News / Africa

    More Affluent South Africans ‘Forced’ to Test for HIV at Public Clinics

    Middle class whites, under financial pressure, now also using free government health facilities once used only by poor blacks

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    Darren Taylor

    People stare at the young woman as she enters the government clinic in a Johannesburg suburb. Some of them shuffle uncomfortably. She’s not like them. They seem disturbed by her presence. She’s dressed in fine clothes. Her face is made up. She doesn’t speak their language. Yet here she is, taking her seat among them on a hard plastic chair, soon sweating like they are under fluorescent lights in the stuffy waiting room…an attractive, well-groomed white South African lady, her blonde hair falling in wavy tresses onto her shoulders. She waits – a picture of elegance – in a crowd of poor black South Africans.

    Today, Brenda Marais is facing the same problem they are, for she, too, is here to be tested for HIV.

    Black face of AIDS

    In South Africa, the face of the AIDS epidemic is almost 100 percent black and poverty-stricken. The vast majority of the more than five million people living with HIV in South Africa black. Most of the bodies of the people who’ve been killed by AIDS over the past few decades have been black.

    HIV/AIDS counselor Cecilia Makiwane advises patient Brenda Marais before Marais undergoes a test for HIV
    HIV/AIDS counselor Cecilia Makiwane advises patient Brenda Marais before Marais undergoes a test for HIV
     

    White South Africans who’ve died of AIDS and those living with HIV – other than a famous judge, Edwin Cameron – are virtually invisible. But, says Marais, while waiting uncomfortably for her turn to be tested, “that doesn’t mean they don’t exist.”

    Marais, though, is no crusading AIDS activist. Just a “run of the mill, middle class, white, suburban woman,” as she puts it. Yet, by virtue of the fact that she’s chosen to be tested for HIV – and at a state health facility usually attended exclusively by the poorest of South Africans – she’s anything but ordinary.

    ‘The end of the world’

    Just before entering the clinic, while parking her vehicle, Marais said she was “nervous,” while simultaneously asserting, “but I do know my status” – implying that she was HIV-free.

    But now, while staring at screaming babies and their HIV-infected mothers lining up to collect their monthly allocations of antiretroviral (ARV) medicines to combat the virus, reality begins to dawn set in. She could soon be one of these people, desperately trying to avoid death. For she suddenly acknowledges, “I’ve never been tested (for HIV).”

    She says she’s had unprotected sex with “quite a few” partners in recent years. She bites her lip, and laughs, the shaky giggles designed to disguise her fear.

    Blood is taken from Marais' finger in order to be tested for the presence of HIV
    Blood is taken from Marais' finger in order to be tested for the presence of HIV

    A few minutes later, a nurse emerges from a dark corridor to lead Marais to an office near the back of the clinic. Here, the nurse introduces her to Cecilia Makiwane, a friendly, soft spoken HIV/AIDS counselor appointed by the state.

    Soon, Makiwane is explaining how the nurse is going to use a surgical needle to prick Marais’ finger, to draw blood to test immediately for the presence of HIV. The counselor reassures an increasingly worried patient, “Don’t worry. Being HIV-positive isn’t the end of the world. If you are infected, we will help you through it and we will teach you all that you must do in order to carry on living a happy, healthy life.”

    But Marais isn’t convinced. She sighs, “If I have HIV, I don’t know what I’ll do.” Her wide blue eyes dart from side to side as she watches the nurse unwrap the testing kit.

    “My worst part about this is the needle,” Marais says, trying to fix her attention on the physical discomforts of the test. When the nurse attempts to prick her forefinger, Marais pulls her hand away, stopping the process temporarily and prompting Makiwane to deliver a brief, but stern lecture.

    “You know, when you pull your hand like this then you are going to hurt yourself. Just relax; you know a needle is painful but it’s not going to be that much,” the counselor tells Marais. The patient responds by shouting, “Ooohhhh! It’s fine; just prick me again! Please make it quick!” and then howls “Ow!” when blood is finally drawn.

    ‘Millions’ have died

    Makiwane uses a dropper to put some blood into an indentation in the testing card. Marais settles uneasily into a chair to wait for the results. If a line appears next to either a number 1 or 2 on the kit, it’ll mean she’s probably infected with HIV. The muscles in the young woman’s face are taut. She knows that in a matter of minutes, her life could change forever.

    Blood is taken from Marais' finger in order to be tested for the presence of HIV
    Blood is taken from Marais' finger in order to be tested for the presence of HIV

    With a quivering lip, Marais stares intently at the test kit on the office table and asks Makiwane, “How’s my results looking?” But the counselor just shakes her head and says, “Just a few minutes more. Keep calm.”

    No one really knows exactly how many South Africans have died of contracting HIV/AIDS, but various NGOs say it’s definitely “millions” over the past two decades. The United Nations estimates at least 350,000 died from AIDS complications in South Africa in 2007 alone.

    Marais is desperate not to become one of these statistics.

    Then, a light red line suddenly shows up alongside the letter “C” on the testing card. “What does that mean?” Marais demands of Makiwane. The counselor informs the patient, “It means you are fine.”

    Marais’ face collapses into relief, and then brightens up with a broad, beaming smile, before she declares in a series of ecstatic exclamations, “C is for clear! I’m positive to be HIV-negative! How’s that! I’m safe!”

    The ‘white’ trap of ignorance

    Reflecting on her experience at the clinic, Marais says she finds it “strange” that at this facility in a relatively upper class Johannesburg suburb, where mostly white South Africans reside, she’s the only white person here today to be tested for HIV.

    Makiwane puts a drop of blood into the test card, while Marais waits for the result
    Makiwane puts a drop of blood into the test card, while Marais waits for the result

    “I think in general, white people think that they can’t get the disease,” she says. “As a white person in South Africa, it’s easy to fall into the trap of being totally ignorant of HIV/AIDS and not being tested at all. You just don’t expect white people in South Africa to be HIV (infected). There’s still this mindset that only poor black people get AIDS, because that is all you ever see on TV, just tons of black people dying of AIDS.”

    But Makiwane insists that growing numbers of white, middle class South Africans like Marais are using public health facilities to be tested for HIV. Up until very recently, she says, they would “send their domestic workers and gardeners to use these clinics. They themselves used to use private clinics. They did not want to put up with the inconvenience of waiting for long in queues to be tested with so many people all at once. They did not want to queue with all these poor, sick people. They preferred to spend a lot of money for a private test.”

    But, says Makiwane and another counselor at a public clinic near the Johannesburg city center, Betty Dube, the ongoing global economic recession is also harming many white South Africans.

    The contents of a 'First Response HIV Card Test' await use at a government clinic in Johannesburg
    The contents of a 'First Response HIV Card Test' await use at a government clinic in Johannesburg

    “Even some of the white people, they have no money now. So they can no longer afford the expensive private tests. Some white women, they tell me that their husbands they have lost their jobs. Now they also have to use the free government clinics, like this one,” says Dube.

    Marais herself acknowledges that “money” was her main motivation for visiting the government facility. She comments, “I can only find part-time work at the moment. It’s getting harder to make ends meet. I have to save where I can. And when it costs about 1,000 rand (US$ 142) to visit a private doctor to get an HIV test, and it’s for free at a government clinic, then I have to use the free service, no matter how good or bad it may be.”

    ‘Good comes out of bad’

    Roshni Govender, a nurse at a private clinic in Johannesburg, says while many white South Africans continue to use “world class” facilities such as the one where she works, a lot more are “definitely being forced into” using free state services.

    “This recession means some can no longer keep up heavy repayments on their private medical aids,” Govender explains, adding, “I feel sorry for these people because the conditions at the majority of the government clinics are very poor indeed. Sometimes they don’t even have ARV medications to give to the HIV-infected patients.”

    A triumphant Marais holds the test card indicating that she's free of HIV
    A triumphant Marais holds the test card indicating that she's free of HIV

    But Marais, in the glowing aftermath of her negative HIV test, is philosophical. She says, “Sometimes good things happen out of bad things, like this poor economic climate. And I would say that more white people using public clinics is a good thing. Maybe it teaches us more privileged South Africans to have more sympathy for our poor fellow citizens.”

    But Dube says “it’s never a good thing for people to be forced into that which they do not want to do.” She adds that if poor black South Africans had the choice, they wouldn’t hesitate to abandon facilities such as hers in favor of well-maintained, clean and properly resourced private clinics.

    “What will be a good thing is for government to improve all conditions at public clinics everywhere, so that people are not forced to use them only if such people are poor,” Dube says, “so that all South Africans, even rich ones, will feel comfortable in using them.”

    But Marais isn’t allowing debate such as this to detract from the triumph of her realization that she isn’t infected with HIV. Still smiling, as she’s about to pull away from the Parkhurst clinic in her smart sedan, she reflects on the “greatest lesson” she’s learned today – “that HIV/AIDS isn’t a white disease or a black disease. It’s a human disease.”

    And on this day, 22 years since the first World AIDS Day was commemorated in 1988, Marais says she feels “like the luckiest human being alive!”

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