The complexity of sexual behaviour is forcing medicine to be unconventional in fighting Aids, writes Julia Grey `Stadiums” – places where “the game” is played – take many different forms around the mines in Carletonville, south-west of Johannesburg. A stadium may be the parking lot in front of a beer hall, a stretch of veld near hulking mine machinery, or any one of the shacks that women occupy. The game being played? One of the oldest, and now, in the era of Aids, one of the most dangerous – sex.
But these “hot spots” in the community are now playing their role in a new kind of Aids prevention project. The taverns, beerhalls and other “stadiums” where mine worker meets sex worker are becoming points for condom distribution and the spread of information about Aids.
This initiative – the second of its kind in South Africa, after a similar one being run in the area around Welkom in the Free State – is based on Aids projects that have been run in other African countries like Zambia, Mocambique and Uganda. The strategy that has been successful in these projects is training sex workers as “peer educators”.
Says project worker Soli Moema, these sex workers will be “the gatekeepers to the community”, eventually establishing a network to provide information about Aids and “to make sure that their colleagues insist on the use of condoms”.
Together with community outreach co- ordinator Zodwa Mzai- dume, and a sexually transmitted diseases (STDs) co-ordinator who is yet to be appointed, Moema works closely within both the formal and informal settlements around the mines to identify prostitutes who could become peer educators.
Not all sex workers are candidates. One young woman called Flora, her face swollen and scratched from being raped a few days before, boasts that by eleven o’clock in the morning she has already “serviced” 10 men from the nightshift, at R20 a time. No, she did not use condoms – and she complains that she lost three other clients who wanted to use them. She tells Mzaidume that she suffers from “a burning feeling in her genitals”, and that “her urine is green”.
Mzaidume says that such a woman would not be suitable as a peer educator, but her older neighbour, who had been cleaning the floors and gossiping while Flora told her tale, would be. This older prostitue told Mzaidume that “there are a lot of diseases these days, and there is a lot of sleeping around, and you have to use a condom to be safe”. She concludes: “I would rather not have those R20s than have Aids.”
Training credible peer educators is one important arm of the strategy; the other is to effectively treat STDs. Mzaidume points out that this not only involves the creation of accessible STD clinics, but also bringing the other health workers in the community – traditional healers – on board. Although there are those traditional healers who work in conjunction with clinics and have received some basic medical training, there are others who work independently and claim they can cure Aids.
One such sangoma, whose stall of skins, jars of roots and piles of herbs was set up outside Joker’s Sportsmans Tavern – one of the “hot spots” – says his cure for Aids is a mixture of roots and herbs. Just boil the brew with water, drink it down, and you’re cured. He reports a great success rate, and says he gets 10 to 15 requests every day for his cure.
These claims from respected members of the community confuse the Aids issue further. The case for using condoms becomes less convincing if there is the impression that it is a curable disease.
Mzaidume says the community is divided in its view of which group – the traditional healers or the clinics – they regard as the most credible health workers. Many go to both and, complains Mzaidume, who worked as a nurse at the Community Health Care Clinic for 13 years, the patient “will never say, sister you helped me. No! He believes he has been cured by a traditional healer.”
There is also a tendency, says Mzaidume, for miners who develop full-blown Aids to say “they’ve been bewitched”. Mzaidume sees this as an obstacle to dealing with the Aids problem, because it shows “they still haven’t come to terms with the fact that it was an Aids-related ailment”. It is an attitude of denial helped by the “invisible” nature of Aids – death seems to have been caused by diseases such as TB.
This Carletonville project, which will be running for three years, is still in its fledgling days. But if the progress being made in the Free State project is anything to go by, there is reason to be optimistic. Dr Tony de Coito, who co-ordinates the Free State project, says that the way to evaluate the success of the intervention is to measure the STD rate among prostitutes and miners. In the year the project has been running, the cases of STDs have dropped by between 50% and 80%.
The complexities of human behaviour around sex make the Aids epidemic a hard nut to crack. But already there are signs that some people have been persuaded to take it seriously. The three miners who refused to have condomless-sex with Flora are one example; and even more encouraging, a group of local high school children have formed their own group of peer educators.
Miners have long been recognised as a high- risk group. This is not only because they are young males, but also the nature of their work – after a hard day’s night underground, it’s not surprising that a popular pastime is ice-cold beer and sex.
Over the past decade, the strategy the mining houses have pursued to contain the Aids epidemic by raising awareness levels among miners has largely failed where it matters most: changing people’s behaviour. Miners may know details of how HIV is transmitted, and even have a pocketful of condoms, but whether they use them during sex is another matter.
This project is trying to combat Aids with a different approach, the ingredient that is being counted on for the success of the project is the fact that it is community- based and driven.
ENDS