EPISODE 18 - Marginalized Groups

Why does the HIV rate in SA remain so high and not really show a big move downwards as is happening in other parts of Africa? Part of the answer lies in the structure of our society. Our advanced economy, the demands of competitiveness in a global capitalist system has massively disrupted family life.

• *Poverty forces families from rural areas to urban informal settlements;
• *Hundreds of thousands of farm workers who used to live permanently on farms are now season workers living in informal settlements;
• *"Traditional" mine worker migration from rural areas continues;
• *HIV has long been known to follow the trucking routes as in Africa including South Africa most goods move by road transport;
• *More recently political turmoil in Zimbabwe and elsewhere has forced people to flee to South Africa.
  
  

The recent National Communications Survey found that only 30% of South Africans are in stable marriages or partnerships.  Most of us are always between partners, because so many of us are on the move. Mobile populations are more like to have many sexual partners, placing them at higher risk of contracting HIV.

Meet Vusi Mhlabati, a mine worker at Evander in Mphumalanga whose wife and children are in Swaziland. Vusi says "poverty is poverty so that is why I am over in SA, there is nothing I can do. If there were job opportunities here, I'd be living at home." His wife, Ma Matrila Mkhalipi says Vusi comes home every second month.  Vusi found out that he was living with HIV sometime in the 90s, he can't remember when exactly. Vusi did an HIV test as a result of a testing campaign on the mine.  Ma Matrila had heard about HIV and when Vusi told her, she accepted it. Vusi lives in a hostel on Evander mine. "Yes, it is common for men who live in the hostels to have girl friends here in SA" says Vusi. The  guys have "sleep outs" girls in town that they stay over with. The conditions of life of migrant workers like Vusi is one of the reasons why HIV is so hard to prevent in South Africa.

In East London we go to the Trucking Wellness Centre where Nurse Fekade is on the night shift. She provides medical services to the truckers moving up and down.  Truckers come in for HIV testing or because they have an STI. Sex workers are known as "pleasure executives" in this part of the world. Sister Fekade says many truck drivers now come in asking for an HIV test because they want to know their status in good time so they can get treated. Miranda, a "pleasure executive" tells us she has been in the business for almost 12 years. She stared this line of work after she ran away from her abusive marriage which she was forced into at the age of 14.  "Some men refuse to use a condom. Others agree on a price and then beat you up and refuse to pay" says Miranda. Many of her friends have passed away. Back when she started in the business in 1998 there wasn't much talk about condoms. When she tested HIV positive she vowed to use condoms regardless of what the man has to say. "No one grows up dreaming of being a sex worker, it's not always a choice one makes." she says. Miranda is in no doubt that "..there is no future in sex work, but we do it because its part of life". Sex work is still illegal in South Africa and this makes it harder to provide services to sex workers like Miranda. No one should be discriminated against, we all have a right to a "better life for all."

In Hoedspruit we meet Patience Mohlala, a farm worker. Patience is living with HIV and took ARVs to prevent her child from contracting HIV. Patience has a beautiful girl who is HIV negative. When she was pregnant Patience received AZT, which she took every day till she went into labour. Then she received Nevirapine which she took when the labour started. After birth they gave the baby the baby received AZT for six weeks. After six weeks they tested her daughter and found she was HIV negative. At the Hlokomela Clinic Dr Mia Erasmus strongly supports moving to full antiretroviral treatment for life when the mothers CD4 count is 350 or below. This way it will even be possible for mothers to safely breast feed their child - so long as the are taking their ARVs properly. Dr Erasmus says that have had a 100% success rate in their PMTCT programme at Hoedspruit clinic because most of the mothers are in a Wellness Programme so pregnancies are picked up early and medication started at the right time. She notes that at some other clinics they are still giving Nevirapine only at time of labour to prevent mother to child transmission. That they haven't even introduced dual AZT and Nevirapine is a failure of service delivery.