God, AIDS, Africa & HOPE

Reflections / Gedanken

The Wedding

Stefan Hippler

The Wedding  –  What to do when a spouse is infected?

Adopted, but never really accepted. Always the feeling that the inclusion in the foster family was an act of charity. Marriage and ascent into the middle class. At some point left by the husband; a new girlfriend, new happiness – for him. After a year he resurfaces and climbs into the marital bed as if nothing ever happened. After another year the husband is dead, officially from organ failure but in reality as a result of Aids. After all those years of fidelity a test produces the dreaded result: Charmaine is HIV-positive. The adoptive family cuts all ties, she is relegated from the middle class, becomes dependent on grants. A fate that many thousands of women share with her.

But there is a silver lining. She is admitted for treatment at Tygerberg Hospital. She assists at the hospital as an unpaid volunteer. She educates patients, performs care tasks, and supports herself by selling her pearl embroidery. But she has no steady income and remains dependent on the charity of patients and colleagues who give her money and food parcels.
I get to know Charmaine at this point. She has made contact with HOPE Cape Town and often visits our small office in the Ithemba ward. In mid-November 2005  I receive a letter from Charmaine and her new boyfriend Nigel. She writes: “We would be very happy if you had the time to conduct our wedding on 1 December. We are both HIV-positive patients and in treatment at the hospital. Because the hospital is such a great source of support, we would like to celebrate our wedding with other patients and hospital staff. By doing so we want to break the stigma against HIV-positive people and in that way give hope to other infected people.” I wonder how people like Charmaine still find the strength to motivate others after all her bitter experiences.
Charmaine’s story is just one of countless others about faithful spouses who get infected. The cases of emotional cruelty, the parting pains, the feelings of abandonment are innumerable – one could write huge tomes about that. Charmaine’s story is also a textbook case about the problems with the now universal ABC strategy. A for abstain; B for be faithful, C for condomise. For the Catholic Church, A and B play the decisive role, while as a priest I sometimes feel that the Church views C as diabolical.

Be faithful! That’s easy to say, and often we nod sagely and think that fidelity is pure common sense. But that is one of the most difficult commandments because it can work only if both partners stick to it unfailingly. Fidelity by itself offers no guarantee against infection. I think here about Lorraine*, a 21-year-old Coloured woman. She was with me as we drove to Tygerberg Hospital for the official launch of our HIV/Aids project on 29 October 2001. She was uncharacteristically quiet in the car. Only later did I learn why: she had just returned from the doctor who had delivered the shattering test result. Lorraine had always been faithful to her boyfriend; he unfortunately not to her. Only 21 years old and HIV-positive: what prospects…

Be faithful! That recommendation also reminds me of Desiree, a young Xhosa mother, whom I met during one of many house visits in the townships. She had been with her boyfriend for a few years and had two kids. During her second birth an Aids test was taken, a precautionary obligation that now applies to most expecting mothers in South Africa. The result – HIV-positive – came as a shock to Desiree. How could that happen? In her desperation she turned to her boyfriend. He had no qualms about admitting to all sorts of adventures and affairs, but take a test? No way! He was insulted by the mere idea that his girlfriend suspected him of having such a disease. He moved out and into a shack two doors down. Alas, the same sad story will repeat itself: new love, new bliss. And, quite probably, soon a new infection.

Be faithful! Perhaps a wife or girlfriend will turn to one of the many Protestant churches that support affected women with prayer meetings and house visits. I don’t see much of that kind of help and solidarity in my church – with some exceptions, my brethren barely acknowledge the problem because they usually don’t know any “such” people. And when they do, they counter with a reproach: “It’s their own fault”. If people followed the Church’s teachings, they’ll say, none of this would happen in first place. Which is true. And yet I wonder why it that such a big chasm exists between the ideal and reality.
Is it a blip in God’s creation? Or a human error in reasoning?

Charmaine and Nigel’s wedding is a poignant celebration. Guests come from all departments in the hospital, and patients form a guard of honour. The mood is happy, relaxed and, yes, defiant. Newspapers, radio and TV cover this unusual event. In all reports the message is the same: there is a future with the virus after all, a livable future in God’s mercy. And that is good.

* Name changed

Translation from:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, , , , , , , , , , , , , , , , , , , ,

Right to life or death penalty?

Stefan Hippler

Right to life or death penalty?  – The contradictions in Catholic moral teachings

How does your church react to the pandemic? What guidance does it give? What measures does it recommend? What is it doing? These are the kind of question Catholic priests are likely to face in the era of HIV/Aids. In theological terms, the Church has no official, defined teaching on the question of HIV/Aids: there are still no answers to the fundamental challenge we are facing. So far a few cautious inferences have been voiced with reference to Church teachings, manifesting the immense gulf between theory and practice. They do not equip the pastor with spiritual tools but more likely drive him to struggles of conscience.

When it comes to care for Aids patients and those affected by it, the Roman Catholic Church is at the forefront. Many consecrated women and men literally sacrifice themselves in the service of suffering people. In many developing countries it is in particular Catholic establishments that carry the greatest load in supporting the Aids-affected because state institutions often are overextended. Many Church leaders around the world have emphasised this service to humanity. My home diocese of Trier pointed out as early as the 1980s that it is an ancient obligation that the Church must stand in solidarity with the suffering and the dying. The diocese stressed that any form of discrimination or stigmatization of HIV-positive people is unchristian. Some theologians even refer to the Body of Christ as having Aids, thereby creating a way to view the disease theologically.

These brave notions stand in contrast to the rigidity and ignorance of many bishops and priests who are still not prepared to tackle the issue of HIV/Aids. Some of them even deny that the disease is a problem in their dioceses. Their resistance ranges from the pious observation that Aids is a punishment from God to a priest asking an HIV-positive parishioner to leave his congregation. Those in charge of the Church are intimidated by HIV, Aids and the implicit association with sexuality. They don’t want to confront these issues because to do so they must enter the minefield of moral theology.
The Church teaches that sexuality belongs in marriage, and only in marriage. It may be practised only in a life-long partnership between a man and a woman who remain faithful to each other. Everything else – premarital sex, homosexuality, multiple partners, one-night stands, cohabitation, polygamy – is sinful. Within the institution of marriage, sexuality was reduced to the dictum of the Church Father St Augustine who taught that every sex act must be open to procreation. Artificial contraception is regarded illicit with reference to the encyclical Humanae vitae, issued by Pope Paul VI in 1968. In an official handbook for confessors, approved in 1997 by Pope John Paul II, the late Cardinal Alfonso López Trujillo, then prefect of the Pontifical Council for the Family, emphasised the unequivocal teaching authenticity of Humanae vitae: “The Church has always taught the intrinsic evil of contraception, that is, of every marital act intentionally rendered unfruitful. This teaching is to be held as definitive and irreformable.” And God wills this regulation, according to the pope as the supreme guardian and teacher of the magisterium. The will of the Almighty permits no discussion, and accordingly there are no ways of dispensing believers from it. Thus millions of people become sinners because they live in defiance of God’s will as defined by the Vatican. And so they must bear the consequences of their godless behaviour, at least as far as fundamentalist theologians are concerned.

Among the proscribed artificial instruments of contraception are condoms. These are, as we know, the only effective means of preventing the exchange of bodily fluids during sexual acts. The Church’s teaching on condoms, still controversial and puzzling to many, refers solely to procreation, but extends now to questions of life and death. The moral theologian Carlo Caffarra – now archbishop of Bologna – in 1989 even called for an end to sexual activity within marriages in which one partner is HIV-positive. Our Church held on to that approach for years. Only a few bishops dared to invoke the difference between protection and procreation of life.

The Belgian Cardinal Godfried Danneels pleaded for the use of prophylactics when one spouse is infected. “Otherwise one sin – breaking the sixth commandment (Thou shalt not commit adultery) – is compounded by another sin, breaking the fifth commandment (Thou shalt not kill).” The German theologian Professor Johannes Reiter called for condoms to be tolerated in some cases as“disaster prevention”. But such ideas have failed to penetrate the centre of the Vatican. Perhaps the Vatican’s new doctrinal study into the use of condoms in the fight against Aids commissioned by Cardinal Javier Lozano Barragán will usher in a change; it reportedly has been circulated already to Pope Benedict XVI and the doctrinal congregation. Cardinal Barragán was the Vatican’s de facto health minister, and he has exercised his mind for some time on the question of whether marital condom use can be licit on the grounds of self-defence when one partner is infected.
As things stand, there is no deviation from the official teachings of the Church. Indeed, the 1968 Königsberg Declaration in which the German bishops emphasised spouses’ freedom of conscience is at risk of being withdrawn so as not to impugn on papal primacy. It seems that papal infallibility is being virtually expanded to include pronouncements which have not been issued ex cathedra, i.e. the official decisions declared by the pontiff in college with the Church under the guidance of the Holy Spirit which are to be regarded as infallible. So people with HIV, who already have sinned, must now also accept that the only available method of protection for their partners is proscribed. Those who use condoms commit one sin on top of another. Of course there is an alternative: abstinence.

But doesn’t our Church teach that celibacy is a gift from God and not intended for every one?

There is a big contradiction in the teachings of our Church: in its support for and care of those with Aids, the Church is a leading light, but at the same time it also contributes to the discrimination of these people. It seems perfectly schizophrenic to call people to a full life with intimacy in holy matrimony, and then deny infected people that intimacy. Catholic moral teaching places the right to life at its centre. But then it puts people who follow that teaching at risk of infection by a deadly virus. The ultimate tragedy resides in our Church’s refusal to reconcile the principles of its moral theology with the insights from sociology, psychology, sexual research and other social sciences. I would add my perception that the Church lacks in humility – the humility to realise that all human knowledge is like patchwork, that nobody has a monopoly on all truth. That’s why the Church does not perceive HIV/Aids as a Sign of the Times, one that not only questions the conduct of individuals, but also that of the Church in its totality. In theological terms, I see the suffering and dying of Aids-infected brothers and sisters as a cry from God. The Church, the Body of Christ, is infected with the virus, and in that body there are only those who suffer and those who suffer with them.
But, one might demur, is it really that important what the Church thinks and does in these permissive times? Does it still have a substantial role to play in global terms? There are so many other churches, congregations and faith movements, and many people have abandoned religious traditions altogether and believe in nothing. That objection is easily rebutted: the Catholic Church has 1,2 billion members. It is the biggest cohesive religious community in the world. As the world’s largest institution it could fight against HIV/Aids like no other. It really could – if only it wanted to.

Translation from:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, , , , , , , , , , , , , , , , , , , ,

History: The minister recommends beetroot

Bartholomäus Grill

History: The minister recommends beetroot – The long silence and the mainly scandalous Aids policy of the South African government

The first time I heard the joke was in Cape Town’s Company Gardens, the exquisite park in the heart of the city which the Dutch settler Jan van Riebeeck had planted after landing in Table Bay in 1652. In one corner of the Gardens, as the locals call it, there is a Victorian toilet block. Sitting on a bench in front of it, a young man told his joke. “Did you hear? The toilets are going be converted into an anti-Aids station so that everybody who has just had sex can shower off the viruses.”

To understand the gag one must know that Jacob Zuma, then the former vice-president of South Africa and a top leader in the ruling African National Congress, had been charged with rape. The accuser, a family friend of Zuma’s, is HIV-positive. Asked by the trial judge whether he wasn’t concerned about having had unprotected sexual intercourse with his accuser, Zuma answered that he had protected himself by taking a shower after the act. Since then, many South Africans have mocked the future ANC president for his “delayed precaution”. But the tragic truth is that quite a few people regard it as a valid protective measure.

I have heard the Zuma joke in Namibia and in Kenya, even in a remote village in Lesotho. It is emblematic of how the African élite deals with the disease. Many ministers and parliamentarians carry the virus, but so far few have mustered the courage to out themselves publicly. There are notable exceptions: Zambia’s former President Kenneth Kaunda publicly revealed that his son Masuzgo Gwebe died from Aids-related causes in 1986. Later, Nelson Mandela openly acknowledged that the death in 2005 of his last surviving son, Makgatho Mandela, was Aids-related, as did Inkatha Freedom Party leader Mangosuthu Buthelezi after losing his son, Prince Nelisuzulu Buthelezi, the year before.

The ubiquitous silence is especially striking in South Africa, the country with the highest prevalence rate on the continent. The Mbeki government’s Aids policy was marked by expurgation, minimisation and bluster, and several members of the cabinet simply denied the facts. They held on to the wisdom pronounced by the former leader of the influential ANC Youth League and member of parliament Peter Mokaba, who said in a 2002 interview with The New York Times: “HIV? It doesn’t exist.” So the virus doesn’t exist, it’s a fiction, and Aids is an invention of “white” pharmaceutical corporations who want to force poor country to buy their wonder drugs. Mokaba again: “Where the science has not proved anything, we cannot allow our people to be guinea pigs. Antiretrovirals, they’re quite dangerous. They’re poison actually. We cannot allow our people to take something so dangerous that it will actually exterminate them. However well-meaning, the hazards of misplaced compassion could lead to genocide.” Making the rounds in ANC circles was a 144-page document which spoke of a “syndicate of white interest groups” which supposedly directs a massive political and commercial campaign for antiretroviral drugs; that “omnipotent” body seeks to subjugate, exploit and kill Africans with their poisonous medicines.

No wonder that the South African author Rian Malan – who has written nothing worth reading since his international best seller My Traitor’s Heart – was roundly applauded by the ruling faction when he claimed in the British journal The Spectator that a “powerful alliance” of pharmaceuticals, Aids activists, aid organisations, economists and hysterical journalists deliberately inflate Aids statistics. The multinationals, Malan maintained, are driven by naked greed. Such conspiracy theories are common in South Africa, and the people have good reason to think the worst. During the apartheid years one Dr Wouter Basson, a cardiologist, led a research team commissioned by the racist regime to investigate ways to sterilise the black population or to exterminate whole townships under the cloak of deliberately unleashed diseases.

Mokaba, the firebrand Aids denialist, died from Aids-related causes. Every ANC comrade knows it, but nobody will say so. Presidential spokesman Parks Mankahlana shared Mokaba’s fate. His family bars the press from writing the truth. “He died of an illness,” it said in the officially sanctioned obituary. R.I.P. – requiescat in pace – nobody must speak ill of the dead.

Under Mbeki, South Africa’s high and mighty pursued a culture of denial, so it isn’t surprising when the wildest rumours circulate amid the population, and when particularly rural people, misled by government policy, solve the problem in their own ways. There is the story about a young girl from Bergville, in the northern Drakensberg, who was stoned to death after revealing her HIV status. There is the old sangoma who announced that he can cure Aids in liaison with the ancestors. There are the unhinged pastors who consider Aids “God’s punishment”. There are any number of sugar daddies – older, prosperous gentlemen – who are absolutely convinced that they can immunize themselves from HIV by having sex with virgins. There are two-year-old infants who are raped by men who believe that their barbaric crime will guard them from the virus. And everywhere in the private sphere that silence, even though no other state spends so much money on public Aids education. “Nobody talks about it, which I’ll never understand,” says the American anthropologist Susanne Leclerc-Madlala, who married a South African. One only whispers about “this thing”.

That silence has followed us to the top: into the chanceries of bishops, the ministerial office, the presidential setting. Question time in South Africa’s parliament in Cape Town, October 2001. President Thabo Mbeki is scheduled to discuss his cabinet’s Aids plan. But he doesn’t answer any questions. He just reads his prepared text, monotonous and unwavering, with a shot of the arrogance which comes with power. The president expresses doubt about South Africa’s high rate of infection and quotes outdated statistics from the World Health Organisation. The foreign observers in the press gallery shake their heads in disbelief. How can the president of the country with the world’s highest number of HIV cases – even then already 4,7 million people – trivialise the situation? What makes him dispute the causal relationship between HIV and Aids? What is he trying to accomplish with his statement that he doesn’t know a single South African who has died of Aids?

The pundits offer simple explanations: Mbeki is acting like a typical African – he is obstinate and stubborn. He is, the commentators say, like so many politicians on the continent, a disciple of “voodoo science”.

But is it really that simple? To understand Mbeki’s stance we must once more take into account how the Aids pandemic is perceived around the world: as a “black” condition which emerged into the light at the end of the 20th century from the medieval darkness of Africa. It was here that the virus jumped from beast to man; it was here that it began its morbid passage around the globe. In the popular imagination, the catalysts for the calamity were primitive jungle people who eat monkeys. It is further received wisdom that Africans spread the virus through their uncontrollable sexuality. They just like to screw around, say the chattering classes and the debate societies around the office water coolers. But these prejudices are peddled even in sophisticated circles. They correspond with the preconceived image of Africa, backed by a long tradition in Europe. Africans project the wild, brutish, uncivilised – “because a black man is something abominable”, as it goes in the libretto of Mozart’s Die Zauberflöte.

A politician like Mbeki, who drafted the vision of an African renaissance – a continental regeneration – must be anguished by these perennial stereotypes. As an African man he already has fundamental difficulties speaking about sexuality. Add to that the fear of racist prejudice by whites who, as Mbeki sees it, regard Africans as rampant sex beasts who can’t control themselves. And what is he supposed to think when he receives an e-mail from a white engineer declaring that Aids can’t spread fast enough so that all the “kaffirs” might die? Mbeki belongs to a generation which dedicated its life to the struggle against apartheid, a system that cultivated such perverse mindsets. Now that apartheid has been conquered, the liberated are dying. Hands are wringing in search for an explanation. And in the process one discovers the hypotheses of David Rasnick or Peter Duesberg, two of the so-called Aids dissidents from the United States. They speak about the “virus lie” and “deadly deception”. They dispute that HIV is sexually transmitted or that it leads to Aids. They insist that poverty is the real reason for the accumulation of deaths. South Africa’s power élite lapped up such false doctrines, because these allowed them to ascribe the pandemic to the abject living conditions that are a legacy of apartheid.

The most outlandish rumours are making the rounds about the origins of the pathogen. According to one, it was spread by white doctors in the guise of a polio vaccination drive in Congo. Or the Pentagon in Washington developed it for military purposes and tested it on black people. Or Aids is a phenomenon of the perverted culture of the North, a gay disease spread by Californian men who are at it like dogs on heat (incidentally, that kind of nonsense is also bandied about beyond Africa). The ostensible proof for that dull-witted theory is that the virus was first isolated in the blood of homosexuals in 1981. The lowest common denominator in any of these conspiracy theories always refers to the mortal danger having originated elsewhere, from those who also perpetrated slavery and colonial terror. Hell always is other people – a classic defence manoeuvre in Africa.

The residents of the townships are all the more receptive to these tales because Mbeki’s minister of health, Dr Manto Tshabalala-Msimang, believed them. For years she blocked the authorisation for the use of antiretroviral drugs because she considered them harmful and even deadly. It required a judgment in Pretoria’s High Court, upheld by the Constitutional Court in July 2002, to force the government to change course. Tshabalala-Msimang, a medical doctor by profession, continued to insist that too little was known about the toxic side-effects of anti-Aids cocktails. In any case, she declared, her country offered adequate medication in the fight against opportunistic infections which Aids patients suffer. She recommended garlic, beetroot, olive oil – preferably cold pressed, that is really cheap in the slums.

The stubborn health minister should become the Ambassador of Blondes, one acerbic columnist suggested, referring to the stereotype of blondes as being not very bright, which also persists in South Africa. The president shielded his health minister, and shared many of her cranky beliefs, and so she could continue in her office for the rest of Mbeki’s term to commit all manner of nonsense.

Stefan Hippler had the opportunity to speak with Tshabalala-Msimang at a national Aids conference in Durban. The exchange was initially rational, but when the conversation turned to antiretroviral drugs the minister reverted to the fantasy world that has caused her to become an international joke.

And all the while an estimated 2,000 people were infected every day in South Africa. The government was not prepared for the disaster and reacted much too late. Dr Mamphela Ramphele, now a director at the World Bank in Washington and previously the head of the University of Cape Town, criticised the Mbeki-government’s Aids policy as “irresponsible, bordering on criminal”. The world can learn a lot in South Africa, about making hair-raising mistakes and culpable negligence, about abjuration and denial and trivialization, about taboos and myths, about superstitions and obtuse conspiracy theories, about culpability and opprobrium and humiliation in the shadows of a tragedy. But the world doesn’t learn, because it is a member of a cartel of silence and disavowal.

It was not until World Aids Day on 1 December 2006 that the Mbeki government adopted its dangerous health policies, presenting in alliance with representatives from business and civil society a new Strategic Aids Plan. This was announced by Vice-President Phumzile Mlambo-Ngcuka, who was commonly regarded as a key figure in the fight against the pandemic. For the first time since apartheid a top official document acknowledged the dramatic situation, noting that the increase in mortality rates among mothers and children belong to the most devastating consequences and represent a massive threat to South Africa’s ability to accomplish the Millennium Goals of development. After years of denial and trivialization, such an admission signified a radical transformation of the national Aids policy. In 2010 the government of South Africa under President Jacob Zuma acknowledged before the Soccer World Cup 2010 the magnitude of the pandemic and changed complete course, initiating a country-wide drive for testing and treatment which continues until today. The game has certainly changed in our days, but it took too long and the cost was too high.

Translation from:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, , , , , , , , , , , , , , , , , , , ,

Silently into the grave

Stefan Hippler

Silently into the grave – Why those with Aids don’t want to know the truth

No, no, it’s fine. Everything’s okay. Whenever we ask Maggie* how she is doing, she always gives the same answer. But we can see that she is getting thinner and weaker by the day. It’s obvious that she struggles to clean the rooms in our guesthouse, she visibly strains just shaking pillows or emptying the bins. And yet she insists: Don’t worry about me. Maggie has worked at the Mediterranean Villa for two years. She is 48 years old. Her husband died in 2004, and since then she has had to find her own way with three children. The two older daughters don’t work, the youngest smokes Tik – crystal methamphetamines – which is all the rage in Cape Town’s drug scene. It’s disastrous for the whole family. While the mother works, the daughter sells all the household’s possessions to buy more drugs. But the money is never enough to gratify her addiction. Maggie’s daughter enters a vicious cycle of crime: she steals, she is arrested, mother bails her out, she does not reform, is arrested again, etc. And Maggie works and earns the money needed to bail her out.

But soon Maggie won’t be able to do that any more, because there is a disorder about which she doesn’t want to talk. She also doesn’t want to see a doctor. All our efforts at persuading her are futile. She makes excuses: “Let it be, it’s fine, I have no time for doctors, it’s just the stress.” Both of us know that it isn’t stress, but the stigma. It’s the dread of being marked out and ostracised if her neighbours in the township should know what ails her. That disease: HIV/Aids. It’s always others who get infected – neighbours, strangers, outsiders. The stigma is remorseless. It draws on ignorance, rumours, credulity and moral failure. It leads to the exclusion of the affected. “Don’t touch me”. “Use another toilet.” One hears such phrases every day. And sometimes: “You’re not one of us any more.”

It’s like a social death penalty – and that happens in a culture which proclaims the principle of ubuntu. A keyword in Africa’s mutually supportive societies, it can be defined as one being human only through other people.
Aids. Maggie won’t even say the word. Her husband’s death certificate also doesn’t say what exactly caused his death. He just was very ill. Nobody needs to know more. And that’s why so many people refuse to go to a doctor. “No problem; it’s not that bad.” Always the same excuses, the same pleading, the same silent complaints, and sometimes also tears – and it goes on like this for weeks. Finally, in November 2006, I prevail and take Maggie to the doctor for a blood test. She refuses to accept the result. No, she doesn’t have this sickness; she isn’t ill. The doctor puts her off work for six months. She gets weaker and weaker, her body is falling apart; it’s too late for the medications which could extend her life. Soon, on a sunny January morning, she dies. The fear of stigmatization killed Maggie – a fate shared by many thousands of her fellow HIV-positive South Africans.

* name changed

Translation from:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

Filed under: General, HIV and AIDS, HIV Prevention, HIV Treatment, HOPE Cape Town Association & Trust, HOPE Cape Town Trust, Medical and Research, Networking, Politics and Society, Reflection, Society and living environment, , , , , , , , , , , , , , , , , , , ,

Nobody dies of Aids

Stefan Hippler

Nobody dies of Aids  –  An introduction to myths and misunderstandings

What exactly is Aids? What does the infamous HI-virus do? You may well argue that these questions are inane, considering that the pandemic has raged for more than a quarter of a century and that these terms have been widely used and discussed in the mass media.
Yet, they are both absolutely relevant questions, because there is still a lot of confusion. The topic is eternally controversial, so its vocabulary tends to be used and manipulated to support one point of view or the other. Many people don’t even know the difference between HIV and Aids, as becomes apparent every time a well-meaning visitor comes to HOPE Cape Town and asks to see the “Aids babies”. The difference between HIV and Aids is critical: Aids is not a pathogen, nor an illness, but a syndrome. When the HI-virus has worn down the immune system, the body has no defenses against viruses and bacteria. The patient then clinically enters into the final stage of a process that, without intervention, will inevitably culminate in death. The term commonly used for that stage is “full-blown Aids”. But note that the patient does not die directly from the consequences of the HI-virus’ attack, but from a so-called opportunistic illness which exploits the immune weakness of the body. In Cape Town’s township that opportunistic illness is mostly tuberculosis.
But back to the basics: HIV is the acronym for Human Immunodeficiency Virus and refers to the pathogen which first resided in the bodies of Central African monkeys – in peaceful coexistence with the host animals. At some point in the last century the virus (Latin for “poison”) was transmitted to humans, possibly after the consumption of simian meat. Then the laws of evolution kicked in, setting off a battle of life and death because the human immune system can’t expel this invader.

How does one become infected? Most people will immediately answer: by having sex. A simple enough answer to a simple question – and that is precisely why the actual process of infection is usually ignored. To put it in simple terms, nobody gets infected through sex. Rather, the virus is transmitted through the exchange of bodily fluids. This delicate distinction may seem pedantic, but in the dialogue about Aids prevention and the stigmatization of infected people it is crucial.

Sexuality does not just mean the mechanical exchange of bodily fluids; it’s also an expression of affection and love between spouses and life partners. The challenge we are facing is to reduce or even neutralise the inherent dangers of exchanging bodily fluids.

Besides the sexual context, there are other ways of contracting HIV. Every accident, every needle prick, every jointly used razor, every blood transfusion creates the risk of infection.

Blood, sperm, pre-ejaculate and vaginal secretions are the bodily fluids that contain the highest concentration of HIV. Breast milk has a lower density of the virus, but it is transmitted in great volumes during the regular nursing of infants. We can safely ignore all other bodily fluids as potential transmitters. There are no documented cases of tears, saliva or sweat causing contagion. The virus also can’t penetrate skin. Provided the skin is healthy, blood or sperm present no hazard. The virus can penetrate skin only through open scratches, wounds or injuries to the epidermis.

And it’s not just HIV-negative people who must avoid the exchange of bodily fluids, but also people who already are infected. They can be infected a second time, because the HI-virus mutates when it is being replicated and “individualises” itself in the human body. This medical fact should bust the myth that those who are HIV-positive don’t need to protect themselves anymore.
HIV is a so-called retrovirus, which means it cannot replicate by itself. To replicate, the virus needs cells on to which it can attach itself – the white blood cells, the generals of our immune system. They are then converted to produce new HI-viruses, in their thousands per millilitre of blood. These settle in the whole body, but according to latest studies especially in the intestinal tract. If pathogen finds an unsuitable host, the virus loses its potency and dies off.
And what happens after infection? In the first stage after contagion many people suffer from flu-like symptoms, swelling of the lymph nodes, and aches in the head, throat and muscles. The virus reproduces in its millions, particularly in the first few weeks after infection – at that time the risk of transmission to others is extremely high. The second stage is called the asymptomatic phase because the infected person now feels completely well. But the virus keeps spreading in the blood, inconspicuously and slowly, and gradually weakens the immune system by corrupting the CD-4 cells, which in healthy bodies help fight off invaders, but now become hosts for the virus through which to multiply. That phase can take years. The infected person is apparently healthy, and the infection can be determined only through an HIV antibody or PCR test.

In the third stage serious symptoms appear: significant weight loss, skin fungi, herpes, skin ulcers like Kaposi’s sarcoma, dysentery, sustained fever and so on. In the fourth and final stage the virus finally conquers the immune system, and the patient becomes susceptible to serious illnesses such as tuberculosis, though even harmless infections can be lethal.

The majority of antiretroviral medicines on the market stop the reproduction of the virus in the white blood cells. But pathogens that proliferate at a rapid pace also make “mistakes” – that’s how genetic mutations of the virus occur. These mutated strains of HIV, creating what is known as resistance, can compromise the efficacy of the antiretroviral drugs. That’s why it is important to inhibit the multiplication of the pathogens in first place. If fewer viruses are produced, the possibility of mutation decreases. That can be achieved only through a fixed regimen of dosages of antiretroviral agents in the body. There are two reasons why no method of removing the virus from the body has been found so far: firstly, the virologists don’t know yet exactly where in the body all the pathogens are hosted; secondly, the virus can pretend to be “sleeping”.

Recent research has intensified to combine medications with a view to easing the use and load of the pills. The product Atripla, for example, covers the necessary daily cocktail of medications with a single pill.

In America a drug going by the name MK-0518 has been developed. It inhibits the so-called integrase enzyme of the HI virus – the integrase adds viral genetic material into the host cell’s DNA, which then allows the infected cell to produce new copies of the virus. Parallel to that pharmaceutical research, testing continues on microbicide gels which can be applied to the vagina before sexual intercourse to kill the virus before it can reach the blood stream. Research is also being conducted into anti-HIV vaccines, but the scientists dampen our hopes: it might be ten years or more before there will be any breakthrough.

Translation from:
Gott – Aids – Afrika
Hardcover: 207 pages  –  Publisher: Kiepenheuer & Witsch GmbH (August 31, 2007)
Language: German  –  ISBN-10: 3462039253  –  ISBN-13: 978-3462039252
Gott – Aids – Afrika
Paperback  – Bastei – Luebbe  –
Language: German  –  ISBN-10: 3404606159  –  ISBN-13: 978-3404606153

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