This resource is hosted by the Nelson Mandela Foundation, but was compiled and authored by Padraig O’Malley. It is the product of almost two decades of research and includes analyses, chronologies, historical documents, and interviews from the apartheid and post-apartheid eras.
15 Nov 1999: Chalmers, Judy
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POM. Judy, there were two things that we didn't have time to talk about the other evening and they were, (i) the searing prevalence of HIV/AIDS in SA. You know the numbers, SA now accounts for 10% of all new infections in the world on a daily basis, life expectancy is going to be reduced by 15 years in 15 years, it's wreaking havoc in different parts of the community and yet despite the fact that everyone is encouraged to wear the AIDS buttons and there's an AIDS Awareness Programme, not much more appears to be done or to be going on. Now I have three questions, the one just came out of a small item I saw in one of the papers yesterday, that the health budget for next year is going to be cut, it means less money available for HIV or less money available for other essential health services. Two, is there an awareness of what a protracted, and I use the word plague now rather than pandemic, will actually do to the social fabric structures, family life of the country, the impact it will have on sustainable development, to the extent that it there is consideration of elevating it from 'this is one of our priorities', to declaring 'we are in a state of national emergency' and national emergency measures have to be employed to deploy all kinds of resources including the compulsory notification of the disease? I know that government was for this but that NGOs and others were against it which is the very same argument I've heard used in other countries, that trampling on people's rights, even in a state of national emergency such as this, protecting people's individual rights is more important than half the population dying. That's one area.
. The second area is the area of rape, child molestation, family abuse, the level of violent crime within the family, I think it accounts for one third of all crime. What is the pathology of this? How do you get to a point where the rape of two-year old children and 114 year old grandmothers, the two ends of the spectrum that you can take, where 75% of all rapes are gang rapes? It's not just rape per se, gratification, it appears to be something much more deep going on.
JC. Yes of course, we don't know to what extent there is a connection between rape and the HIV/AIDS plague that is very much a part of our society at the moment. I think I will start to talk a little bit about just what my experiences have been regarding the HIV/AIDS campaign and some of my thinking on it which is for me, as you have stated, it is something that is confronting our country in a way that is not visible in society and I think that is why it doesn't seem to be being taken nearly as seriously in the social stratas as it should be.
. When one looks at the rest of Africa and what has been happening in Uganda and Zambia where it has critically affected society, it has critically affected industry, it has critically affected the family units but it doesn't seem to be even there, and it has happened there in advance of the SA situation, it is not until every family has been affected, until every person knows somebody or knows a beloved one who is either dying or has died of the disease or of manifestations of the disease, that the state really got to grips with some serious strategies and ways of functioning. I believe in Uganda, the statistics seems to show, that a halt has been called to the incredible upsurge that there has been in that country and I've spoken to people about it and they say, well there has been a definite change in people's sexual behaviour but that we were finding ourselves with whole villages that were left with a few aged and AIDS orphans, many of them infected, and we had to deal with it.
. At the moment when I talk to my colleagues who have constituencies in the rural areas and they are trying to discuss and in our constituency programmes we have been given an absolutely clear directive that HIV programmes must be paramount in bringing the whole scenario to those constituencies. What people are saying is that when they talk to groups of people, when they talk to church groups, what seems to happen is that in a little while they will have a mixed group of people who have come to listen but when they talk about the actual story of how you contract HIV/AIDS, of the physical procedure, of the sexual process, when you look, in a little while you see that most of the elderly people, the older people will have gradually left the room, they do not care to be a part of it. Maybe it's that they do not care to be a part of it with the young people and we may have to address that so that they are done in different groups but even then a colleague of mine who works in the old Ciskei says she would start talking to the women about it and having been a vibrant inter-active group on all sorts of issues, they will lower their eyes and they just won't talk. They won't ask questions, they won't discuss and afterwards one or two of them may come to her and say, we would like to know more about it and we are worried about our young people and, yes, I have a niece or a son or a daughter who has been sick on and off all of this year and I am so worried that this is what he or she has but we don't talk about it, we don't like to talk about it. There is a whole veil of silence that has been drawn over the issue which is very, very scary.
. One of the names I've given you is a woman called Jean Underwood who runs a AIDS Haven in Port Elizabeth where they take AIDS orphans, they take young children that are suffering from AIDS, they take people who have been pushed out of their families, and she was saying that they went to a little community in a small town called Alexandria a couple of weeks ago and had a big group of people. They ran a two-day workshop but after the first afternoon once again all the older people had left and she said we had a wonderful Saturday with the young people who were asking really, really intensive questions and it was clearly, except for one young man, she said they were hugely ignorant about how you contracted it, where it comes from, how it started, what the future looks like. But the older people were not there and somehow we have to effect a breakthrough that goes into the community because those older people are the people who are going to be having to deal with it down the line.
POM. The conference in Lusaka, among some of the studies in communities that had been cited, one was in West Africa and a comparison of that with East Africa was that the prevalence was much, much lower. One of the factors that was found to be of significance was the age of sexual initiation for a young girl and the age difference between her and her sexual partner. So it would be like young girls, older men. At these workshops do men ever participate? Not young men, older men. I don't mean 70 or whatever, I mean men in their prime, forties, fifties or whatever.
JC. I would say, I can't make a categorical statement on that but I would say for the most part no, because when you run these workshops on any issue except very clear job creation, which would include something that men would be comfortable with, the women attend. It is mostly women, it is nearly always mostly women but with the HIV/AIDS, yes you would very much get the young men there, the sort of 19, 20, 21 year olds, because very often they will be out of a job, very often they will be concerned themselves having watched the news, having read bits about it in the paper. They will be concerned about their own HIV status and they want to know more about it and they want to know just as much as they possibly can. But older men? Something interesting happened and maybe this shouldn't be put into your book, but in our caucus, in our ANC caucus some time ago we had the woman who is the Director of AIDS nationally in the Department of Health and she looked around our caucus of 200 odd people and she would say, "I can guarantee that 40% of the people sitting in this room are HIV positive." Well there was a deathly hush, these are for the most part sexually active, a lot of the men in their forties and early fifties and there wasn't a question asked about it. It was a statement that fell like a stone into a pool and disappeared but there would be ripples and people would be thinking about it.
. But for the most part I haven't myself spoken in any depth, women ask me about it, young people ask me about it, but the men don't seem to do that and it is worrying because when one looks at the degree of relationships that goes on in the schools, in the townships, between older men and young girls there is definitely cause for concern and I don't know that the men are considering it seriously. In the rural areas they may not even be accessing condoms so it is a cause for great concern.
POM. Are there any, just taking the use of condoms which has never been, at least according to both articles and conferences I've attended on AIDS, has never been a success as an intervention. You end up with a situation of where the women carry the condoms around and it's up to the woman to say to the man, you must wear a condom before I will have sex, rather than the man volunteering, "Of course I'll use a condom." Is there any data that you know that is collected or are people collecting data on trying to estimate the degree of usage of condoms say vis-à-vis two or three years ago or the degree of awareness in particular communities versus the degree of infection and whether there is any relationship. Again, the evidence is that there is no real relationship between awareness and behaviour change which brings up how do you change behaviour when making people aware of the risks of engaging in certain activities? It's not sufficient in itself to bring about behaviour change.
JC. You see they don't perceive the risks as such. In Graaff-Reinet, which has been my constituency for the past five years, the young head of the ANC there died of AIDS two years ago and everybody said, oh yes he died of AIDS. It didn't seem to be hushed up in any way. He had been in exile, he came back and probably three years later he finally succumbed having been ill on and off for a considerable period. I don't know of any statistics that are specifically being done to the question you are asking but it would seem to me that, for instance, the group at Rhodes University who are going out into the rural areas surely that might be part of the information that they're trying to put together as well as part of the education that they are doing for nurses in rural clinics to be able to say, as women come in for their pre-natal check-ups and for their general check-ups, "Is your partner using a condom? If he is not why is he not? Are you able to talk to him about it?" Because when people don't see the sickness, when they don't see the devastation and they don't read the newspapers and they would listen to the radio and a certain amount of TV but it is not sufficiently on TV in a sufficiently horrifying way, as they are now starting to do with road accidents. Some really, really telling stuff on TV that brings it home to you, and on the radio as well, what terrible devastation there is on our roads. But it doesn't seem to be happening sufficiently or in effective enough a way on TV.
. When I think of my rural constituency and the doctors I have spoken to in the hospitals that are dealing with this situation, in Somerset East the doctor there, I said to him, "What are you seeing?" and he said, "Yes, we're seeing it in an increasingly large number but it's mainly the towns along the trucking route, along the national highway." That is the lifeblood of the AIDS virus and then it filters out on both sides into the more rural communities. So that is a major factor.
. But an interesting thing that also has to do with this AIDS Haven where I have spent some time in PE is that I've seen littlies coming in there at the age of nine months, a year, 18 months, really terminal with scabs and sores all over their bodies, with terrible diarrhoea and gone back six months later and I say, "Well what happened to little whatever his name is?". They say, "Oh there he is", and he's up and playing and romping about. I said, "Well what happened?" and I was told that with adequate hygiene and food and tender loving care and a routine you can boost their auto-immune system sufficiently to push back the intrusion of the disease. They have children there who had been given up by the clinics and they've taken them in and they've turned them around and they have a very good record.
POM. When you say turning around, you mean they've prolonged their lives as distinct from 'curing' them?
JC. No, they still are HIV but the AIDS symptoms have receded. I was told by a doctor, an American doctor, that in the States it is regarded as chronic condition. People can live with due care for 12, 15 years, which is why this Jean Underwood from the AIDS Haven has said to me, "We will never be able to manage it in any reasonable way while the poverty exists." That is because it is so tied to that.
POM. The statement of the President, and I'm not picking on him, but his statement regarding AZT was, to be as fair as possible, one of the craziest statements, irresponsible statements, I have ever heard anyone in authority, especially a President of a country, say with regard to AZT where there is no evidence anywhere of serious detrimental effects. Rather than there being a debate on the issue he seemed to shift the focus of the issue from 'is AZT useful'. Did he find his information on the Internet? There was a shifting in attention, of focus, away from what the real problem is which is that you face what some people would say is catastrophe. Yet within the caucus do people say, when they talk about the issues the country is facing, does anybody say, forget about jobs, forget about economic growth; unless we find a way of mobilising our national resources to get a grip at least to stabilise the AIDS situation we're not going to have much of a country to govern in 20 or 25 years.
JC. I agree. To me the President's statement and what he had to say I don't agree with. I feel that certainly there should be a debate. I don't know if you've seen the current Financial Mail and the current copy of Noseweek where there is a great deal of concern around the drug AZT and whether people in fact are not in certain circumstances dying as a result of the drug and not from the disease itself. Noseweek, it's a sort of commentary on - an analysis in a very waspish way of South African politics, quite interesting. AZT is a controversial drug, it's a retroviral drug, it has in many instances the same effects as chemotherapy. It is that sort of chemotherapy, it kills across the board, but it has been abandoned as an anti-cancer drug in part because it is so destructive in the way it operates and there has been a great deal of debate. If you had seen the Carte Blanche TV programme of the week before last, once again the whole AZT debate was opened up. I can't comment on the pros and cons of the drug itself but I imagine no I can't even imagine what the President was trying to do but it is not straightforward as a drug. There are the cost consequences, not only the cost of administering the drug, the cost of buying the drug, but also the cost of, once the mother is lost, keeping the child alive with alternative milk, other methods of feeding which is hugely costly. For me, and I've been saying this to the Health Department, I'm no longer on the Health Committee, but for a year, 18 months, I just hope that it's not something that is being dismissed out of hand because an intervention pre-natal is something that must be hugely considered. We now have a new Minister of Health and quite a lot of her medical experience has been in the AIDS scenario and looking at that.
. What you had to say, the second point you made which I completely agree with, is that we are not looking at in five years time what the impact will have been if we do not take appropriate budgetary measures as of now into what we are looking at and what we are dealing with. I don't think we're going to really be able to afford something like the full cocktail to be able to keep people alive and that's what it is. I was in Brazil two years ago and one of the things we did in Rio was to go to an AIDS Centre. Now AIDS in Brazil is a notifiable disease, and I'll comment on that, but at this AIDS Centre people would go in, they would be given a number, it was completely anonymous, they would be given a number, they would go back two weeks later, they would be told whether they were positive or negative. If they were positive they would be given counselling, they would be given ongoing counselling for as often and as much as they needed it. If they were pregnant of course that would be a different sort of counselling. But we then went into a large room which had about 20, 30 beds in it and in it were lying seven or eight women on those beds, all women who were receiving their weekly cocktail drips and we spoke through an interpreter to a couple of them. The one woman said she had been starting to manifest AIDS symptoms about five or six years ago and she said she has a large family and this keeps her alive. But when we spoke to the health people in Brasilia they said it is crippling our country, we are not going to be able to sustain it. It is hideously expensive but at the moment the state does the full anti-AIDS scenario of keeping people alive.
POM. The state does?
JC. The state, they provide the cocktail, they provide the counselling, they provide the testing. We didn't get as far as seeing what they are doing with the AIDS orphans but probably there is some way of managing that as well. And there the rate is nothing like it is in Africa and certainly not in South Africa. Costa Gazi from the PAC is bringing an action against the Minister of Health and certainly it has served the purpose of making it a very, very public debate, which I think is useful.
. As far as notifiability is concerned there are very polarised positions. On the one side there is, yes, it will bring it out into the open, it will, as happened with TB, one would hope the sort of situation would not happen that happened in KwaZulu-Natal where a young woman came out and was stoned to death. It might or might not be of assistance as far as statistics are concerned to give us an idea of what is happening, where it's happening, to whom is it happening.
. I think the point I was making was that the statistics, we have been told that the statistics would be so out of date, they would be three or four years old and not really current enough to be of use as far as trying to put together an AIDS map of SA that would really be useful.
. This is an article written by Mark Colvin (I can give you his telephone number) in which he's also saying that there is
POM. What publication?
JC. It comes out on a regular basis, from the Medical Research Council. I was looking for my most recent one but there are some useful but Mark Colvin works for the Centre for Epidemiological Research in SA for the Medical Research Council and his telephone number is 031-2051481.
. There was a National HIV/AIDS Review which was commissioned by the Department of Health which made the following recommendation in its final report. Notification of AIDS is not recommended as a mechanism to improve surveillance. Alternative mechanisms exist which can be utilised which do not have the negative consequences of notification.
. Mark Colvin then says, "I suggest that the Minister heeds this advice." Now it will be interesting to find out from him exactly why he takes that stance.
POM. This is the Department of Health that issued this report?
JC. It was the National STD/HIV/AIDS Review. It was done by the Department of Health, it came from the Department of Health. There is an Editor's note underneath which says, "This article by Mark Colvin is based on an editorial which appeared in the SA Medical Journal 1999, No. 89(2) pages 147-8."
POM. Just on rape?
JC. It's quite interesting, Charlene Smith is an old friend of mine so we've been keeping in touch on that issue. I do think, or I hear that there is a connection between the degree of rape of young women, of girls, and men -
POM. This is the virgin myth?
JC. Yes. I hear from people that it is happening but I have no idea to what degree, to what extent or if it's one of those urban myths that seems to have gained momentum because it is such a dramatic story, but I think it is happening and it's very, very scary. In my constituency there's a fairly newly formed Policing Forum, in fact it has been there for some time but it's only this year that it seems to be happening effectively and last week I sat down with some of the welfare workers and asked them what degree of domestic violence they were seeing, what was happening as far as rape was concerned. And they said yes, it's a Friday night, Saturday night syndrome when the men get their pay and they get drunk and then it happens much more. They see very little during the week. So it's definitely alcohol related as well. This is domestic violence in which you will get husbands raping wives as well and domestic rape taking place. But they say since the Policing Forum was put in place we're seeing a lot less of it because women now know that there isn't the same they feel bolder, they feel they can report it, they feel they're getting more backing from the community if they do report it and they said they're making interventions early into really what has the potential to be an explosive domestic situation. You almost have to deal with each case on a one-to-one basis. I don't think blanket speeches and advice to communities and to families about the inadvisability of domestic violence really I think it does help, but it's where you make those personal interventions and you make people, and particularly men, look at themselves and look at what they're doing but it's difficult to have the person power to enable that to happen. It's also all tied to the poverty thing, to the unemployment thing, people's perceptions of themselves.
POM. This is a very speculative question, do you think that the level of rape is probably as high in other poor countries but that they lack the first world sector of communications, technology, call it what you wish, that gets it out there? Here it's known, there it may exist and simply there's no attention to it because there's no media coverage. Or is it higher here for some reason?
JC. I think it's a whole multiplicity of factors. I think we're a very violent society. I think that the violence of what apartheid did to this country, of the separation of people I've just finished reading JM Coetzee's book Disgrace over the weekend and there there is that unhappy conviction within the book that people almost inflict violence on one another as a sort of a revenge, as a right for taking things because we have a right to have those things. They say that rape is an act of violence and not an act of sex but clearly it is an act of sexual violence. I mean to rape old ladies and to rape little children, I can't think how somebody who has committed an act like that can ever become a whole person in themselves again. Once you've done it once, as with murder, it's so easy to do it again and again. But it's so disgusting to rape a 90-year old, I can't bear to think of it. There was that one in Humansdorp where this young man raped his grandmother.
POM. 114 years of age. It could make the Guinness Book of Records.
JC. Can you believe it? We laugh but you have to because otherwise you'd be weeping and it is so disgusting. On a farm next to where my daughter farms not only did they rape this old woman but they did unspeakable things to her with a broomstick handle. She eventually died in agony and she was a solitary, sweet old lady who should never have been living on her own but was and that sort of violence seems almost endemic in our society at the moment and clearly we hear a lot more about it than we ever did before.
POM. Can one say this is all the legacy of apartheid?
JC. No, not all.
POM. This is like carte blanche, one total sweep it all under the legacy of apartheid.
JC. You can't sweep it all under, but I do think it is a legacy of apartheid just by virtue of the fact that why is it happening much more here than in other states? I have friends who live in Zimbabwe and in Zambia and in Northern African states and I say to them, "Does it happen like this there?" And they say, "No, it doesn't happen like this here."
POM. That's what I'm getting at, what is it in this country?
JC. There's no one thing but it is also the fact that we have so much media, people's values have become so tied up with material possessions and if you don't have a cell phone and a car, the fact that you need to work for them and have a job and sometimes those things may come way down the line and when they don't happen quickly and immediately then they grab them and part of that grabbing seems a rape along the way, a physical grabbing as well as a material theft. And the gang rapes, I can see that when a group of probably drunken or high young men get hold of a woman you're not going to get just one of them raping her, it will be the whole shooting works, and by that time they show off and they do it she's no longer a person. I understand quite a lot of the psychological reasoning behind what happens but I cannot accept it as a social phenomena but I think it is a social phenomena in SA and how one begins to address it I don't know. What Suzanne Vos had to say about castration I don't entirely disagree with. I think that you're going to have to take some very drastic measures to make people scared to do it.
POM. Do you have to adopt a similar strategy on the AIDS side, that you've got to scare, in a way you've got to terrorise people into changing their behaviour?
JC. Yes, I think people become immune to too much public looking at horrifying stories of the AIDS scenario but I don't think the doctors are doing enough, I don't think the nurses are doing enough, I don't think the clinics, I don't think we are doing enough. I have a 19 year old granddaughter and I terrify her with some of the stories I tell her but I don't know if it impacts on her at all.
POM. I know you have to run. Just Charlene Smith's number, do you have her number?
JC. No. I have an e-mail number for her. I'm not even sure if I have that here, it's on my computer. Do you have e-mail?
POM. Yes, I'll give it to you.
JC. No, but I'll send it to you on your e-mail and I'll give you mine as well. Yes, then I can just top up every now and then.
POM. That's what I intend to try to do is put everybody on e-mail so I can send their transcripts to them by e-mail.