Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic

by Jonny Steinberg

  “Sizwe Magadla”

  On the first Monday of April 2007 I boarded a dawn flight from Johannesburg to Mthatha. An hour and a half later, the plane sank gently into the morning fog and deposited its twelve or so passengers in the old Transkei capital’s miserable little airport terminal. I hired a car and began the ninety-mile drive to Lusikisiki. Making my way through Mthatha’s rush-hour thicket of schoolchildren and minibus taxis and those outlandishly long 1970s-era Mercedes-Benzes one seems to find only in the old Transkei, the mist lifted off my windshield and evaporated into a clearing sky. By the time I hit the coastal road from Port Saint Johns to Lusikisiki I was driving through a crisp autumn day.

  I met up with Sizwe outside the Metro Cash & Carry warehouse store on Lusikisiki’s main street. For the rest of the morning and through to the early afternoon, I followed in his trail as he went about his business. Then I drove him home to Ithanga, my car filled to the brim with supplies for his shop.

  I had phoned him a few days earlier to tell him of my intention to come, and to ask whether he had a morning and an afternoon to spare for me. He said that he did. He did not ask why I was coming. He regarded such inquiries, I had learned by now, as rude. It is for a person to tell you in his own time the reason for his journey and the nature of his business.

  I had come because I could not finish writing my book. I had resisted making this journey for some time, trying to shape the closing chapters with the material I had. It was futile.

  I had arrived in Lusikisiki in the first week of October 2005 and met a man too afraid to test for HIV. Nineteen months later, pretty much to the day, he was in the same position, too afraid to test, and despite some progress I had made in understanding his world, he still had not revealed to me, and perhaps not to himself, either, the deeper sources of his fear. I had come in the hope that he would take me to a place inside him he had not shown me before.

  FROM THE VERY beginning of this project, I knew in the back of my mind that my own experience of AIDS prefigured Sizwe’s in ways that were astoundingly obvious. I noted this idly, in the way one registers the humming of an electrical appliance or a singing cricket: something that is just there, something that deserves no attention. And yet, as I struggled to finish this book, so I began, with some reluctance at first, to give the connection its due. As I did so, I started to notice, with some alarm and embarrassment, that the crickets had been singing very loudly all the while, that their noise was indeed so deafening I could barely hear myself think. They were singing about a portion of my own history that I had long ago chosen to forget. It was the history of my testing for HIV, and it was deeply troubled.

  Over the following weeks, events from my past began gradually to return to me, not so much in increments as in deeper sweeps of emotion. The more I permitted myself to remember, the more difficult and anxiety-ridden my memories of testing, and of trying to test and failing, became. I grew familiar once again, after a long period of forgetfulness, with something of a nightmare.

  The more I thought about it, the stronger my suspicion grew that the history of my own and Sizwe’s respective anxieties might resemble each other in the way the chins and noses of relatives do. That the faces are related to one another is as clear as the fact that they are also very different. It would be through the route of the common chin or nose, I began to believe, that I would come to understand better the things Sizwe does not share with me. For his anxiety is obviously modulated by cultural and political forces that are of his world, not mine. But that is precisely what I hoped I would come to understand better by drawing out what we had in common.

  So I left home that Monday morning in early April with a story in my head, one about my own forgotten history. My intention was to share it with Sizwe. I hoped that his response would help me to finish my book.

  WHEN I WAS fifteen or sixteen—about as old as Sizwe was when this book picks up the thread of his story—few people foresaw that AIDS would kill hundreds of thousands of young South Africans. We were living in the mid-’80s, the final years of apartheid, and our minds were on the body politic, not the human body. We knew dimly that the spread of AIDS had reached pandemic proportions in some African countries thousands of miles to the north of us. We knew too that, unlike in the developed world, it was being transmitted primarily by heterosexual men and women. Yet Cameroon, Uganda, and Zaire were faraway places, not only in miles, but in our imaginations. Under apartheid, South Africans, both black and white, grew to think of ourselves as exceptional Africans, indeed, as exceptional human beings, a hubris the world’s fascination with us only quickened.

  Back then, less than a tenth of a percent of the population was thought to be HIV-positive. As in the developed world, AIDS was considered a ghettoized disease, one that primarily afflicted middle-class, homosexual men.

  I am gay, middle class, and entering my late thirties. When I became sexually active in the mid-1980s, I was considered to be at the heart of the epidemic’s highest risk group. In Lusikisiki, the word AIDS had yet to pass into popular currency. Teenagers who had unprotected sex were believed to be at risk of pregnancy, not death.

  When I drove into Lusikisiki for the first time in October 2005, our respective positions had been turned inside out. The prenatal HIV prevalence rate at Lusikisiki’s clinics was nudging at 30 percent. I doubt whether a single young person in the villages had not witnessed the death by AIDS of someone she had known since childhood. I, on the other hand, had lost nobody. Among the friends I had made in my late teens, none, nearly two decades later, had fallen ill with AIDS. The epidemic’s center of gravity had shifted from my world to Sizwe’s.

  I was as sexually adventurous during my late teens as Sizwe was during his. From his perspective, I was probably more so; unlike him, I slept with people whose names I never learned, and whose faces I would not remember for long. And I was at least as careless as Sizwe about using condoms. Sometimes I did, sometimes I didn’t. When I did, it was usually at the insistence of my partner. If Sizwe is lucky to be strong and healthy today, I am as lucky as he.

  MY FIRST HIV test was little short of catastrophic. I was eighteen or nineteen, I don’t quite remember. Three and a half months earlier, I had had unprotected sex with a man I knew well. I thought nothing of it for a week or two until suddenly, while taking notes at the back of a lecture hall, I was overwhelmed by the conviction that he had infected me with HIV. I lost the thread of the lecture, felt my pen become slippery with sweat in my fingers, put it down, and stared ahead. By the time I walked out into the sunlight, I felt dizzy and nauseous, as if the virus had already started making me ill. I walked across a wide campus piazza. All around were students in jeans and t-shirts, absorbed in conversation, laughing, or walking in silence; they seemed menacingly indifferent to me.

  As my sense of panic rose, I wondered, with some desperation, about the connection between my actions and my anxieties. Why had I not insisted at the time that we use condoms? Why was I now bathed in sweat, the thought of my impending illness and death drawing me close to tears, when all this could have been prevented by a simple decision?

  These questions were more upsetting than clarifying. If you had asked me, under less troubled circumstances, what sex meant to me, I would have told you that it conjured mastery: being an adult, not a child; being desired, not humored; acquiring the force to be free, instead of being shunted and ordered about. What I felt now, above all, was deep humiliation; I had somehow robbed myself of my authority over my body, my health, my well-being, for reasons I could not begin to fathom. And this feeling of blindness and self-resentment attached itself to my thoughts about sex itself; I wondered whether the act of sex was for me not a groping toward a picture of myself I could imagine but never earn. I was very much a child again: I needed the protection of someone much wiser, saner, and gentler than I.

  I understood that the virus was undetectable for three months after infection. I waited three months to the day, and then walked into the student
health center at Wits University in Johannesburg, where I was studying for a B.A., and asked for an HIV test. I chose the campus health center for its anonymity; I wanted merely to be a face interchangeable with innumerable others.

  It was 1988 or 1989, the final years of apartheid. The most outrageous of the dying regime’s puritanical fears remained on the statute books, sometimes enforced, usually not. In law, sodomy between consenting male adults remained a crime so grave that the police were permitted to use lethal force to prevent those suspected of it from resisting arrest. South Africa in the late 1980s was hardly the best place to be dealing with the prospect of HIV infection. But Wits University prided itself on being a liberal, oppositional institution, one that spoke the discourse of human rights with great fluency. If there were places in Johannesburg that ought to deal well with a virus transmitted primarily by gay sex, Wits was surely among them.

  The pretest counseling did not make for a promising start. A prudish nurse looked at me with what I could only interpret as squeamish distaste and asked whether I slept with men. I shrugged and asked her to test me. She looked down at her clipboard, put the tip of her pen to the page, then thought better of it. She glanced at me again with a thin, distracted smile, one that seemed to express the magnitude of her professional burden: I have chosen to work at a place crawling with eighteen- and nineteen-year-olds who have come from God knows where and get up to God knows what, her thin smile said. But mine is to keep my head down and do my job.

  I went to get my results a few days later. The waiting room at the health center was full. A long and jagged line started at the door and ended at a reception window being worked by three staff members. When I got to the front, I found myself jammed up against the bodies of those waiting alongside me.

  The young woman attending my section of the line asked me what I wanted. She had to make herself heard above the noise around her and spoke in a loud, hurried voice. I told her my name, and that I had come to get test results. A little impatiently, she asked what the results were for. That is a private matter, I replied.

  She picked her head up sharply, showing me her chin. Looking at me very carefully, she asked me to repeat my name, and wrote it down. She turned her back, went to a filing cabinet in the recesses of the room, and spent some time searching through it. She returned to the reception desk with a folder, and opened it. As she read, her brow furrowed.

  “Ah,” she said, looking up at me: “You are here for the results of your HIV test.” The expression on her face and the tone of her voice communicated a dense package of messages. Her eyes were furtive and quick: she was embarrassed to have ignored my request for privacy. Her voice dropped a note or two, as if she knew that what she should have done was lower her voice, but could not, because of the noise around us, and thus spoke deeper instead, a quite useless substitute.

  I nodded coldly. Her eyes noted my hostility and threw back a reciprocal anger; her silent apology had given way to the indignation of one who stands accused.

  She dug her hand into the bottom of the folder. It emerged a moment later holding a folded sheet of paper. She unfolded it, glanced at it, then put it back in the folder.

  “There’s no need for counseling,” she said, her voice now soft and sympathetic. “You tested negative.”

  I turned around, put my head down, and walked away. I did not look around to see whether anyone had taken interest in our exchange. I simply needed to leave.

  Out in the open air, I discovered that my forehead was wet with perspiration and that my cheeks were burning. I needed to shake off the unpleasant feelings as much as to flee the health center itself, and so I did not pause to reflect on what it was that had upset me. I just kept walking, the health center and my experience of it behind me.

  Some months later, I began talking casually of what had happened with a cool smile on my face; I had turned the episode into a light anecdote about a prudish nurse and a thoughtless receptionist. I no longer remembered that there had been sweat on my brow, never mind what had put it there.

  But looking back now, the scene I was rehearsing in my mind as I walked briskly away from the health center is vivid and unmistakable. I was imagining that the people around me had overheard the entire exchange. I put myself in their shoes and thought their thoughts. Comeuppance. That is what they were thinking. He has been gallivanting around town with the hubris of a nineteen-year-old fool, and now he is paying for his excesses. His dick is humbled and shriveled up in his pants, and there are beads of worry on his forehead. We have nothing but contempt for him.

  Their accusation was one I had put to myself over and over again without ever having heard it clearly: he has been trying to take more than his due.

  REMEMBERING THAT MOMENT now, I am struck by how fluently my experience describes the architecture of shame. Neither the nurse who took my blood nor the receptionist who announced my results was overtly hostile. And as for the crowd in the health center, there is no evidence that anyone overheard the exchange between the receptionist and me, let alone cast any judgment. And yet I felt I was walking a gauntlet of sniggers: that was the very heart of my experience, its sine qua non.

  And that is also the sine qua non of shame. At its root lie myriad watching, judging eyes that look at one and see a disgusting and gluttonous figure. They are the eyes of others, but one has internalized them. They are strangers’ eyes whose watchfulness is nonetheless experienced in secret on the inside. When one stands in a crowded room and a person shouts “HIV,” the very name and embodiment of one’s shame, the secret opprobrium expressed by the strangers inside heads for the real strangers on the outside like electrons in a force field. You are suddenly struck with the sickening feeling that the contemptuous eyes have always been on the outside; that is their natural home.

  I SHARED THESE memories with a friend who practices as a psychotherapist. From some remarks she had recently made, I knew that she was preoccupied at the time with understanding shame among her patients.

  I recounted as simply as I could my memory of the scene in my mind as I escaped the clinic. “It was a hallucination,” I said. “It was as if the feelings of scorn I had toward myself had always been searching for a bunch of strangers, as if the proper place for this scorn was always on the outside. As soon as the three letters H-I-V were enunciated, they grabbed the scorn and placed it in every pair of eyes in that room.”

  “You call it hallucination,” she replied, “but it is quite real, quite shared. And the proof that it is real is in a thousand social conventions. If you look for it, you’ll find analogues of your experience all over.

  “The simplest one I can think of is the prohibition in force three or four generations ago on pregnant women appearing in public. Pregnancy was referred to as confinement; the pregnant woman literally had to be confined. She could not be seen in public in her bloated state; it would have been a source of huge, huge shame.

  “What was at the root of that shame? What was it that had to be concealed? It is not the fact that she has had sex. Everyone knows she has. It is the external manifestation of the sex she has had that must be hidden. The bulge in her stomach shouts out: what you have done is manifest now, what you have done is known; your guilt is now on public record.

  “The letters H-I-V were your bloated stomach, your public record, only far worse, for HIV is a virus. The scorn you felt inside not only became manifest, it became manifest as a deadly disease.”

  “But what guilt is now on record?” I asked. “What am I and the pregnant woman guilty of?”

  “Of being gluttonous,” she replied. “Of being disgustingly greedy. Of being shameless. The closest analogy I can think of is having an audience watch you while you sleep. You are snoring raucously and lines of spit dribble down your chin. You are grotesque.”

  It was an arresting image, but it did not quite answer my question. Why should an external manifestation of sex be a sign of such disgusting greed? I can only answer in terms of my own experience: i
n the sneering accusations I had imagined emitting from the crowd at the health center. What is it they were accusing me of taking that was not mine?

  Quite simply: sex. That I had come with my tail between my legs to test for HIV, they said accusingly, that I had done something I feared was making me sick, affirmed that I was a child trying to take things that only adults are licensed to have. I had stolen into an arena in which I had no place. It is as if the marital bed one spends one’s childhood nudging and disturbing and edging one’s way toward, is forever off limits.

  AT THE TIME I went to the campus clinic to test for HIV, half of my university fees were being paid by a scholarship, the other half by my parents. My fee invoices came quarterly, and were addressed to my mother. Some six weeks after my visit to the campus health center, she opened an invoice from the university to find an eighty-rand charge for a blood test.

  “What was it for?” she asked with concern.

  “I didn’t know I’d be charged for it,” I snapped irritably. “It is my business.”

  The moment they left my mouth I understood that my words were unacceptably cruel; I could not possibly leave her with this half-knowledge indefinitely.

  “It was for HIV,” I continued. “I’m fine.”

  She bowed her head in embarrassment, then looked up at me briefly and smiled. “That’s a relief,” she said cheerfully, and emitted a forced chuckle. We shuffled around each other for a few moments before she left the room.

  I had told her a year or two earlier that I slept with men, but I had always studiously revealed nothing to her about my sex life. In retrospect, it is quite clear that my secrecy was in part an attempt to court her attention; I wanted her to wonder about me a great deal. And now her imagination would certainly follow me as vividly as it ever had behind the doors I closed, but not with the inquisitiveness of one who is curious or jealous. Rather, she would be imagining a son who cannot look after himself, who goes out into the city seeking pleasure and returns with trouble and anguish and pain.