Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic

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At the age of twenty-nine, Sizwe Magadla is among the most handsome, well-educated, and richest of the men in his poverty-stricken village. Dr. Hermann Reuter, a son of old South West African stock, wants to show the world that if you provide decent treatment, people will come and get it, no matter their circumstances.

Sizwe and Hermann live at the epicenter of the greatest plague of our times, the African AIDS epidemic. In South Africa alone, nearly 6 million people in a population of 46 million are HIV-positive. Already, Sizwe has watched several neighbors grow ill and die, yet he himself has pushed AIDS to the margins of his life and associates it obliquely with other people's envy, with comeuppance, and with misfortune.

When Hermann Reuter establishes an antiretroviral treatment program in Sizwe's district and Sizwe discovers that close family members have the virus, the antagonism between these two figures from very different worlds -- one afraid that people will turn their backs on medical care, the other fearful of the advent of a world in which respect for traditional ways has been lost and privacy has been obliterated -- mirrors a continent-wide battle against an epidemic that has corrupted souls as much as bodies.

A heartbreaking tale of shame and pride, sex and death, and a continent's battle with its demons, Steinberg's searing account is a tour-de-force of literary journalism.

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About the Author:

Jonny Steinberg was born and bred in South Africa. His previous two books, Midlands (2002) and The Number (2004) both won South Africa's premier nonfiction literary award, the Sunday Times Alan Paton Prize. Steinberg was educated at Wits University in Johannesburg, and at Oxford University, where he was a Rhodes Scholar. He has worked as a journalist at a national daily, written scripts for television drama, and has been a consultant to the South African government on criminal justice policy. He is currently writing a book about immigrants in New York.

Excerpt. Reprinted by permission. All rights reserved.:

Preface

I came upon the idea of this book sometime during the afternoon of April 9, 2005, while reading Edwin Cameron's book, Witness to AIDS.

In that book, Cameron tells a ghastly story one does not easily forget.

Knowing that up to a third of its population had HIV or AIDS, and that about one hundred thousand people were in urgent need of drugs, the government of Botswana announced in 2001 that it would offer free antiretroviral treatment to every citizen with AIDS. It was a dramatic declaration of intent, unprecedented in sub-Saharan Africa. By the time the drugs had hit the shelves and health personnel were ready to administer treatment, just about every soul in Botswana knew of it.

And yet, on the last day of 2003, more than two years after the launch of the program, only about fifteen thousand people had come forward for treatment. The rest -- over eighty-five thousand people -- had stayed at home. The majority would now be dead.

Why did they not go to get the drugs?

"Stigma," is Cameron's answer. "People are too scared -- too ashamed -- to come forward and claim what their government is now affording them:...the right to stay alive...In some horrifically constrained sense, they are 'choosing' to die, rather than face the stigma of AIDS and find treatment."

Does this foreshadow an entire region's response to AIDS? When the history of this great epidemic is written, will it be said that an untold number of people died, not because the plague was unstoppable, but because they were mortally ashamed? Will it be said that several successive generations of southern Africans were decimated by a sense of disgrace?

About 2.1 million people died of AIDS in sub-Saharan Africa in 2006. Another 25 million are living with HIV. In South Africa, where I was born and bred, nearly 6 million in a population of 46 million are HIV-positive: more than one in eight people. Some eight hundred South Africans die of AIDS on an average day. And the epidemic is spreading at a rate of more than a thousand new infections a day in South Africa. That death could keep accumulating on this scale despite the presence of lifesaving medicines is chilling beyond description.

A certain intellectual temperament greets such spectacles with excited fascination. The moral of Cameron's story, it may be tempting to conclude, is that human lives are not sunny and progressive projects, but the sites of blunt, blind tragedy. Not just the world, but even our own natures are indifferent to our programs of betterment.

I am not one of those fascinated souls. When I read a story like Cameron's, my gut response is that something is wrong, something that might be fixed. This is not to say I subscribe to the proposition that, at core, our natures are healing and life-giving. There is a surfeit of shame and envy and destruction within us, quite enough to go around. But it seems to me that what becomes of this darkness is not a question of fate but of politics. When people die en masse within walking distance of treatment, my inclination is to believe that there must be a mistake somewhere, a miscalibration between institutions and people. This book is a quest to discover whether I am right.

When I finished reading Cameron's book I began to look for the most successful antiretroviral treatment program in South Africa. I wanted to find a place where poor villagers lived within walking distance of well- administered drugs, and where nobody need die for lack of medical care. I wanted to go there and find people who were staying at home and dying, and I wanted to know why they were doing so.

The closest thing I found to what I was looking for was the rural district of Lusikisiki in Eastern Cape province. It is not quite true that everybody there lives within walking distance of antiretroviral (ARV) treatment, or that nobody need die for lack of medical care. It is a chronically poor place, where people have been dying for want of decent care since long before the HIV virus. But extraordinary work was being done there. The international nongovernmental organization Médecins Sans Frontières (MSF, and called in English, Doctors Without Borders), in partnership with the Eastern Cape Department of Health, was using the district's rickety and neglected primary health-care clinics to administer antiretroviral treatment. When MSF arrived in 2002, nearly one in three pregnant women was testing HIV-positive. At least one person a day was dying of AIDS at the hospital on the outskirts of town. Most of those infected with the virus were still asymptomatic; in the absence of a medical intervention, an avalanche of death was to come.

MSF was putting out very good news indeed. Staffed by a cohort of laypeople and ordinary government nurses, the clinics were up and running, the organization said. Thousands of villagers were cramming the waiting rooms to test for HIV. And the shelves were stocked with drugs. By the time I made contact with MSF in mid-2005, a thousand people were on ARVs.

The program was run by an MSF doctor called Hermann Reuter. He is to occupy quite a few of the pages that follow. Reuter's guiding proposition was quite simple: If you provide treatment that works, people will come and get it. If you provide poor treatment, make people stand in lines, or shunt them from one institution to another, they will look elsewhere for succor, or they will stay at home and die. His work was that of a medical missionary: he wanted to show that you could provide decent AIDS treatment anywhere, even in places that had long ago been routed, and that if you did so, people would come forward.

I went to Lusikisiki deeply skeptical of Reuter's evangelical simplicity. While I wanted to resist the stance of the morbidly fascinated, I suspected that things in Lusikisiki were a lot more complicated than he made out. And it did not take long to find people who lived close to a clinic staying at home and dying. The question was why.

If the brochures produced by the area's negligible tourist industry are to be believed, Lusikisiki owes its name to the sound of the wind moving through reeds. According to locals, the word does not mean anything, or if it once did, its meaning is lost to memory. In any case, they say, Lusikisiki refers to two things: the town center with its commercial street and its smattering of suburban-like homes, and the thirty-six or so villages scattered around it in a forty-mile radius.

It is not an easy place to describe. Were you to read its economic data off a spreadsheet without seeing it in the flesh you might think it was a depressed inner-city zone. The majority of adults are un- or underemployed, and most households get their income either by cheap, unskilled labor, or survivalist self-employment, or government grants.

And yet its physical setting is anything but urban. Lusikisiki's 150,000-odd people live in about three dozen villages spread liberally over a spirited, temperamental landscape. Streams and rivers run through villages flanked by wild forests; cows, horses, and goats graze off deep green grassland; the villages along the seaboard stand on high cliffs and command breathtaking views of the ocean. Wandering through this place, it takes dogged labor to remind oneself that its political economy is no longer rural, that almost everyone you meet is either unemployed, or in a job that earns less than a thousand rand a month (roughly equivalent to 140 U.S. dollars), or is the recipient of a grant.

You know it, however, when you leave the villages and make your way to Lusikisiki's town center. There you see what transpires when a single market street becomes the focal point for 150,000 residents of a rural district who must come to one central throughway to purchase everything in their lives, from the food in their stomachs to the tin roofs over their heads. There is no place to move -- not in a car, not on foot, not inside the massive warehouse stores. The rows of hawkers push the pedestrians off the pavements and into the streets, leaving a narrow tunnel for the cars. And there are too many cars. Five days a week, eight hours a day, the street is dense with people, metal, noise, and a cloud of carbon. By seven in the evening it is quiet and empty.

At first I thought that this anomaly between the rural landscape and the urban profile was simply a symptom of my outsider's incomprehension. Yet I soon discovered that the villagers were as confused as I was, that they themselves felt the place to be in a painful and extended interregnum, and that it was this state of affairs that shaped the meaning of the AIDS epidemic.

More than a century ago, Lusikisiki was the capital of Eastern Pondoland, the last independent black polity in these parts to surrender its independence to the British. Political defeat spawned economic defeat; its economy hobbled by its political impotence, the men of Eastern Pondoland began working nine or ten months a year in Johannesburg's gold mines some six hundred miles away, beginning a pattern of circular migration that would persist throughout the twentieth century.

The kingdom's subjugation took a new and cynical form in 1963, when it was incorporated into the northeastern reaches of the Transkei, one of apartheid's notorious old bantustans, the separate "homelands" in which black South Africans could claim citizenship and whose sovereignty was recognized only by South Africa and its most credulous allies. Until the early 1990s, the Transkei was run by a succession of small-time dictators, among them callous and expedient men, their regimes heavily underwritten by the apartheid government.

As a reservoir of cheap labor for Johannesburg's gold mines and a dumping ground on the margins of South Africa's economy, Transkei districts such as Lusikisiki are no strangers to chronic illness. For the last eighty years, at least three out of four residents have incubated the tuberculosis bacillus, a disease that plagued South Africa's gold mine workers and their rural families throughout the twentieth century. Yet during the final decade of apartheid, the annual maintenanc...

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Book Description SIMON SCHUSTER, United States, 2010. Paperback. Condition: New. Reprint. Language: English . Brand New Book ***** Print on Demand *****. At the age of twenty-nine, Sizwe Magadla is among the most handsome, well-educated, and richest of the men in his poverty-stricken village. Dr. Hermann Reuter, a son of old South West African stock, wants to show the world that if you provide decent treatment, people will come and get it, no matter their circumstances. Sizwe and Hermann live at the epicenter of the greatest plague of our times, the African AIDS epidemic. In South Africa alone, nearly 6 million people in a population of 46 million are HIV-positive. Already, Sizwe has watched several neighbors grow ill and die, yet he himself has pushed AIDS to the margins of his life and associates it obliquely with other people s envy, with comeuppance, and with misfortune. When Hermann Reuter establishes an antiretroviral treatment program in Sizwe s district and Sizwe discovers that close family members have the virus, the antagonism between these two figures from very different worlds -- one afraid that people will turn their backs on medical care, the other fearful of the advent of a world in which respect for traditional ways has been lost and privacy has been obliterated -- mirrors a continent-wide battle against an epidemic that has corrupted souls as much as bodies. A heartbreaking tale of shame and pride, sex and death, and a continent s battle with its demons, Steinberg s searing account is a tour-de-force of literary journalism. Seller Inventory # APC9781416552703

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Book Description Simon & Schuster. Paperback. Condition: New. 368 pages. Dimensions: 9.0in. x 5.9in. x 1.3in.At the age of twenty-nine, Sizwe Magadla is among the most handsome, well-educated, and richest of the men in his poverty-stricken village. Dr. Hermann Reuter, a son of old South West African stock, wants to show the world that if you provide decent treatment, people will come and get it, no matter their circumstances. Sizwe and Hermann live at the epicenter of the greatest plague of our times, the African AIDS epidemic. In South Africa alone, nearly 6 million people in a population of 46 million are HIV-positive. Already, Sizwe has watched several neighbors grow ill and die, yet he himself has pushed AIDS to the margins of his life and associates it obliquely with other peoples envy, with comeuppance, and with misfortune. When Hermann Reuter establishes an antiretroviral treatment program in Sizwes district and Sizwe discovers that close family members have the virus, the antagonism between these two figures from very different worlds -- one afraid that people will turn their backs on medical care, the other fearful of the advent of a world in which respect for traditional ways has been lost and privacy has been obliterated -- mirrors a continent-wide battle against an epidemic that has corrupted souls as much as bodies. A heartbreaking tale of shame and pride, sex and death, and a continents battle with its demons, Steinbergs searing account is a tour-de-force of literary journalism. This item ships from multiple locations. Your book may arrive from Roseburg,OR, La Vergne,TN. Paperback. Seller Inventory # 9781416552703

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