it to him? And what happens, for instance, if I put his dummy in my mouth, and then he sucks it again straight afterward?”
“There is some of the virus in your spit,” Akona replies, “but very, very little. The medical scientists say you need gallons of spit to infect someone, much more spit than is in your mouth. You can taste your child’s food. You can do everything normal. You will not infect him.”
Another man stands up to ask a question. At the beginning of the meeting, he had announced that he tested HIV-positive two months ago, that when his CD4-count results came back they measured 316.
“My girlfriend doesn’t know her status,” he says. “I told her I was positive the day I got the results, but she refuses to test. And she says she would rather die than use condoms. But I have learned here that I must use condoms for my own health. I suspect she is HIV-positive, and that she has a plan. She wants to go to the police to tell them she got HIV from me. I do not understand her behavior. I do not trust her.”
“You must not jump to conclusions,” a man responds. “Denial is a very strong force. After I tested positive I went to the mother of my children and told her. She refused to believe me. It took three months before she went to test.”
“That’s all very well,” the aggrieved man replies. “But every time we have sex she could be infecting me with another strain.”
“You are right to worry about that,” Akona says. “But you are probably wrong to suddenly treat your girlfriend as a stranger with criminal intentions. I do not know her, but I would be surprised if she is trying to harm you. Probably, she cannot come to terms with the fact that she might be positive. She is not ready to face that. You must try to help her.”
ON A MORNING in early spring, I sit in on
a support group at the clinic that has Ithanga in its catchment area. It is a tough walk from Sizwe’s home: two and a half hours at a brisk pace, up a series of tall hills and down the other side.
I find an empty chair and cast my eye over the assembled people. Among them is a face so familiar and yet so out of place that at first I fail to recognize it. We make eye contact, and in that brief moment of mutual recognition his eyes bulge with fear. He springs from his chair like a jack-in-the-box, turns his back, and flees to the shelter of a tree some twenty steps away. He stops and swivels, takes in the scene he has just fled, breathes deeply and watches furtively, calming himself, deciding on a course of action.
His name is Vukani, and he is a regular drinker at Sizwe’s spaza shop; I must have sat with him at least a dozen times.
I watch his eyes until they meet mine. I smile and nod a silent greeting, and I try to tell him with my face that I will not inform Sizwe or anyone else that I have seen him here today. He looks back at me with strained and studied nonchalance, as if I am making a fuss over nothing, as if his moment of panic and flight were a figment of my imagination. The chairperson opens the meeting and Vukani listens to proceedings from his place under the tree. After some time, he makes his way back to his chair and sits down.
The support group is an old and solid one, and much of the discussion is taken up with the management of various associations that its members have formed. There is a group that grows vegetables together in a nearby village; it is almost time for planting, and they request that the support group assist them in buying seed, and in acquiring wire for a protective fence. There is also a knitting group; its members want the support group to subsidize the purchase of wool.
A middle-aged woman speaks. She is clearly a long-standing figure here; the chairperson refers to her as MaDlamini. She says she wants to report a problem in her village. “The question of stigma is not resolved at my place,” she says. “There is an HIV-positive woman not far from me, and when I go to visit her I am badgered. They tell me she is infected and I must not go and visit a person like that.”
Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic Page 22
