No Place Left to Bury the Dead: Denial, Despair and Hope in the African AIDS Pandemic

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9780743270953: No Place Left to Bury the Dead: Denial, Despair and Hope in the African AIDS Pandemic
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A cautionary evaluation of the AIDS epidemic in Africa seeks to raise awareness about the human side of the disease, placing an emphasis on the sufferings of women who are coping with its impact on their families and daily lives while offering hope about new treatments and prevention methods.

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About the Author:

NICOLE ITANO has reported for numerous newspapers and magazines, including The New York Times, The Christian Science Monitor, and Elle. She spent more than five years living in and reporting from Africa. She now lives in Athens, Greece.

Excerpt. Reprinted by permission. All rights reserved.:

Introduction

By the time I first stepped off the plane in Johannesburg in early 2001, at the beginning of what was to be a five-year stay there, a new sense of urgency had arisen over the issues of AIDS. In part, the country had finally awoken to the sheer magnitude of the crisis. By then, South Africa was home to an estimated five million HIV-positive people, more than any other nation in the world. But I suspected the real reason for the new energy was that, finally, it seemed something tangible could be done to halt the epidemic: treatment.

Efforts to prevent the spread of the disease had always seemed depressingly ineffectual and immeasurable; for two decades infection rates had largely continued their upward momentum. Most Africans did not even know their HIV status, and for those who did know they were infected there were few treatment options available; most were simply sent home to die. Communities were staggering under the weight of the sick, dying, and orphaned. The epidemic seemed unstoppable.

The five years that I spent living in South Africa and working there and in neighboring countries, however, was a period of enormous change and new optimism. Treatment that had seemed impossible in Africa just a few years before was becoming possible. A new grassroots activism arose around AIDS, new international money poured in, and treatment centers opened across the continent. In the jumble of new initatives, some projects were ill conceived, and there was much overlap and duplication. But for the first time in nearly two decades, progress was being made.

This book tells the stories of three families and their communities during this period of enormous change, although I try to put their experiences into a broader context and to show how the epidemic unfolded in Africa. I spent more than a year -- between 2004 and 2006 -- visiting the three communities I've written about in this book, talking to ordinary people, community leaders, and activists. Much of the time I spent simply observing, and to a degree participating in, the daily life of the families who generously allowed me to chronicle their lives. I ate meals with them, helped wash their laundry and harvest their fields, and even occasionally slept at their houses. My goal was to try to paint a picture of how real people and real communities were dealing with the epidemic, not based on a single snapshot in time but over a period as they adjusted and dealt with the virus.

The three families whose stories comprise the bulk of this book do not represent the most extreme or tragic cases. In many ways, the stories I have chosen to tell are quite ordinary. Some of the people on whom I've focused are even relatively prosperous or fortunate within the context of their communities. As you will see, however, all the families have been stricken not once, but many times by the epidemic. Often I discovered the other cases of HIV/AIDS only much later, after I had spent many months with the family. But increasingly, in the nations of Southern Africa particularly, few families remain unscathed. In these cultures where familial ties and responsibility include not just sisters and brothers, but cousins many generations removed, there are few people who have not lost some relative and many who have lost more than one.

The main characters in this book are predominately women. In part this was out of necessity -- it is largely women who are willing to talk about the epidemic -- but it also reflects the fact that in Africa it is women who are bearing the brunt of the epidemic. They are caring for the sick and orphaned, and they are dying in larger numbers and at earlier ages. For the women I met, the AIDS epidemic was intricately entwined with abuse, alcoholism, poverty, and hunger. It was rarely, if ever, simply a matter of choice.

From the beginning, I also did not feel that, ethically or emotionally, I could watch someone die and do nothing to help. Therefore I chose to work in places and with families that would likely be able to avail themselves of new treatments as they became available. As a result, this book is less about dying from AIDS than living with it. For many of those I met, however, the line between life and death was often perilously thin.

Often this process was difficult to witness: I saw families crumble and disperse and watched young women I had come to care about return again and again to abusive situations where they put themselves at risk of being infected. I sometimes despaired and frequently felt helpless. The challenges, for the families and their communities, at times seemed insurmountable. In the three places themselves -- located in the Southern African countries of Lesotho, South Africa, and Botswana -- I often encountered a similar bewilderment. Few understood, much less knew, how to stop the slow disintegration of their communities.

I was painfully aware throughout the process of researching and writing this book of the limitations of my own perspective. I was an outsider, a wealthy Westerner. In a region with a deep and divisive racial past, I was also a "white" person writing about black subjects, with all the cultural baggage that entailed. Although I do not classify myself as white -- my mother is of Japanese heritage and my father of mixed Mexican and European -- in the context of Africa I am very aware that I am usually identified as such. In writing this book I chose to use a limited first-person narrative, so that I could explain as much as possible the relationship I had with my subjects. I knew that, given the long-term nature of my involvement with them, I would be unable to stay true to the traditional ethic of journalistic noninvolvement, an ethic I have come to suspect, in any case. Inevitably, though, given the difficult nature of this subject and the many cultural and economic divides that lay between us, finding the appropriate relationship was often difficult, and I didn't always succeed. I have tried to be honest about these failures in part because I think the readers of this book deserve to know, and in part because I think they are themselves instructive.

Given the enormous cultural divides between myself and those I was writing about, there is much that I struggled to understand and probably more that I misinterpreted. Yet I think there is an even greater danger in not trying to understand each other. How can we begin to break down such barriers if we are too afraid of giving offense to confront our differences? I hope one day an African writer will tackle this subject and write the story of AIDS on the continent from an inside perspective. For now, though, I have tried to keep an open mind so as not to let my preconceptions color my views. In some cases, people I spoke to made sweeping statements about their own people and culture that may seem offensive in our Western, politically correct culture. In some cases I disagreed with these statements, and in others thought they contained elements of truth. But in general, I have chosen not to edit these and to let people speak with their own voice about their own lives and struggles.

In the course of researching and writing this book I found more questions than answers, but I also discovered that much of what we had thought was unshakable truth about AIDS in Africa might not be so uncomplicatedly true after all.

1

On a warm October day in 2003, a young woman named Adeline Majoro made her way across Maseru, the capital city of a small mountain kingdom at the tip of Africa called Lesotho. A hint of spring was in the air, but the land lay parched after several years of drought. Most of the city was brown: dusty dirt roads, mud-colored mountains, gray-brown concrete buildings. As she usually did, Adeline walked a few blocks down a rutted lane from the single room where she lived alone, to a main road. There she waited for one of the run-down, sagging Toyota vans, called taxis, that serve as the main form of transportation in the city.

On most days Adeline caught a taxi to the city center, where she taught business and accounting to high school students not much younger than herself. That October day, however, Adeline had steeled herself to make a journey she had been avoiding for weeks. She climbed into a taxi and headed to a small mission clinic on the other side of the city for the results of an AIDS test.

Then just twenty-two years old, Adeline had a broad face, wide hips, and a big, ever-present smile. She dressed conservatively, avoiding the tight, revealing clothes popular among many of her contemporaries. Her mode of dress reflected a certain seriousness in her character. Adeline knew what she wanted from life and worked hard to get it; she had no time to spend at bars or looking for men. During the day she taught, and at night she took classes on a government scholarship to become a chartered accountant. At home, in the village where she was born, she had a young son who lived with her mother.

Like most Basotho1 -- the collective name used for the people of her country -- Adeline was born in a rural area but had been lured to the city in hope of a better life. In 1966, when Lesotho was granted its independence by Great Britain, its capital of Maseru was a sleepy colonial town of about 15,000 whose grandest buildings were a handful of administrative structures built from yellow sandstone hewn from the local mountains. There was a single hotel and a handful of paved roads. In the four decades since, Maseru has sprawled outward from a small center. Today it is home to around 170,000 people and is the only city of any size in a country that remains largely agrarian.2 But beyond the loud and bustling city center, which now awkwardly pairs those original buildings with a handful of modern office blocks and run-down shopping centers, Maseru still has a rural feel. In the neighborhoods that ring the center, such as the one where Adeline lived and the one to which she headed for her test results, the houses were scattered over the landscape rather than squeezed in close together in the manner of a classic slum.

When Adeline arrived later that warm morning at Mal...

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