“Clearly,” the chairperson says, “we must ask the TAC to go door-to-door in that area and talk to people. There is clearly not enough work being done there.”
“The TAC has been twice to my village,” the woman replies. “It seems that it does not help.”
Yet precisely what she has said and what she wants remain ambiguous. Is she in fact the woman in her village whom people are discouraged from visiting? And if so, why has she conjured another person from her stigmatized self? Or does she mean what she implies: that her own status is not known in her village, that she watches the victimized woman in guilty silence, protected by the shelter of her secret? Perhaps what she is asking is for the TAC to saturate her village while she takes cover and watches from the privacy of her own home. Perhaps she hopes that by the time they have done their work she can come out into a world in which she will not be shamed.
This is, ironically, something the support groups do for their members in powerful fashion after they have died. At Lusikisiki’s clinics, one in six people die within the first year of beginning ARV treatment. The support groups thus know death well. When a member dies, the group makes contact with the grieving family and asks permission to attend the funeral wearing their slogan-emblazoned t-shirts. If the family says no, they stay away. If it says yes, they arrive in large numbers, “HIV-positive” or “viral load undetectable” in bold purple letters across their backs and their chests. They assemble under the funeral tent and they sing old freedom songs, the lyrics no longer about guerrillas and machine guns, but about blood tests, CD4 counts, ARVs, and viral loads. The voices and t-shirts of the singers become the ceremony’s emblem; it is now an AIDS funeral, the one being mourned has died of AIDS: visibly, audibly, undeniably.
The discussion turns to the clinic itself. A woman complains that there has been no co-trimoxazole on the pharmacy’s shelves for several weeks. Co-trimoxazole is a general prophylactic for people with diminished immunity. It is required by a broad spectrum of patients, particularly those preparing to begin ARV treatment. Another woman reminds the group that the new clinic doctor did not pitch on his appointed day last week, that three people who were meant to begin ARV treatment were left waiting, and are still waiting now.
I am attending the meeting with Akona, the TAC activist who, in a previous meeting at another clinic, had assured a young father that he could taste his son’s food. “What do you plan to do about this problem?” she asks.
“We will report it to the TAC’s clinics organizer,” someone says.
“But he is not here. And the clinic is here. Is there not a better course of action?”
“We should appoint a delegation to approach the sister in charge of this clinic,” says a young woman. “She is sitting just over there.”
“I think that is better,” Akona adds. “But let us choose some of the quiet ones to the delegation. Let everyone get some practice at speaking.”
Among those who have not said a word is Vukani. He and four others are appointed to approach the sister in charge. He listens attentively as the meeting briefs the delegation on what to say. He speaks for the first time: he asks the minute taker to ensure that her notes are accurate; he does not want to forget what it is he must take to the nurse.
To appreciate the meaning of this discussion under the trees, it is necessary to plot it on a timeline. Three years ago, doctors did not visit Lusikisiki clinics and there was no co-trimoxazole on the shelves. Three years ago, it was an unusual Transkei patient who knew the name of the drug she had been prescribed, let alone possessed a layperson’s account of what it does in one’s body. The very idea of taking action to put a drug on a shelf was nonsensical, for it was in the nature of things that drug supplies were erratic, a fact as immutable as the hills that lie between Ithanga and the clinic.
It is necessary to go back further in time. From the early 1960s to the early 1990s, the Transkei was run by a Bantustan government with a tinpot brutality bordering on madness: the sort of government that could arrest a person in his own home and lock him in jail without trial or fathomable reason. The idea of demanding that a drug be put on a shelf, or that a doctor arrive at his appointed time, is without precedent. The social movement to which AIDS medicine has given birth is utterly novel in this part of the world, the relationship between its members and state institutions previously unheard of.
Yet if it is a novel movement, an aspect of its novelty is surely its uneasiness and its ambivalence, for the identities of some of its members are exquisitely opaque. As I watch Vukani listening to and memorizing his brief, I am struck by the slipperiness of his place in the world. This afternoon, he will take part in the most innovative social action of his times: a patient demanding from the head of his clinic the drugs and doctors necessary to tackle a great epidemic. When that is done, he will undertake the long walk back to Ithanga; by the time he arrives home the things he has done and the person he has been during the course of the day will vanish into the invisibility of his interior. He will get drunk at Sizwe’s place and play the clown.
By strange coincidence, on the very day I see Vukani at the clinic, I am reading a book about other places and other people that nonetheless speaks directly to the things I have seen. Love in a Dark Time, by the gay Irish writer Colm Tóibín, is a collection of essays about gay lives before the advent of gay politics. One after the other, the characters who fill its pages live masked, double lives, their very beings animated by the fear of who they are and the scandal of their possible discovery.
“The gay past is not pure (as the Irish past can often seem too pure),” Tóibín writes. “It is duplicitous and slippery, and it requires a great deal of sympathy and understanding.”
I do not know Vukani well enough to see inside his heart. But I suspect the doubleness that has come to constitute his life since he tested HIV-positive reaches as deep inside him as would a forbidden love of men. It takes a great deal of shame, a great fear of one’s self, to have to scale a series of hills and walk two and a half hours every Thursday morning, in order to embrace one’s identity as a man with a virus.
I wonder, though, just how solid is the wall between his two lives. In the support group, his HIV-positive status is public, but not public. Back in his life, his status is secret, but not really secret, surely. I can hardly have been the first person he knows to spot him sitting under the trees in the support group meeting. And in a village as small as Ithanga, it cannot have gone unremarked that he disappears into the hills in the direction of the clinic every Thursday morning.
His health status is secret but not secret. People don’t know, but they do. He lives his life in a twilight where everything is and isn’t.
IN APRIL, I attend a support group meeting at Village Clinic in the center of Lusikisiki. It is the oldest, largest, and most cosmopolitan of all the support groups. Sizwe is with me. He places his chair against mine and translates the Xhosa proceedings in a quiet murmur. He is a natural: he listens and translates at the same time, his English unbroken and lively, his intonations performing each speaker’s character.
It is clear from early on that there is going to be trouble. The meeting is chaired by a woman called Thembisa. I do not know whether she is from MSF or TAC, or just a long-standing member of the group, but she has about her the demeanor of an activist, of one who must guide the discussion without bulldozing it. There are two women in the group who have signaled from the start that they are going to challenge her authority. One has bright yellow cloth spun around her head. The other is strikingly obese. They whisper to each other while Thembisa is talking, and cluck their tongues loudly to show their displeasure.
Somebody has placed the question of condoms on the agenda. Thembisa leads the discussion.
“They are something that can make a hypocrite out of you,” she says. “Today I tell people to condomize; tomorrow I come to you with a big, pregnant stomach.”
“It is hard,” a middle-aged woman in the group responds. “Fo
r twenty-five years my husband and I have had sex without a condom. He is not used to it. He doesn’t like it.”
“Your husband is one thing,” Thembisa says. “He knows your status. But if you sleep with a man who doesn’t…Yo! If he is negative, and you make him sick, he can take you to court and you can get ten years. You must disclose your status.”
The woman with the bright yellow headdress is shaking her head in disagreeement. “It is hard to tell someone you are positive,” she says sharply. “If a man proposes love to me, I cannot tell him my status. Even at home it is difficult to disclose. How much more difficult with a stranger?”
Thembisa frowns irritably. “You don’t just jump into bed with someone. It goes slowly. When you are in bed with him, you ask him to use a condom. If he refuses, you suggest that you go and test together. If you walk out of here and sleep with someone flesh-to-flesh, I will blame you for killing him.”
The fat woman speaks for the first time. “Maybe you see a man,” she says, “and you really want to sleep with him.” She slams the back of her hand into the palm of the other. “It is urgent. You want him. You must have him.”
A few people giggle shyly. Thembisa brushes off the challenge with a dismissive wave of the hand. “There is no such situation,” she says.
“Yes there is. You can love a man immediately and propose love to him.”
“Please,” Thembisa says. “If you love him and he loves you, you must know each other’s status. Otherwise how can you even talk of love?”
A TAC activist has appeared from nowhere and joined the discussion. Her name is Nomasamaria.
“There is no debate here,” she says. “Since you know your status, you must use condoms. It is simple.”
“I am not saying no condoms,” the fat woman says. “I am saying you can meet someone today and sleep with him today if you love him. And in that situation, you cannot disclose your status.”
“In any case,” Thembisa says uncomfortably, suddenly changing the subject, “people still need to be taught how to use a condom. It is no use using them if they are not going to work.”
She marches off in the direction of the clinic, leaving Nomasamaria to chair the meeting, and returns a moment later carrying a large wooden penis, a pair of surgical gloves, and a box of condoms. She stands on a chair in the middle of the meeting, tucks the penis under her arm, and puts on the surgical gloves. Some people giggle. Two very dour-looking women in long, starched shirts stare expressionlessly. Another takes out a scrap of paper and a pen and watches carefully, preparing to take notes.
A man who has been silent until now swaggers over to Thembisa and tries to grab the penis from her.
“You will embarrass yourself,” she says, lifting it high in the air, beyond his reach. “You are isishumane. You do not know how to do this. You have no experience.”
“Why the gloves?” he asks. “Are you afraid to handle meat?”
“Go away. You are making a fool of yourself.” She stands on her toes and lifts the penis higher.
Thus, Sizwe and I look on as a mottled patchwork of Lusikisiki’s citizenry gather around a young woman who stands on a chair and holds aloft a large wooden penis like a pagan idol.
I chuckle out loud. “Is this what Moses saw when he came down the mountain with the Ten Commandments?” I ask Sizwe.
“I don’t think Moses saw anything like this,” he says quietly.
A woman who has not spoken before puts up her hand.
“Is it true,” she asks, “that if you put hot water in a condom, you will see fly larvae?”
“I have heard that, too,” another woman comments. “I have heard that the slippery substance on the condom is HIV. Is that true?”
“It was true of the old condoms,” someone replies. “The ones that used to come from America. Today they get the condoms from other poor countries, made by black people and Indian people. They are safe.”
“Indian people? Why should the ones made by the Indian people be safe?”
Thembisa is distracted by the gloves and the penis. Nomasamaria says nothing. The explanation goes unchallenged.
Excitement about the wooden penis ebbs; Thembisa gets off her chair; the discussion drifts toward the last item on the agenda. The support group is organizing a party, a beach braai. It will take place next Saturday. Most of the discussion is taken up with the question of expenses.
“Does anyone’s boyfriend drive a bus?” a woman asks. “If we can save on taxi fare, we will be okay.”
“Doesn’t your boyfriend work in a butchery?” another asks. “Can he supply the meat?”
“If everyone brings their boyfriend,” the woman with the yellow headdress says, “there will be no problem with expenses.”
“But this is not a party for boyfriends. It is for the group.”
“Then the group must find a way to pay.”
THE MEMBERS OF the support group vanish in pairs and in threes into the thick crowds of Lusikisiki’s market street, leaving Sizwe and me alone in the clinic’s garden. Thembisa had held a penis aloft, but I wonder whether the meeting’s proper object of contemplation should not have been a vagina. The discussion, it seems to me, had been nothing less than a tour through its many meanings: a source of pleasure and exuberance, a path to money and subsistence, a site of risk and selfishness, an occasion for restraint and responsibility to others.
I once arrived at Hermann Reuter’s house on a Sunday morning to find him absorbed in anthropologist B. A. Pauw’s classic study of Transkei churches, Christianity and Xhosa Tradition. “All these women’s groups in the churches,” Hermann had said excitedly, “all these forums generations ago where the women had space to talk. TAC has recreated them with the support groups. It is one of their biggest achievements.”
I am relishing talking to Sizwe now, for the meeting has delivered a veritable feast for discussion: the men largely silent, those who did speak curiously inarticulate or meek, the women boisterous and obstreperous and free with their mouths, the discussion proudly and unashamedly taken over by the question of female desire.
“Let’s go,” he says, before I can say anything. “This place has made me so anxious.”
I look at him properly for the first time in a while. All morning I have been listening to his voice without taking in his mood. He is gray and troubled. He fidgets with his hands.
“About what?”
“Everyone here today looked healthy. And yet everyone here was sick. I looked from one face to the next one and wondered whether it was possible that they were all sick. And if it is true, if they are all sick, it is possible that everyone in Ithanga is sick. The whole village. Everyone. Me. My mother, my father, the people who drink in my shop. Everyone.”
Ithanga’s Kate
A few days after we attended the support group meeting at Village Clinic, Sizwe knocked on the door of Jake’s brother, Xolela. The previous year, Xolela had gone to a distant clinic where nobody knew him and had tested positive for HIV. Sizwe had silently watched his health decline over the months and knew that Xolela was going to die; “Jake’s mother is going to lose another son,” he had told me sullenly. I had responded with an outburst: I had told him that there was medicine for Xolela a few miles away, that he was choosing to allow Jake’s mother to lose another son.
Now, Sizwe knocked on Xolela’s door and told him that he wanted to take him to Village Clinic to test all over again.
“I am unemployed,” Xolela said. “I cannot afford the taxi fare.”
“I will pay for you,” Sizwe replied. “I will take a day off work and we will do the whole thing together.”
I cannot say for certain what precisely passed between the two men, but it appears that Sizwe laid great stress on the disability grant of 790 rand per month Xolela would receive were it found that his CD4 count was less than 200. You are poor, Sizwe told him. The money will not hurt. And I will be with you: from the moment you get in the taxi until you get your results, I will be there
.
They boarded a taxi early the following morning, arrived in the town center shortly after nine, and took their place in Village Clinic’s crowded waiting room. On its route to town, their taxi had passed within a couple of miles of the clinic where I had encountered Vukani, and two others besides. I am not sure why they chose Village over their local clinic: perhaps because Sizwe had accompanied Hermann and me there, and believed that Xolela might see a doctor rather than a nurse; perhaps for the sake of anonymity. If it was indeed the latter, then that overpopulated waiting room became yet another arena of the epidemic’s twilight, for it is certain that Ithanga people, or people who know Ithanga people, would see them, and would remark on the fact that they had been there. And why else would two young Ithanga men spend the morning in Village Clinic’s waiting room unless one or both of them suspected that he had the three letters?
It was almost lunchtime before they were ushered into a small office for Xolela’s pretest counseling. When the counselor asked Xolela whether he’d tested before he said no.
“I got angry when he said that,” Sizwe told me when we next saw each other, about three weeks later. “But my anger passed quickly. He was not accepting. I thought to myself, That’s okay. I understand that he is not accepting.”
Ten minutes later, they were back in the counselor’s room; she showed Xolela the bars on the test kit into which his blood had vanished: he was HIV-positive, she said. They listened politely to her post-test counseling, but when it was over they insisted on seeing a nurse.
“It was long after lunch when the nurse could finally see us,” Sizwe told me. “The clinic was already half empty. She explained like Kate, but not nearly as well. She just said very quickly you must do this and this and this. Don’t smoke. Don’t drink. Luckily, he has already stopped smoking, and he hardly drinks.”
Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic Page 23
