Part 3 | 08.16.01 | Life and Death in Leeu-Gamka
Perhaps yesterday's assessment was a bit glib and grim. Leeu-Gamka is a living town of living people, not a collection of pathologies. Alcoholism is endemic, but so is family. Poverty reigns, but his queen is community solidarity. Leeu-Gamka was moved five times in 50 years under the apartheid regime, yet retained its character and relative unity. Men and women are born here, learn here, work here and die here.
The intended focus of my visit is on this final element of the Leeu-Gamkan life cycle, but there is no way to avoid learning about the others. Desrae, a 25-year-old preschool teacher who looks 19, showed me around today. Some kids got out of class to talk to me about HIV: most of them started having sex at around 13 or 14, they all know how HIV is spread, and few of them use condoms. I saw the preschool, full of 40 four-year-olds (taught by Desrae and a 44-year-old).
The kids marveled at my dental retainer; they'd never seen one. I walked down the big dusty roads that bisect the government-funded huts, talking about Desrae's successful application to college and unsuccessful search for a scholarship. Desrae is afraid to be tested for HIV, although she says that she will be tested if she can convince the rest of the newly formed HIV/AIDS committee to go with her.
I also visited the undertaker and the clinic. The undertaker modeled the silence around HIV/AIDS that pervades much of Africa; yes, some young people are dying and the graveyard has recently become overfull, but no, they are not dying of AIDS, she said. TB is a common cause of death. TB, I recalled, is the immediate cause of 40 percent of AIDS deaths.
At the clinic, I talked to a doctor who comes through once a week. A line for his attention wound from the edge of his doorway along three walls and outside of the clinic door. Wherever we went, Desrae spoke to those present in Afrikaans about the purpose of my visit, and how they should talk to their children about how to protect themselves. Dr. LeGrange said that the only testing is done amongst pregnant women; five or six cases have been certified so far.
The fear and denial around testing is such that a man whose wife died of AIDS refused to undergo the test. It is difficult to blame the husband, however — no treatment of any kind is available for AIDS in Leeu-Gamka. The estimated 50 or 60 people living there with HIV have no incentive to learn of their status. Even Nevirapine, a dose of which reduces the chance of mother-to-child HIV transmission by half — and which is offered free by its manufacturer — is not stocked at the clinic. "The government won't send it," LeGrange told me.
As I left, I asked the nurse at the desk for a condom. She asked a nurse in another room, who beckoned me to come in and join her. Yet another employee found the box, opened it, and offered me its contents. As I took two, I asked how often these free condoms are taken. At about 1 on this Thursday afternoon, I was the day's first customer. The clinic would close in four hours, and not reopen until Monday. It is the town's only source of condoms.
LeGrange's analysis was dire: people don't protect themselves, and no treatment is available. "Millions will die," he said.
Leeu-Gamka is far from the marches of AIDS activists, the courtroom defenses of patent rights and WTO agreements and the media outcry over South African President Thabo Mbeki's public questioning of the link between HIV and AIDS. But in this poor and isolated town, which lacks even a bus to carry the rugby team to games 10 miles away, the consequences of those faraway dramas can mean death or life to strong people like Desrae.
The prevention programs that will be initiated by the people of Leeu-Gamka will play an important role, but until treatment is available, the success of such programs will be limited by the fear surrounding steps as elementary as a blood test. The lack of means to help those with HIV preserves the silence around it; the silence and shame around HIV allow children and young men and women to think that it will never happen to them.
Thus the lack of treatment dooms the kind of buy-in that can allow prevention efforts to move from education to changed behavior. Thousands of hours of
work from activists worldwide have led to enormous reductions in the prices of AIDS drugs for those in the developing world, but this has yet to make a
difference in the lives of the residents of Leeu-Gamka. South Africa, a relatively wealthy country, can probably afford to finance its own AIDS
treatment programs; to encourage it to do so, the international community must support groups like the Treatment Action Campaign with money and with calls to the South African Embassy.
Most of the developing world, however, could not imagine paying for AIDS medications — or even general prevention, which costs much less. International funding is necessary. Kofi Annan has called for $7-10 billion
annually for a Global Fund for AIDS and Health, which will work on treatment, prevention, support for orphans, prevention of mother-to-child HIV transmission, and research. But only $1.4 billion has been donated. Those of us with the resources to read articles on the Internet have the resources to
contribute to this fund — and the know-how to influence the contributions of our governments.
Through organizations like mine (the Student Global AIDS
Campaign) and the Health GAP Coalition, we can make sure that African lives count for something in Washington. AIDS is a chronic condition in the West — it shouldn't be a
death sentence in Africa.
Even a couple of days in Leeu-Gamka bound my perception of AIDS to the realities of people's lives. Words like "rural" and "resource-poor" now attach themselves to specific images. I can't reach conclusions about all of Africa from a brief exposure to a single village. However, visiting Leeu-Gamka means that I will not be able to walk away from the AIDS crisis and pretend it does not exist. I know that my actions have consequences for Desrae and Theodore.
So do yours.
E-mail Benjamin Wikler at wikler@fas.harvard.edu.
