News / Africa

Colleague’s Death Sparks Shift in HIV Testing in South Africa

Blood is taken from someone’s finger to test it for HIV at Bulungula, South Africa (D. Taylor/VOA)
Blood is taken from someone’s finger to test it for HIV at Bulungula, South Africa (D. Taylor/VOA)
Darren Taylor

This is Part Two of a five-part series 
Continue to Parts:   1 / 2 / 3 / 4 / 5 

Women dressed in bright red overalls light roaring fires under huge cast iron pots to heat liters of sunflower oil and stock. They tear open plastic bags filled with mounds of frozen chicken pieces and pour boiling water over the pale meat to thaw it.
 
Scrawny dogs of long lost pedigree are threatened with sharp sticks and berated with screeches of “Voertsek!” [“Get lost!”], when the bedraggled beasts get too close to the piles of food.  

A woman peels vegetables for the mass meal in Bulungula (D. Taylor/VOA)A woman peels vegetables for the mass meal in Bulungula (D. Taylor/VOA)
x
A woman peels vegetables for the mass meal in Bulungula (D. Taylor/VOA)
A woman peels vegetables for the mass meal in Bulungula (D. Taylor/VOA)
In the shade offered by a tin shack that looks as if it could collapse at any moment, more women armed with blunt knives peel, scrape and cut carrots, cabbages, onions and pumpkins. They murmur disapprovingly when a young woman wearing skintight jeans and a T-shirt that strains against her chest saunters past their sweaty huddle; but they mutter approvingly when they notice it’s the face of Nelson Mandela smiling down at them from the woman’s tight-fitting top.   
 
Soon, cauldrons of chicken, maize and vegetables are bubbling, steam rising into the powder blue sky. It’s a hot summer’s day in Bulungula district on South Africa’s southeast coast and the cooks slave over the black metal vats of simmering stew.
 
Hundreds of people from surrounding villages are here to enjoy the feast. The atmosphere is electric with gossip and laughter. New friendships are formed; old enemies are ignored.
 
It’s a celebration, a happy outpouring of community spirit – yet in the very recent past the people of the surrounding four villages associated this occasion not with the joy of life…but with fear, pain and even death. They were so terrified of it, in fact, that most boycotted it.
 
Colleague’s death leads to commitment
 
Every month, a local nonprofit organization called the Bulungula Incubator [BI] would set up a tent near one of the villages in the traditional heartland of the country’s Xhosa ethnic group.
 
In this part of South Africa’s Eastern Cape province, according to the state health department, about one in four people aged between 15 and 49 has HIV. Desperate to slow the rate of infection, the BI would invite local residents to be tested for the virus by nurses and counselors in its tent.
 
But, other than a few curious old people, no one turned up. Few in the impoverished region wanted to know their HIV status. Those who found out that they were infected, during medical check-ups at the nearest hospital, kept it secret. The virus remains highly stigmatized in the Bulungula area; those known to be HIV-positive are often shunned – despite the disease’s high prevalence. 
 
And so HIV continued to spread here, courtesy of a toxic cocktail of irresponsible sexual behavior and willful ignorance. Illness and death reigned.
 
One of the casualties was a 24-year-old BI employee.  
 
Preparations are made for the community feast on the occasion to encourage the people of Bulungula to be tested for HIV (D. Taylor/VOA)Preparations are made for the community feast on the occasion to encourage the people of Bulungula to be tested for HIV (D. Taylor/VOA)
x
Preparations are made for the community feast on the occasion to encourage the people of Bulungula to be tested for HIV (D. Taylor/VOA)
Preparations are made for the community feast on the occasion to encourage the people of Bulungula to be tested for HIV (D. Taylor/VOA)
​“She was a lovely, healthy, vibrant person. It was very, very hard for us because she contracted HIV and then she just gave up. She lost weight rapidly. Within three months…she looked like a skeleton,” said Rejane Woodroffe, the organization’s director. 
 
“Everybody sat around and basically begged her to take her ARVs [life-prolonging antiretroviral medication]…and she just refused. Then she engaged in some traditional [healing] ceremonies after which she got even more ill. And we slowly watched her die.”
 
Their colleague’s terrible death had a profound effect on everyone at the NGO. But, out of the loss and the agony sprang a commitment from the health workers that they would do all they could to prevent others in the community from suffering the same fate.
 
‘Cherry on top’  
 
“We decided we had to do something really radical to get the attention of the community and to get as many people as possible tested for HIV, so that they could get onto treatment and so that we could educate them about the best ways not to infect other people,” explained Nomzingisi Hopisi, health manager at the BI.


Bulungula Incubator health manager Nomzingisi Hopisi prepares to draw a name of the winner of the cellphone… She says a colleague’s death inspired innovative action against the spread of HIV in her home area . (D. Taylor/VOA)Bulungula Incubator health manager Nomzingisi Hopisi prepares to draw a name of the winner of the cellphone… She says a colleague’s death inspired innovative action against the spread of HIV in her home area . (D. Taylor/VOA)
x
Bulungula Incubator health manager Nomzingisi Hopisi prepares to draw a name of the winner of the cellphone… She says a colleague’s death inspired innovative action against the spread of HIV in her home area . (D. Taylor/VOA)
Bulungula Incubator health manager Nomzingisi Hopisi prepares to draw a name of the winner of the cellphone… She says a colleague’s death inspired innovative action against the spread of HIV in her home area . (D. Taylor/VOA)

 “We saw how fear of discrimination made our colleague refuse to disclose her status and we were determined that this should not happen to other people here. Now we are trying by all means to make them disclose [their HIV-positive status]. When you are keeping it secret, it consumes your life,” she said.






“But the more you talk about it, the more normal your condition becomes and so the more you accept it and then you become willing to take the steps necessary to prolong your life.” 

​“We really ramped up our testing efforts after our colleague’s death. Everything we do now is geared towards saving lives, because of the experience we went through with our colleague,” said Woodroffe.
 
The BI decided to transform testing days from somber, serious events into fun occasions that would attract the residents of Bulungula instead of repelling them.
 
​“We just started thinking of gimmicky things and novelty factors that would draw people. So we just got big speakers and played some great music and we cooked a nice lunch,” Woodroffe told VOA.
 
The BI also filled attractively sewn “goodie bags” with toiletries, condoms and other goods. People who agreed to be tested for HIV were given the bags.
 
But the “cherry on top,” as Hopisi put it, and the BI’s main strategy to get more people in the area to test for HIV, was a cellphone raffle to be held on each testing day.
 
“People here love cellphones. This is an area that’s so isolated that a cellphone is most peoples only link with the outside world. But most people here are too poor to afford even the cheapest phone,” said Hopisi.
 
High demand for tests
 
There’s a blue hue clouding the balmy interior of the tent that’s pitched on the rocky field. People form a long queue snaking away from the structure as they wait to be tested for HIV. Some tote large beach umbrellas as shelter from the fiery sun.  
 
The manager of the test center at Bulungula, Sityhilelo Mandlingana, surveys the queues of people waiting to be tested for HIV (D. Taylor/VOA)The manager of the test center at Bulungula, Sityhilelo Mandlingana, surveys the queues of people waiting to be tested for HIV (D. Taylor/VOA)
x
The manager of the test center at Bulungula, Sityhilelo Mandlingana, surveys the queues of people waiting to be tested for HIV (D. Taylor/VOA)
The manager of the test center at Bulungula, Sityhilelo Mandlingana, surveys the queues of people waiting to be tested for HIV (D. Taylor/VOA)
The manager of the test center, Sityhilelo Mandlingana, smiled as he surveyed the scene. He became mildly exasperated with two elderly men who were demanding that he test them. “We tested you two gentlemen just a few weeks ago; we can’t test you again now!” Mandlingana barked at the insistent old men, who muttered in annoyance as they hobbled away from the tent.
 
Mandlingana laughed and said, “They’re so old I doubt whether they are still capable of sex! Yet they are turning up here for HIV testing! They just want to win the cellphone!”
 
He continued, “Can you believe it? We are now turning people away from being tested!”
 
Just a few months ago, less than 10 people arrived at Mandlingana’s door to undergo HIV tests. “Now we have tested 91 today,” he beamed.  
 
Nurse Nokwezi Dishi counsels a man who’s just tested positive for HIV (D. Taylor/VOA)Nurse Nokwezi Dishi counsels a man who’s just tested positive for HIV (D. Taylor/VOA)
x
Nurse Nokwezi Dishi counsels a man who’s just tested positive for HIV (D. Taylor/VOA)
Nurse Nokwezi Dishi counsels a man who’s just tested positive for HIV (D. Taylor/VOA)
Inside the canvas enclosure, nurse Nokwezi Dishi gazed firmly into a young man’s face, struggling to meet his eyes, which were hidden behind a floppy khaki hat. Her features softened as she grasped his hand, blood still seeping slowly from the prick in his finger. The man had just tested positive for HIV.
 
He seemed shocked into silence. But Dishi told him, “Be calm. It’s not a death sentence; it’s not the end of your life; it’s just a new beginning.” She explained to him that he would now have to take ARVs, and she made an appointment for him at the local Madwaleni Hospital – “for counseling and a medical examination” and to collect his first supply of drugs.
 
“Hopefully, after the counseling, he will be educated enough to keep himself alive and he will not infect any other people,” said Dishi.
 
Lots of infections
 
Halfway through the day, three people out of 41 had tested positive for HIV. “That’s actually quite a low number,” Mandlingana commented. “Sometimes we can get about 10 positive…. That’s out of every 40 people tested.”
 
He explained, “There are a lot of people who test positive in places like this because there are no clinics here where they can get tested and so how can they know their status?”

Nurses test streams of people of all ages now, as a result of the incentives offered by an NGO (D. Taylor/VOA)Nurses test streams of people of all ages now, as a result of the incentives offered by an NGO (D. Taylor/VOA)
x
Nurses test streams of people of all ages now, as a result of the incentives offered by an NGO (D. Taylor/VOA)
Nurses test streams of people of all ages now, as a result of the incentives offered by an NGO (D. Taylor/VOA)
Mandlingana said it’s the lure of a hearty meal, free goods such as toothbrushes and toothpaste and especially the chance to win a cellphone that’s now attracting great crowds of people to his HIV testing facility.
 
“This lucky draw event is helping us to prevent many new infections and resulting in many people going onto treatment and so saving a lot of lives,” he added.
 
​Most of the people waiting patiently to be tested agreed that it was the possibility of winning the cellphone that had motivated them to find out their HIV status.  
 
A community worker asked one of them, a young man named Thandisa
Sinyoko, “What is more important – knowing your status or winning the cellphone?”

The winner with his prize… (D. Taylor/VOA)The winner with his prize… (D. Taylor/VOA)
x
The winner with his prize… (D. Taylor/VOA)
The winner with his prize… (D. Taylor/VOA)
​Sinyoko replied, “It’s the phone, that’s by far the most important thing for me!”
 
Another woman in her early 20s said, “I want to win the phone but I would come even if there was no phone because I want to know if I have HIV.”
 
But later she acknowledged, “If I am honest, then the main attraction for me is not to know whether I am HIV-positive or not…. I want to take a chance and [hopefully] win that phone.…”
 
Positive results
 
​Inside a massive big top tent filled with people chomping on chunks of chicken, the excitement was palpable as BI workers prepared to reach into a cardboard box and draw one of the names written on tiny pieces of paper.  
 
When one of the organizers announced a name via a loudhailer, a great cheer erupted and a young man clad in a navy blue football shirt sprang to his feet to claim the cellphone. His white teeth shone in the sunlight as a permanent smile creased his face.

Community members serve food to all the people who’ve gathered to be tested for HIV at Bulungula (D. Taylor/VOA)Community members serve food to all the people who’ve gathered to be tested for HIV at Bulungula (D. Taylor/VOA)
x
Community members serve food to all the people who’ve gathered to be tested for HIV at Bulungula (D. Taylor/VOA)
Community members serve food to all the people who’ve gathered to be tested for HIV at Bulungula (D. Taylor/VOA)
“I’m really, really happy to have won the cellphone,” he said. “I was not expecting to win. But knowing that I could maybe win the phone – yes, it was something extra that really made me feel like this is an occasion I should not miss and that I should get tested here today.”
 
For Sam Partington, an American medical student who’s a volunteer health worker at Bulungula, offering people incentives such as the possibility of winning a cellphone is a new approach in the struggle to minimize HIV infections.

People who’ve been tested for HIV are also fed snacks throughout the day (D. Taylor/VOA)People who’ve been tested for HIV are also fed snacks throughout the day (D. Taylor/VOA)
x
People who’ve been tested for HIV are also fed snacks throughout the day (D. Taylor/VOA)
People who’ve been tested for HIV are also fed snacks throughout the day (D. Taylor/VOA)
​“I’ve worked on various projects around the world and I haven’t seen it being done elsewhere,” he said. “But the positive results that it causes have been wonderful to witness. It gives people more of a reason to go to the events. It gets rid of the stigma [associated with HIV testing]. People can say, ‘Well, I’m just going [to the event] to try to win a cellphone.’ They don’t have to say, ‘Well, I’m going because I think I may have HIV.’”
 
Ethics of incentives
 
But for some in South Africa – most notably certain politicians and academics – offering people food and other free gifts in exchange for them being tested for HIV is wrong. 
 
​When Helen Zille, the leader of South Africa’s Democratic Alliance party, last year offered cash prizes to people who got tested in the Western Cape province, the ruling African National Congress criticized her strategy as “unethical” and “irresponsible.” 

Some of the crowd gathered at a recent BI HIV testing day in Bulungula (D. Taylor/VOA)Some of the crowd gathered at a recent BI HIV testing day in Bulungula (D. Taylor/VOA)
x
Some of the crowd gathered at a recent BI HIV testing day in Bulungula (D. Taylor/VOA)
Some of the crowd gathered at a recent BI HIV testing day in Bulungula (D. Taylor/VOA)
​But the BI’s Nomzingisi Hopisi argued, “This is the country in the world with the most people living with HIV [5.6 million people, according to the United Nations] so we need to get radical in terms of how we decrease the spread of HIV…. People who criticize incentives should just get real.”
 
Her colleague, Rejane Woodroffe, was even blunter, saying, “I understand philosophical, ethical debates but I think that in terms of our situation, I don’t think it’s appropriate or relevant.”
 
The estimate that one in four adults in the Bulungula district is infected with HIV spurred Partington to comment: “Excuse the cliché but desperate times call for desperate measures and HIV is an extraordinary disease and so extraordinary measures must be taken against it. I don’t see the negative side to the incentives. I don’t see how encouraging people to test, regardless of how you encourage them to test, can ever be a bad thing – because it is ultimately saving many lives.”
 
​Even state health workers acknowledge that government testing programs in some areas, such as Bulungula, aren’t adequate. “We are not testing as many people as we should. The people simply don’t come to us. So when a project like this comes along we must support it and not criticize it,” said one.
 
“Our testing incentives have changed attitudes to HIV here and are resulting in better management of the disease,” said Woodroffe. “So I don’t see any harm in providing these incentives. I see lots of harm when there aren’t any incentives and people die.”

Listen to report on HIV testing in Bulungula
Listen to report on HIV testing in Bulungulai
|| 0:00:00
...    
🔇
X

You May Like

Video Anti-Muslim Sponsor of Texas Cartoon Contest Draws Ire

Pamela Geller's supporters say she speaks truth about sensitive topic, while critics say she preaches 'that Islam is inherently evil' More

East Meets West in Exhibition Showing Chinese Influence on Fashion

Metropolitan Museum of Art exhibition juxtaposes influence of art, imagery and culture, from Imperial China to the present day, on Western fashion and design More

South Africa Begins New Love Affair With Vinyl Records

Enthusiasts say the 'rebirth' of vinyl is resulting in a rebirth of music in South Africa More

This forum has been closed.
Comments
     
There are no comments in this forum. Be first and add one

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
Mass Grave Exposes Entrenched Trafficking in Thailandi
X
May 05, 2015 5:50 PM
Police in southern Thailand have found two more camps believed to have held human trafficking victims -- one containing a buried skeleton. This comes just days after officials announced arrests in connection with the grisly discovery of 26 bodies in a mass grave at another location. Officials suspect as many as 400 mostly ethnic Rohingya from Myanmar were being held for ransom at the remote camp near the Malaysian border. Steve Sandford reports on developments in the case.
Video

Video Mass Grave Exposes Entrenched Trafficking in Thailand

Police in southern Thailand have found two more camps believed to have held human trafficking victims -- one containing a buried skeleton. This comes just days after officials announced arrests in connection with the grisly discovery of 26 bodies in a mass grave at another location. Officials suspect as many as 400 mostly ethnic Rohingya from Myanmar were being held for ransom at the remote camp near the Malaysian border. Steve Sandford reports on developments in the case.
Video

Video Russia's 'Victory Day' Glory Over Nazis Overshadowed by Ukraine

ussia is preparing to commemorate the 70th anniversary of the end of World War II, known since the Soviet era as “The Great Patriotic War,” with a massive parade on May 9th of military hardware and millions of medals handed out to veterans or their relatives. But critics say the Soviet-style display of power and nationalism overshadows tragic scars during and after the war that still influence politics and foreign policy, especially in the current Ukraine crisis.
Video

Video WWII Anniversary Brings Old Friends and New Worries

The 70th anniversary of the end of World War II has special significance, with Russia becoming more assertive in Ukraine and sending its military planes to the edges of western countries’ airspace. Changes in the geostrategic balance and the transatlantic relationship are felt across the continent, not least in German towns that have hosted U.S. military bases since the defeat of Nazi Germany. VOA’s Al Pessin visited Schweinfurt, Germany, where a large base closed last year.
Video

Video Abraham Lincoln Funeral Re-created for 150th Civil War Anniversary

Over the last four years, commemorative events to mark the 150th anniversary of the U.S. Civil War have brought thousands of visitors to battlefields and historic landmarks across the country. As VOA's Kane Farabaugh reports from the Midwest state of Illinois, the final event in the Civil War's sesquicentennial honors the final journey home of the slain American President, Abraham Lincoln.
Video

Video Campaign Raises Money to 'Uncuff' Journalists

Beginning Sunday – World Press Freedom Day – the Committee to Protect Journalists, a private U.S. group, is launching a campaign to bring attention to their plight and encourage efforts to free them. Deborah Block reports.
Video

Video Volunteers Pull Together to Aid Baltimore Riot Victims

Calm has returned to Baltimore, Maryland, after authorities lifted an overnight curfew imposed almost a week ago to stem the rioting that followed the funeral of Freddie Gray - the 25-year-old black man who died of spinal injuries suffered while in police custody. Six police officers, three of them African-American, have been charged in connection with his death. Baltimore is now trying to get back to normal, in part with the help of volunteers who responded to calls to help those in the city'
Video

Video From Aleppo To Berlin: Band of Brothers Escapes Civil War

Hundreds of thousands of Syrians have fled the civil war in their country and journeyed to Europe by boat across the Mediterranean. It is a terrifying ordeal with dangers at every turn. A group of Syrian brothers and their friends describe their ordeal as they try to reach Germany. VOA's Henry Ridgwell reports. ...
Video

Video Rural Nepal Suffers Brunt of Quake’s Devastation

Nepal is still coming to grips with the full extent of the devastation and misery caused by last Saturday’s magnitude 7.8 earthquake. Some of the hardest-hit communities have been cut off by landslides making it difficult to assess the precise toll. A VOA News crew has been among the first to reach a few of the smaller, remote communities. Correspondent Steve Herman reports from the Sindhupolchak district, east of Kathmandu, which suffered greatly in Nepal’s worst quake in more than 80 years.
Video

Video Obama Praises Work of 3 Immigrant Journalists

President Barack Obama met with three immigrant journalists at the White House Friday to praise them for their work ahead of World Press Freedom Day, May 3. In attendance: Dieu Cay (his pen name) a blogger from Vietnam recently released from prison; Lily Mengesha from Ethiopia who was harassed and detained for exposing the marrying off of young girls as child brides, and Fatima Tlisova, an ethnic Circassian from the North Caucasus region of Russia, who works for VOA's Russian Service.
Video

Video Middle East Atheist Channel Defies Taboo

In Egypt, a deeply religious country in a deeply religious region, atheism is not only taboo, it is dangerous. It is sometimes even criminal to publicly declare nonbelief. Despite the danger, one group of activists is pushing back with a new online channel that defends the right not to believe. VOA’s Heather Murdock reports.
Video

Video Nepal Quake Survivors Tell Their Stories

Against all hope, rescuers have found a few more survivors of the devastating earthquake that hit Nepal last Saturday. Mountain climbers and hikers trapped in remote places also have been airlifted to safety, and aid is finally reaching people in the areas closest to the quake's epicenter. Survivors and rescuers are now recounting their experience. Zlatica Hoke has this story.
Video

Video Lessons for Germany, Europe Remain on Anniversary of WWII's End

The 70th anniversary of the end of World War II will be marked May 8-9 in all European countries except Germany, which lost the war. How is the war viewed there, and what impact is it still having? From Berlin, VOA’s Al Pessin reports.
Video

Video Nepal Town Destroyed By Quake Counts Itself Lucky

Foreign search teams on Wednesday began reaching some of the communities outside Kathmandu that suffered worse damage than Nepal’s capital from last Saturday’s massive earthquake. VOA Correspondent Steve Herman is in Sankhu - a town of about 10,000 people - where there is relief the death toll is not higher despite widespread destruction.
Video

Video Somali Hotel Chain Owner Strives to Make a Difference

Many in the Somali diaspora are returning home to make a new life despite the continuing risks. Since 2011 when a military campaign against Al-Shabab militants began making progress, members of the diaspora community have come back to open hospitals, schools, hotels, restaurants and other businesses. Abdulaziz Billow in Mogadishu profiles the owner of a chain of hotels and restaurants who is helping to bring change to the once-deadly Somali capital.
Video

Video Child Migrants Cross Mediterranean Alone, Face Unknown Future

Among the thousands of migrants making the deadly journey by boat to Europe, there are unaccompanied girls and boys. Some have been sent by relatives to earn money; others are orphaned or fleeing war. From a shelter for young migrants in the Sicilian town of Caltagirone, VOA's Henry Ridgwell reports.

Poll: Baltimore Police Charged

Poll archive

VOA Blogs