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MANDENI, A RURAL VILLAGE IN SOUTH AFRICA, HAS BEEN RAVAGED BY AIDS. WOMEN AND CHILDREN BEAR MUCH OF THE LOAD
MANDENI, SOUTH AFRICA - Khumbuzile Cele is thin and gaunt. Cradled in a bed at Blessed Gerard's hospice, she struggles to raise her head to greet visitors, but only manages a weak smile.
Cele's throat and blotched tongue are swollen with thrush, a fungal infection of the mouth. It is painful for her to eat or to even speak above a whisper. But with the voice she finds, she tells her story.
Cele, whose first name in Zulu means "a token of remembrance," has AIDS.
A single mother, CeIe, 33, says she put off getting tested for HIV because she was "afraid of blood tests." She discovered she had AIDS in December 2002, when she was hospitalized for tuberculosis.
"The hospital told me I had AIDS," says CeIe, who speaks occasionally in English, but converses mostly in Zulu. "I did not want to believe it," she says through an interpreter. She kept her HIV status to herself, afraid of being harassed and being branded a loose woman or a prostitute. "I didn't want to hear the rumors," she says.
Cele knew about HIV and the dangers of unprotected sex, but she couldn't say no when her boyfriend, Senzo, 36, refused to wear a condom. She no longer sees Senzo. The relationship is over, but she says he is HIV positive and is suffering with TB as well.
THE NEW BATTLE IN ZULULAND
The town of Mandeni, barely a dot on the map of South Africa, is a land of rolling hills, lush sugarcane fields and emerald pastures. Its main road is brightened by women in jewel-toned traditional dress walking to market. Muscled, dark-skinned men and nimble-fingered women churn the nearby factories, paper mills, shops and food markets. Off the main road, red clay pathways are lumpy and dusty. The countryside so fertile and green the locals call it "heaven."
Welcome to the kingdom of the Zulu, once home to the great 19th century warrior King Shaka and the former battleground of the 1879 Anglo-Zulu war. Welcome, also, to the kingdom of AIDS.
There are 40 million people in the world infected with HIV, the virus that causes AIDS, and 70 percent of them live in sub-Saharan Africa. According to the United Nations AIDS program, South Africa has the largest number of HIV-infected people in the world, about 5.3 million, or more than 11 percent of its population of 45 million.
To understand how HIV has battered South Africa, just contemplate Mandeni, a town that sits about 80 miles north of Durban, a vibrant coastal post on the Indian Ocean. Situated in KwaZulu-Natal, the largest of the nation's nine provinces, Mandeni is a bedraggled industrial town of some 180 factories that produce paper, sugar, steel, furniture, clothing and household appliances. It is also at the heart of South Africa's HIV epidemic.
Provincial health department statistics have shown the incidence of HIV in Mandeni is 33.5 percent - the highest rate in all of South Africa. Though a 2002 study conducted by the Nelson Mandela Foundation showed comparable rates in Free State, Gauteng and Mpumalanaga provinces, Mandeni's deeply embedded epidemic secures its reputation as the AIDS capital of the world.
Here's what makes it so. Mandeni draws a large population of migrant workers - some 30,000 in all, mostly men. The timber and sugarcane harvests promise jobs and income. The male laborers, separated from their families for long periods of time, attract prostitutes who turn to sex work as a means to feed their families. Add a massive dose of poverty, the systemic legacy of apartheid and women burdened by male-dominated social customs and you get a recipe for a raging HIV wildfire.
"Poverty and AIDS go hand-in-hand. Together they are ravaging Africa," says Tamara Mathebula, director of the Planned Parenthood Association of South Africa.
A SACRED PLACE
Before moving to Blessed Gerard hospice, Cele lived in a tin-roof shack with her sister, Buyi, her daughter, Simangele, 16, and her grandchild. To make ends meet, CeIe toiled for poverty-level wages for eight years at a sportswear factory where laborers earn as little as 70 rand (about $10.50) per week. Before becoming ill, she worked more than 44 hours a week.
Supporting CeIe during her illness had become a challenging family affair. Her sister helped out, but eventually her daughter had to drop out of school to attend to her mother's bathing and feeding. Too sick now for her family to care for her, she arrived at the hospice two days ago.
Blessed Gerard hospice is a sunny, airy Catholic care home that sits next to a golf course. Compared with the homes in which townspeople like CeIe typically reside, the accommodations at the hospice are exceptional.
The hospice, which opened its doors in 1996, is funded by private grants and donations. Named for Blessed Gerard, a Benedictine monk who founded one of the oldest hospitals in Jerusalem some 900 years ago, the white, two-story building is tucked away on quiet tree-lined Anderson Road in the heart of a mostly middle-class enclave of neat lawns and green vistas.
Until you enter the hospice, it is difficult to imagine the ferocity with which HIV and poverty have struck this land. Cele's new home is run by Father Gerard Lagleder, the founder and president of the Brotherhood of Blessed Gerard who is a Bavaria-born paramedic who became a priest. Faith without works is dead, believes Lagleder. "I can't just pray and the Good Lord will sort it all out," he says.
Lagleder, 48, who says he has a "German accent, but a South African heart" speaks with a sense of tempered pride as he describes a rare occurrence here in Mandeni - the ability to shelter and comfort those living with AIDS. At any one time there are about 29 children and 14 adults at the hospice.
Cele is one of four women in the ward. Most women who are cared for at the hospice are 18 to 28 years old. The turnover rate at the facility is high. Some months, hospice workers say, there can be up to four deaths a day. AIDS medications are available at Mandeni pharmacies for those who can afford to pay for them. Cele cannot. But like most everyone else at the hospice, she has a warm bed and receives comfort. Her AIDS, however, goes untreated.
IN HARM'S WAY
The most tragic aspect of the HIV deaths at the hospice is that they are not unique. Each death is a daily reminder of the social instability, economic blight and all of the politics of Africa's pain. And as the AIDS epidemic spreads, it snares more and more women in its deadly grip. In Mandeni, as in much of South Africa, the social reality creates a situation where women don't have the power to say no to sex. Also, in sugar-daddy relationships young girls turn to older men to provide clothes or food in exchange for sex.
Schooling is not free in South Africa. Some young girls have sex with older men in exchange for school fees and uniforms, which increases a young girl's risk for exposure to HIV.
A horrifying reminder of the vulnerability of women and HIV: the case of Gugu Dlamini. While a volunteer with the National Association of People Living with HIV/AIDS, Dlamini disclosed that she was HIV positive on World AIDS Day 1998. Her township of KwaMashu, on the outskirts of Durban, felt she shamed the community. Days later, Dlamini was beaten to death by a group of local men.
In South Africa, women contract HIV largely through heterosexual contact. By most indications, it is the volatile convergence of cultural fracture and generational poverty that spikes HIV rates among South African women. Of the 1.3 billion people in the world living in poverty, 70 percent are women, according to United Nations reports.
Among young Africans aged 15 to 24, women are 2 1/2 times more likely than men to become HIV-infected. This gender disparity has been attributed to several factors. For one, HIV is generally more transmittable from men to women. Also, sexual activity tends to start earlier for women and young women tend to have sex with older partners. Moreover, HIV infections in Zululand are rooted deeply in poverty and social politics.
"Women are trapped," says Ntombifuthi Mtshali, a former nurse who now works with the KwaZulu-Natal Provincial AIDS Action Unit, a prevention and awareness program that targets women and children in rural areas. "Many times in our society, a woman dare not say 'no' to sex or insist on her partner wearing a condom. It could mean she could face abandonment and be pushed even further into poverty."
Mtshali's work takes her into Mandeni's poorest areas. "I see the women everyday," she says. "Many of them become prostitutes or continue relations with abusive husbands to feed their children They are afraid of the poverty, of being hungry."
Mtshali and her organization are hopeful that the U.S. Congress will release the funding President Bush pledged as assistance to stem the HIV/AIDS pandemic.
