Discourse on HIV/AIDS in Cape Town

Kattie Whitelaw '14 (L) and Lauren Barbera '15 (R) making a new friend in Langa Township.

Kattie Whitelaw ’14 (L) and Lauren Barbera ’15 (R) making a new friend in Langa Township.


Discourse on HIV/AIDS in Cape Town, South Africa in Regards to Apartheid Memory and Reconciliation

by Katie Whitelaw and Lauren Barbera

 

Introduction

Our HIV/AIDS project changed dramatically throughout performing our field research in Cape Town, South Africa. We initially thought that this complex problem was actually a simple lack of education. After all, why would South Africans continue to spread this deadly disease if they knew the consequences? We knew we would find some posters discussing HIV/AIDS, but we thought we would have to go out and purposely find them. However, without lifting a finger, announcements and ads flooded our vision as tourists. Within the first three days, we had seen ads on billboards, graffiti awareness symbols and murals, condoms in our house and the Boulders Beach bathrooms, and posters in children’s libraries and swimming pools. We found this surprising since we initially thought that a lack of awareness and education led to the HIV/AIDS epidemic in South Africa. This plethora of announcements made us wonder how the epidemic continues as a national problem.

To help us gain a better understanding of the prevention methods used in Cape Town, how successful those prevention methods are, and how to help improve the prevention methods, we interviewed eight Cape Town residents with different backgrounds and socioeconomic statuses. We discovered that many of the answers we were given could be stratified into similar answers for comparable socioeconomic and age classes. For instance, when asking the different groups about the level of AIDS education within Cape Town, the higher socioeconomic brackets said there is a lack of knowledge, whereas the lower socioeconomic brackets said everyone knows but they have no desire to wear condoms or even that people spread this purposefully.

The different responses received from many of the people interviewed vary not only according to differences in education levels and socioeconomic classes but also in relation to memories of apartheid and President Mbeki’s denialism policy, stigmas, myths, and gender roles and power. Historical experience, belief systems, gender and power add additional layers to form the current day representation of HIV/AIDS in South Africa. Since we saw that no general consensus about these subjects exists, the current day discourse is a mixture of many different ideas. This layering reveals the complexity of the AIDS culture and further uncovers some of the complexity involved in halting the epidemic.

Apartheid Era Oppression and Thabo Mbeki

While interviewing Cape Town residents and conducting our field research on AIDS, it was impossible to overlook the memory of life under the apartheid regime. Although every individual commented on how far the country has come since then, they all made it clear that no positive measures can be taken without considering the lasting effects of apartheid. This surprised us as it came in stark contrast to the media we saw throughout Cape Town of a nation fully unified post-apartheid, now known as the “rainbow nation.” For example, one of the major campaigns run by both the government and non-profit organizations spreads the idea to “condomise.”[1] This can be seen throughout all of Cape Town on billboards, in graffiti and murals, and in smaller posters throughout the townships. In the Langa community pool, one specific poster with the Cape Town city logo reminded people to condomise under the proclomation that “This City Works for You” (see Fig 1).

Aids Poster

Aids Poster

This unified advertising gave the impression that the government post-apartheid is working to prevent AIDS equally amongst all its citizens with no thought to the drastic inequality left over from the apartheid days. In fact, it seemed that to speak against this idea of full equality under the rainbow nation was to speak against South Africa itself. In her article AIDS After Apartheid, Suzanne Leclerc-Madlala described her work with HIV/AIDS prevention in South Africa and encountered this same paradox (Leclerc-Madlala, 19). She even went so far as to say that “…attitudes to the AIDS epidemic that may be culturally informed and strongly associated with specific groups can’t expect a warm reception from local academics” (Leclerc-Madlala, 19). In other words, culturally informed attitudes, such as acknowledging that there is a difference in the epidemic for heterosexual couples versus homosexual singles, are seen as simply politically incorrect and ignored in order to not offend anyone. However, Madlala also mentioned that “culture is important and the local people will impress this on us whenever we take the time to listen” (Leclerc-Madlala, 19). Likewise, by listening to the people around us and accepting both the continuous struggle against the remaining damage of apartheid and the new struggles accompanying the pride of a unified nation, we were able to look deeper into the way apartheid life affected the AIDS epidemic in South Africa.

Through our interviews, we learned that the separation of people based on color under the apartheid government had a lasting effect both physically and mentally on South Africa despite the government’s work to unify the people through this “rainbow nation.” Although the separation of races began prior to apartheid, it was the apartheid government of 1950 that began the process of forcefully relocating black and colored people into townships (Hlongwane, 51). The quality of life there was abysmal with no running water or adequate sewage systems, drastic overcrowding, and increased malnutrition. These conditions allowed for the quick and easy spread of HIV. Although some improvements have been made post-apartheid, these impoverished conditions remain the same for many people living in townships. Thus, the physical aspect of life due to apartheid has contributed greatly to the spread of AIDS.

The forced removals and oppression under the apartheid government also led to mental repercussions amongst South African citizens, most notably in the denialist policies of President Thabo Mbeki and his Minister of Health Manto Tshabalala-Msimang. In 2000, early in his presidency, Thabo Mbeki began working with dissident scientists to better understand the AIDS epidemic (Mbali, 104). In spite of clear scientific evidence linking the HIV virus with AIDS, President Mbeki rejected this link and claimed that AIDS was caused by things like poverty, malnutrition, and even witchcraft. This belief transcended the scientific data and formed many of the government’s policies on HIV/AIDS, including denying people antiretroviral medications. Nicoli Nattrass, director of the AIDS and Society Research Unit at the University of Cape Town, argues that these policies caused nearly 333,000 AIDS deaths and 180,000 HIV infections (Nattrass, 4).

In today’s society it is obvious that the scientific community overwhelmingly points towards HIV as the cause of AIDS, and thus we began our research on President Mbeki thinking he was simply a crazy man pushing his denialist policies. However, throughout our interviews, it became clear that many people in South Africa did not fully agree with this. Although the people we spoke with all stated that President Mbeki’s denialist stance was incorrect, they also told us that they understood how living through apartheid could hurt a man to such an extent that he was fearful of agreeing with any ideas put forth by white populations. Yvonne Muthien, a prominent woman in the government under Thabo Mbeki’s presidency, said that his denialist policy was based on a “deep-seated pain about racism,” and if he acknowledged the origin of AIDS in Africa, he would make the people of Africa look bad (Muthien, Y). Kate Snyder, a socio-behavioural researcher at the Desmond Tutu HIV Foundation, mentioned that after living under a Western system of oppression, she understood President Mbeki’s policies to stem from a “general suspicion of Western culture and powers” (Snyder). [2]

While it would be easy to look at South Africa as a happy, unified, rainbow nation, it is impractical when discussing HIV and AIDS prevention methods. Though neither of these women were defending Mbeki’s denialist policies, they were making it clear that apartheid has had resounding effects in the modern day discourse on AIDS in South Africa, as is apparent in the discourse of prominent political figures like President Mbeki.

Socioeconomics & Gender Violence and Power

One view into the complexity of the AIDS epidemic is sexual, gender-based violence. The public does not commonly discuss this topic within HIV prevention, but the “high (50%) rate of coerced sex (rape) among adolescents complicates education [for] safer sex (condoms)” (Muthien, B). When it comes to the male role in South Africa, “research has established that men who rape and are physically violent towards partners are more likely to engage in sexual risk taking than other men” (Jewkes et al, 1). South Africa’s high prevalence of rape and HIV leads to a rate of 10-25% of rape survivors who are already HIV-positive at the time of rape, emphasizing how essential condom usage is for HIV prevention (Muthien, B). No matter how much money is put into HIV prevention and education, HIV will continue to spread unless something is done about sexual violence.

HIV transmission via sexual violence leads to the bigger question of gender roles within this epidemic. When researching the subject, we found that “over 40% of men report in research interviews having been physically violent to a partner and 40-50% of women report having been victims” (Jewkes, Sikweyiya , et al 1-2); therefore, research tells us that gender plays a huge role in sexual violence. Also, when interviewing Sisanda Siyaka, a woman from the Langa township, we learned that there is a group of boys within the township that prey on young girls out of revenge for their HIV-positive condition (Siyaka, Sisanda).[3] This story suggests that one possible reason for revenge is because the boys themselves are not used to a lack of dominance. They may feel that they must defend their masculinity through acts of sexual coercion.

Although this may not be an apparent thought to the boys or an outsider, it is clear that men generally play a highly dominant role in South African society. However, that is not always the case. Janet Mate, a student at the University of Cape Town, mentioned seeing a lot of posters advertising girls saying “no” to male persuasion against condom usage around campus, but she “[doesn’t] just think it’s the guys” (Mate). She has heard many stories of  “the girls […] putting pressure on the guys” to have unprotected sex and believes that “girls don’t think and act the way they did in the 90’s so that whole submissive to [the] superior is not so much of a problem anymore” (Mate). Although this does not mean girls are sexually violent towards males, this viewpoint poses a large contrast to the stereotypical view of sexual violence in South Africa; women too are trying to take a stand in the bedroom. Without more field research, it is hard to know whether Janet’s perspective is a minority perspective or truly representative of a generational/cultural shift, but it shows a sharp difference nonetheless.

Does this new phenomenon only exist in the upper socioeconomic classes or in areas away from the everyday toils within townships and other low-income neighborhoods? Although we were unable to interview a great number or even random sample of people, we found that UCT students differed from others we interviewed in a few aspects, such as the gender roles mentioned previously. Since a certain amount of money is necessary to attend an institution such as UCT, socioeconomic factors must play some role in one’s view of the epidemic. In 2009, Mathews et al found that “early coital debut is a risk factor for HIV” and that kids who did this were “among students with a lower socio-economic status” (Mathews and Leif et al 1). Even throughout our everyday interactions, we found that many people believed HIV infection was more common among those with lower socioeconomic standing.

Education

While there are many topics that add to the discourse surrounding HIV and AIDS in South Africa, perhaps the most obvious one is education. Following the presidency of Thabo Mbeki, it became clear that people did not have adequate education on the subject of HIV/AIDS. Although the scientific evidence was available, many people in South Africa did not have access to it, leaving  the government and non-profit organizations to take the lead in spreading awareness about HIV/AIDS. This can be seen today in the various billboards, posters, and campaigns present throughout South Africa.

As visitors to South Africa, we based our original understandings off of the idea that the general consensus throughout the country is that lack of education is the main driver in the AIDS epidemic. Thus we were shocked when we conducted our first interview with Sisanda from the Langa Township. She told us that in this day and age there are posters, adverts, and TV shows everywhere blasting the message of AIDS prevention.[4] As a result, she said there is no excuse to not know about HIV transmission. She believes that people who still don’t take the necessary steps to prevent transmission do so because they don’t want to, not because they don’t know how to. Sisanda told us that while the adverts are plentiful enough, they need to be harsher in order to fully scare people into being careful (Siyaka, Sisanda). In an interview with Sisanda’s brother Sabu Siyaka, we got similar answers. He estimated that 80-90% of people know how HIV is transmitted, a far greater number than we were expecting (Siyaka, Sabu).[5]

After these two formal interviews and numerous conversations with other township citizens, we were forced to rethink our original understanding of HIV/AIDS education. However, further interviews with University of Cape Town students revealed a discontinuity in the beliefs amongst Cape Town residents. They claimed that from their perspective, the leading cause of HIV transmission is lack of proper education. Kabwe Musonda, a recent UCT alumn who was involved in AIDS education on campus, said “in the first year, a lot of them [students] don’t really know [about HIV and AIDS].” She also said that the advertisements surrounding AIDS prevention are effective because they increase education in a way that young people can relate to which is important since many don’t know the true facts (Musonda).[6] This sentiment was echoed by the other students we interviewed.

The extreme difference in viewpoints between residents of Cape Town shows that there is no single understanding surrounding HIV and AIDS. We found it interesting however, that the thoughts on education levels were divided amongst socioeconomic lines, with the township residents saying there is plenty of education and the UCT students saying there needs to be more. When speaking of education, it is obvious that there are many layers of thoughts and attitudes adding to the discourse on HIV and AIDS.

Myths and Stigmas

AIDS Poster

AIDS Poster

This stratified discourse on education led us to question the myths and stigmas surrounding HIV and AIDS in South Africa. From our previous research, we learned of many myths circulating in Africa such as ‘sleeping with a virgin will cure AIDS’ and ‘if you fall next to an infected man you will get AIDS’ (Kalichman et al, 299). We saw these as a natural progression, resulting from lack of education. After all, if people don’t have the facts, they want to have some sort of explanation for trauma in their lives. Although some of our interviews supported this idea, others showed us that the discourse surrounding myths and stigmas is just as varied as the general discourse surrounding AIDS.

Bernedette Muthien, a lecturer at UCT and prominent political activist during the apartheid era, told us that people who spread HIV do so out of malice or revenge in spite of their knowledge (Muthien, B). Kate Snyder with the Desmond Tutu HIV Foundation agreed that most people know the facts, but rather than out of malice they spread the disease because it is simply more pleasurable to not use protection (Snyder).[7] In essence, both women told us that myths survive because people want to do what they want to do, and a myth is an easy way to place blame instead of taking responsibility.

During our interviews, the topic of stigmas was brought up alongside education and myths. According to a UCT student named Aaqielah Pillay, stigmas such as ‘if you have TB you must have AIDS’ and ‘if you suddenly become very skinny it must be from AIDS’ are very common in South Africa where people are largely identified as being HIV/AIDS positive (Pillay). When we showed the Langa residents a poster from Mannenburg Township children’s library that asks “Which people in this picture are HIV positive?” (see Fig 2), they immediately tried to find someone with HIV. Sisanda told us that she expected to look at the poster and know exactly who had HIV and for that she thought the poster played directly into the stigma (Siyaka, Sisanda). When we showed the same poster to Aaqielah, she immediately identified this poster as trying to break that stigma saying “It tries to teach kids that a disease or infection shouldn’t define who you are, at the end of the day you’re still human” (Pillay). Although they were looking at the same poster, the differing myths and stigmas present for each person added to the complexity of their understanding and perceptions of HIV/AIDS discourses in South Africa.

Conclusion

When we arrived in Cape Town, South Africa, we expected to find that a lack of education about HIV transmission was the single driving force behind the AIDS epidemic. Though many people agreed (namely the UCT students) that lack of education was a major problem, many others (namely the adult activists, healthcare workers, and township residents) argued that education is everywhere and easily accessed. Furthermore, everyone we interviewed then pointed towards the stigmas created by the apartheid government and the power struggles amongst gender as other contributing factors. Not only did we get different answers from students versus adults, we also got different answers from those in low socioeconomic brackets versus those in high socioeconomic brackets, and those who lived through apartheid and Thabo Mbeki’s presidency versus those who did not.

Although we were not able to interview a large number of people, we were able to interview a range of people with different backgrounds. Each person brought their distinctive life experiences to the table when speaking about HIV and AIDS. And even amongst a group of people living in the same city, there are many more viewpoints concerning this epidemic than can be captured in this paper. All of these ideas layer on each other to create a uniquely varied discourse on HIV/AIDS within South Africa today and must be considered when attempting to apply AIDS prevention strategies in the country.

Works Cited

Hlongwane, C. N. (2003). How apartheid predisposed blacks to HIV infection and AIDS in South Africa. (Doctoral dissertation).

Jewkes, R., Yandisa S., Morrell, R., and Dunkle, K. (2009) Understanding men’s health and use of violence: interface of rape and HIV in South Africa. MRC Policy Brief. 1-2. Print.

Kalichman, S. C.,  Simbayi, L. C., Kaufman, M., Cain, D., Cherry,C.,  Jooste, S., and Mathiti, V. (2005).  Gender attitudes, sexual violence, and HIV/AIDS risks among men and women in Cape Town, South Africa. The Journal of Sex Research. Vol 42, Iss 4, pp. 299-305.

Leclerc-Madlala, S. (1999). AIDS after apartheid. Anthropology News. Vol 40, Iss 7, pp. 19.

Mate, Janet. Personal Interview. Cape Town. 11 Jul 2013.

Mathews, C., Aaro, L. E., Flisher A. J., Mukoma W., Wubs A. G., Schaalma H. (2009), Predctors of early first sexual intercourse among adolescents in Cape Town, South Africa. Health Education Research. 24.1. 1-10. Print.

Mbali, M. (2004). AIDS discourses and the south african state: government denialism and post-apartheid AIDS policy-making.  Transformation (Durban, South Africa). Vol 54, Iss 1, pp. 104-122.

Muthien, Bernedette. “Gender and HIV/AIDS.” Meeting. Engendered. University of Cape Town, Cape Town. 10 Jul 2013. Lecture.

Muthien, Yvonne. “History of South Africa.” Class. University of Cape Town, Cape Town. 02 Jul 2013. Lecture.

Nattrass, N. The AIDS Conspiracy: Science Fights Back. (2012) New York: Columbia University Press. 4. Print.

Pillay, Aaqielah. Personal Interview. SHAWCO Center, Khayelitsha Cape Town. 10 Jul 2013.

Snyder, Kate. Personal Interview. Desmond Tutu HIV Foundation, Cape Town. 04 Jul 2013.


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