HIV and AIDS HIV Prevention Rural Health Sexuality Women's Health

Fatal attraction

In Vulindlela, the pleasures an older man with money is able to give to a teenage girl come at a price: six times’€™ greater risk of HIV.

‘€œThe men know that we come from poor families, so they say ‘€˜here is R10 for pocket money’€™. They know our parents can’€™t afford that,’€ says 15-year-old Nomcebo Ngubane, explaining how she and her classmates are wooed by older men.

Her companions murmur agreement.

‘€œIf you have an older boyfriend, he can buy you things and it is nice to show your friends that you have things,’€ adds Nomasonto Masango, a talkative 15-year-old with an expressive face.

The most prized of these things are cellphones, jewellery and fashionable clothes, say the girls. But they can be as humble as school stationery, food and cold drinks.

‘€œGirls also want to go to expensive places like the hotel,’€ says Thandazile Chonco, a cheerful 14-year-old wearing a jaunty hat.

Nomcebo, Nomasonto and Thandazile are part of a group of girls waiting to have HIV tests at a clinic in Vulindlela in the KwaZulu-Natal Midlands run by the Centre for the AIDS Programme of Research in SA (Caprisa).

Sitting with them are Nqobile Sikhakhane who is 14, Thembeka Madlala, aged 17, Nonhlanhla Phungula who is 19 and 20-year-old Silindile Khanyile.

Today these seven girls have all decided to have themselves tested for HIV.

They feign nonchalance, insisting that they have decided to take the test because just want to know their HIV status. But there is an edge to their giggling, and a lot of shuffling and hiding of faces when talk shifts to boyfriends.

Like many rural KwaZulu-Natal communities, Vulindlela is hard hit by HIV/AIDS and poverty.   The girls all say that they know ‘€œmany people’€ ‘€“ in their own homes, families and among their friends ‘€“ who have died of AIDS.

An apartheid-designated ‘€œblack spot’€ in a sea of lush green farmland near Midmar Dam, Vulindlela is crowded, land is eroded and there is very little local employment. Those who do work are migrants, usually in Pietermaritzburg.

Only one of the seven girls lives with her father and he is unemployed. Three others have migrant fathers while the remaining three have no contact with their fathers.

When the working men come back over weekends with a bit of cash in their pockets, they are kings in this deprived community.

‘€œNormally, the older men who come and talk to us look nice. They wear expensive clothes and they have a cellphone. They talk nicely to us. They probably have other girlfriends, but they don’€™t tell us,’€ says 17-year-old Thembeka.

While older men courting younger women is as old as the hills, in Vulindlela’€™s hills young women pay dearly for this attention. Teenagers with boyfriends older than 24 are six times more likely to contract HIV, according to researchers who have conducted   extensive testing and interviewing of pregnant women at the antenatal clinics.

In a survey of pregnant women conducted in Vulindlela last year, over one in four teens were HIV positive.

More than half the women aged between 20 and 24 were HIV positive and a staggering two-thirds of women aged 25 to 29 were infected with the virus.

Dr Janet Frohlich, manager of the Caprisa research site that was established in Vulindlela in 2001, has worked in community HIV/AIDS projects for over 20 years.

‘€œWhile older men being involved with younger women is an established pattern, I have never seen it on such as scale as it is here and with such young women,’€ says Frohlich.

Sexual activity among teenagers is high, and a third of the clients at family planning clinics are under the age of 20.

Frohlich, together with Caprisa’€™s director, Professor Salim Abdool Karim, and head of Caprisa’€™s Women and AIDS Programme, Professor Quarraisha Abdool Karim, soon realised that, given Vulindlela’€™s high HIV rates, it would not be possible ethically and morally to simply conduct prevention research in this community without offering direct assistance to the community.

Fortunately, Caprisa enjoys the enthusiastic support of the local chief, Inkosi S Zondi, who estimates that he has lost a quarter of his subjects to AIDS in the last four years.

Thus with Inkosi Zondi’€™s encouragement and donor funds, Caprisa opened a HIV/AIDS treatment clinic alongside one of the seven primary health clinics in the district.

Since January, it has enrolled 400 people on antiretroviral (ARV) treatment ‘€“ saving them an hour-long and expensive taxi ride to Pietermaritzburg, where the nearest government sites for antiretroviral drugs are.

Sonti (not her real name) is a recent beneficiary of the treatment programme. In August, after becoming very ill with tuberculosis, the 21-year-old was tested for HIV at Impendle Clinic.

The test came back positive and her CD4 count, the measure of immunity in her blood, was just 60.   A healthy adult usually has a CD4 count of above 600.

A month later, after being trained about HIV and how to take her ARVs, Sonti was sent to the Caprisa clinic to start ARV treatment.

‘€œBy now my CD4 was 35. I was a size 32 from being a size 36. I was very weak. My legs were shaky. I had no strength,’€ says Sonti.

Sonti’€™s blouse is still voluminous and her now spacious skirt is gathered up with a belt, but she feels her strength is returning.

‘€œOver the weekend I was doing Zulu dancing for my family to show that I have amandla. Some people told me I would go mad if I took the ARVs, but I see that the treatment works. I have lost three brothers to AIDS. If they had known about treatment, maybe they could still be alive.’€

Since starting treatment, Sonti has broken up with her boyfriend ‘€œbecause I know he has other girlfriends’€ and has decided to ‘€œabstain from sex and live a different kind of life’€.

But abstinence is a difficult choice. Are condoms an option for the young people of Vulindlela?

In the hot room in one of the modular units that make up Caprisa’€™s clinic, Nomcebo and her friends laugh.

‘€œSome of the younger guys are aware about condoms. But most say they want nyama enyameni; flesh-to-flesh,’€ says Nomcebo.

‘€œThey say they can’€™t taste a sweet with its paper,’€ adds Nomasonto.

‘€œThey question your commitment if you insist on a condom. They ask why you don’€™t trust them,’€ says Thembeka, a highly articulate somewhat serious young woman. For her, love means friendship and being able to trust her partner. But, she concedes, for most of the young men she knows, ‘€œlove means sex’€.

If the young women’€™s HIV tests are negative, they may be enrolled in a microbicide study soon to be run in the district. A microbicide is a vaginal gel and there are high hopes that one can be developed that can act as a barrier preventing the HI virus from entering women’€™s bodies.

For Frohlich, the sexual patterns in Vulindlela and men’€™s antipathy to condoms, makes the development of an effective microbicide, which a woman can apply without her partner’€™s consent, essential.

Women who have already been enrolled for the microbicide study so far have monthly clinic appointments where they are tested and treated for sexually transmitted infections. They also get ongoing counselling about how to protect themselves from HIV and have four HIV tests a year.

It is now late morning and the moment of truth is drawing closer for my seven young companions. The tests have been done and they are now being called in one-by-one for their results.

By 2pm, it is all over. Relief comes in the form of an outpouring of excited chatter from the six who have tested negative, and promises that they will abstain from sex until they are ‘€œready for marriage’€.

But for one of the girls, the news is not good. She remains with the others but looks dazed, shock registering deep in her eyes. Today, the reality of HIV has become lodged in her body and the course of her life will now be very different from that of her friends. ‘€“ Health-e News Service.

About the author

Kerry Cullinan

Kerry Cullinan is the Managing Editor at Health-e News Service. Follow her on Twitter @kerrycullinan11