Rural communities fight back against HIV/AIDS

The Daliwonga clinic in South Africa’s impoverished Eastern Cape province has become the area’s best-known landmark. The pristine brick-built structure stands in stark contrast to the dusty thatched huts that surround it. The clinic, funded by big business, was opened a year ago by former President Nelson Mandela, in his drive to bring development to communities like Daliwonga, 50 km from the nearest tarred road.

A new secondary school and a telephone mast courtesy of Mandela mean the community is better off than most. But the growing prevalence of HIV/AIDS in the region may soon cancel out these benefits. The only drug available at the clinic to fight HIV/AIDS is paracetamol. “We help where we can, the really sick people we send to Umtata or Bizana,” Sister Nosisa Nogxima told IRIN. In areas like the Eastern Cape, where 50 percent of people are unemployed and eight out of ten families experience malnutrition, poverty accelerates the epidemic. It remains a critical factor in South Africa’s infection rates, among the highest in the world.

A new report by the UN Food and Agriculture Organisation (FAO), projects that deaths caused by HIV/AIDS in the 10 most affected African countries will reduce the labour force by as much
as 26 percent by 2020, which will have a devastating effect on rural production and food security. The report estimates that since 1985 some 7 million agricultural workers have died from AIDS related diseases in 27 severely affected African countries. An estimated 16 million more deaths are reported likely in the next two decades.

Sipho shuffles past the clinic at Daliwonga, knowing there’s nothing the medical staff inside can do for him. He has been HIV-positive for four years and he’s suffering from advanced tuberculosis, the biggest killer of HIV positive people in Africa. Often he cannot afford the US $1 bus fare to Umtata where his condition is being treated. “I’m not optimistic, I’m very weak now, sometimes I have to decide whether to eat or travel for my medicine,” he spluttered.

Health care workers attached to Daliwonga clinic told IRIN that in the scattered community of Amambisi that the medical facility serves, hundreds are dying alone and unseen. “Where there is no breadwinner or income we see people passing away quickly because of AIDS. Often they have treatable conditions, people want to help them but often they have nothing to give,” one worker said.

Sister Nogxima estimates that seven out of 10 people she sees in the district have AIDS-related illnesses. “The problem for most of those we see is that they need feeding up. I’ve seen patients completely recover from opportunistic infections after two weeks on good food, but most just cannot afford to eat well,” she said. “Even if we had these fancy new AIDS drugs I’m not sure things would be any different,” she added.

Sometimes the first the clinic hears of an infected individual is when the body is unceremoniously dumped outside, meaning there’s no money for a proper funeral. The victim will then be given a pauper’s funeral at the state’s expense. “It shows how poor people are around here, the relatives get tipped off by the grave diggers, then they show up,” Zwelibanjiwe Njomi, the principal of the local school told IRIN.

Education projects at the clinic have had some success, Nogxima said, but the facility serves 30,000 people dispersed over an area of about 60 square km. “Transport is a huge problem, but prejudice and fear are bigger difficulties,” she said. Every Thursday morning the clinic’s sisters run classes with the many visitors and patients. “Women complain that their husbands threaten to leave them if they push the issue of condoms, there’s a long way to go,” she added as she pressed packets of condoms into the palms of departing visitors.

The head of Amambisi Tribal Authority, Chief David Lingazwe said the epidemic had taken everyone in the area by surprise. “We thought it was a town thing, we didn’t know it would kill our families like this,” he said. HIV/AIDS has also brought new social problems to Lingazwe’s community, including crime. “Stock theft and stealing generally have increased, I’m told people are desperate for money to pay for treatment,” he said. Local police confirmed the trend and said they were often in a dilemma over prosecuting sick people.

Another phenomena, unheard of in the area, is also taking hold. “Young girls are prostituting themselves, often to get cash for themselves or infected family members, of course this is just spreading AIDS,” Tolly Xigau, a rural social worker in nearby Bizana, told IRIN. She added that desperate women often foresake condoms if it means making more money. “It’s really sad because often the girls will do anything to get money for food, drugs or transport to urban areas where better treatment is available,” she said.

But Amambisi and comunities like it are fighting back against the disease with the few weapons at their disposal. “You are a journalist, don’t say we are helpless against this scourge, we are doing a lot,” Chief Lingazwe told IRIN. The endless funerals have also brought the reality of HIV/AIDS home to Amambisi. Sister Nogzima’s classes and a new outreach programme means the safe sex message is finally getting through and communal structures are managing to absorb the growing number of AIDS orphans. “Our close networks means people are talking and learning and behaviour is, I think changing,” said Lingazwe. “We’ll see many more funerals, but we’re not just lying down and letting this thing eat us, we need government support and international help, and we need it now,” he added.