A Very Un-Valentines Day

This country has a horrible way of biting you in the bum .... just at those moments when you start thinking that a corner has been turned and that there is hope for this country after all ....

I spent yesterday schlepping around hospitals, clinics and GP surgeries in rural mpumulanga (province of SA where Kruger national park is) .... following up on patients, training doctors, etc etc ..... and i suddenly realised quite how much had changed here since a year ago.

At my first training session in this area over a year ago - only three patients turned up, they bolted the doors of the hall and were clearly terrified of being seen there and hence "outed" as being HIV positive ... they wouldn't even leave the room at the same time and certainly wouldn't be seen with any of us foreigners - a sure-fire sign of having AIDS (the only outsiders that come to these parts are do-gooders) ...

A year on - we have to barricade ourselves into the room to avoid the huge mass desperate to to get onto ARVs .... having wider access to treatment and witnessing others in their community actually getting better has definitely reduced stigma and given them hope .... the message has trickled through that knowing whether you are postive is no longer an immediate death sentence and so more people get tested ... and the numbers needing ARVs keeps rising ....

And so it was a rewarding moment realising that a year of our programme had made such a difference to a community .... and importantly to see the patients who had been so pitifully ill just a few months before actually job-seeking and looking well ....

I returned home to my B&B feeling as though I was finally doing something worthwhile .... and over dinner with two of my colleagues we earnestly talked about things getting better for this country after the twin scourges of apartheid and HIV .... and so in between courses we got up to get some fresh air and walked onto the front street ... to be greeted by the sight of a gaggle of young girls all dressed up to the nines ....

This sadly was not some asbo-inducing fest of fourteen year olds gathering for valentines day and just hanging out on the street .... instead these girls were flashing at the passing truck drivers (this being a big timber region and transport route with lots of trucks) ... and if any of them stopped at the traffic lights ... they would clamber onto the bonnet shouting to the driver all the things they could offer him and the price ....

Horrified and yet somehow also fascinated - we ran down to the nearest girl to ask her why she was doing this ... and it was just wrist-slittingly depressing to hear that it was the only way any of them could make money and that often they were sent out onto the street by their families ....

We asked her if she'd ever heard of HIV (of course she had ... there's not a a soul here under the age of 50 here who hasn't) .... and if she used condoms (of course she said she did .... note to all doctors about people telling us what we want to believe ...) ..... and sadly like the good HIV doctor I am - I was of course NOT carrying spare condoms to dish out to all and sundry on the street ....

But within a few minutes - she had a client .... who said that for sex without a condom he'd pay her three times the going rate (about 300 rand - less than 30 quid) ... she looked at us and shrugged her shoulders ... it had been a quiet few days and she wasn't going to turn him down - she needed to eat .... we tried to plead with her and even offered to match the money ... but in a flash she'd hoisted herself up and the driver was shouting obscenties at the interfering foreigners about trying to make him eat sweets with the wrapper on ....

I looked up and noticed he didn't have a seat belt on .... and so here's the rub ... how do you get a nation to start using condoms and avoid a fatal threat which will affect them 5-10 years on ... when you can't even get them to wear a seatbelt to protect against an immediate threat? How do you get people to value their lives when they have so little to look forward to at age 14 that they sell their bodies and potentially their long term health for under 50 dollars?