Product Description

At the age of twenty-nine, Sizwe Magadla is among the most handsome, well-educated, and richest of the men in his poverty-stricken village. Dr. Hermann Reuter, a son of old South West African stock, wants to show the world that if you provide decent treatment, people will come and get it, no matter their circumstances.

Sizwe and Hermann live at the epicenter of the greatest plague of our times, the African AIDS epidemic. In South Africa alone, nearly 6 million people in a population of 46 million are HIV-positive. Already, Sizwe has watched several neighbors grow ill and die, yet he himself has pushed AIDS to the margins of his life and associates it obliquely with other people's envy, with comeuppance, and with misfortune.

When Hermann Reuter establishes an antiretroviral treatment program in Sizwe's district and Sizwe discovers that close family members have the virus, the antagonism between these two figures from very different worlds -- one afraid that people will turn their backs on medical care, the other fearful of the advent of a world in which respect for traditional ways has been lost and privacy has been obliterated -- mirrors a continent-wide battle against an epidemic that has corrupted souls as much as bodies.

A heartbreaking tale of shame and pride, sex and death, and a continent's battle with its demons, Steinberg's searing account is a tour-de-force of literary journalism.

Product Details

• Amazon Sales Rank: #17785 in Books
• Published on: 2008-02-12
• Number of items: 1
• Binding: Hardcover
• 368 pages

From Publishers Weekly
Starred Review. Award-winning South African journalist Steinberg, a gay white man, conceived this book to understand the AIDS crisis in his country and, to a limited degree, in himself: though HIV testing and treatment are readily accessible, he wondered, why did so many abstain? Steinberg journeys to the poor black village of Ithanga, where antiretrovirals (ARVs) are available, but electricity and running water are not. He examines the disease through the pseudonymous Sizwe Magadla, a 30-year-old shopkeeper who has resisted testing. Sizwe becomes Steinberg's interpreter and explains the village's traditional health-care system in which witchcraft thrives and Western medical missionaries challenge healers and herbalists. Steinberg traces Sizwe's growing awareness of the myths and realities of the three letters—one persistent belief, that whites created and deployed HIV as a means to regain power, echoes the legacy of apartheid still overshadowing the country—and his attempts to reconcile cultural beliefs with increasingly unassailable medical facts. Steinberg becomes intertwined with his subject, but balances critical distance and compassion with gleanings from his own psychological barriers to HIV testing that further deepen the concern and understanding he accords to Sizwe's story. (Feb.)
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Review
"Development is challenging not only because of poverty and lack of political will, but also because of failures in human understanding. By addressing the AIDS crisis with acute insight, imagination, and extraordinary compassion, Jonny Steinberg and Sizwe Magadla have done us a great service."

-- Helen Epstein , author of The Invisible Cure: Africa, the West, and the Fight Against Aids

"In this trenchant work, Jonny Steinberg brings us an eloquent and compassionate yet tough-minded view of how one young aspiring South African man, in a marginal village setting, confronts the threat of HIV/AIDS. It is a window onto a complex set of realities -- the power of culture, shame, fear, male identity -- that are difficult for most of us to see or understand. Replete with insights and surprises, Sizwe's Test is a major achievement."

-- J. Stephen Morison , Executive Director, HIV/AIDS Task Force, Center for Strategic and International Studies

"In this vivid account of a journey to the frontline in the battle against AIDS, Jonny Steinberg portrays with acute perception the impact of the epidemic on village life in a small rural community in South Africa."

-- Martin Meredith , author of The Fate of Africa

"Medical specialists and well-meaning bureaucrats working on HIV and AIDS seldom understand the inner struggles of those they seek to help. Jonny Steinberg's account of Sizwe Magadla's story begins to unravel the mix of feelings of shame, pride, and stubborn hope that responses to the AIDS epidemic will have to take into account to be successful."

-- Alan Brody, the former UNICEF Representative in Swaziland, pioneered new approaches to education on HIV and AIDS through the arts.

"Steinberg's narrative...builds a disturbing picture of a society caught in a tragic situation with no clear solutions."

-- Kirkus Reviews

"Award-winning South African journalist Steinberg...balances critical distance and compassion with gleanings from his own psychological barriers to HIV testing that further deepen the concern and understanding he accords to Sizwe's story."

-- Publishers Weekly (starred)

"[T]his forceful narrative...[with] sharp insights and value...has to do with the immense power of stigma, the ways in which we mirror the real or imagined condemnation of others by internalizing it, and of how easily stigma becomes entwined with sexuality."

-- New York Times Book Review (Editor's Choice mention)

"A real eye-opener."

-- Booklist

"Not since Abraham Vergese's haunting 1994 book about eastern Tennessee, My Own Country, has the AIDS epidemic been described so deeply and humanly, and from so many angles. Steinberg...is keenly attuned to the many way a community encounters illness...[and] has ended up with a big, brave, poignant look into the heart of his country."

-- Time Out New York

Excerpt. © Reprinted by permission. All rights reserved.

Preface

I came upon the idea of this book sometime during the afternoon of April 9, 2005, while reading Edwin Cameron's book, Witness to AIDS.

In that book, Cameron tells a ghastly story one does not easily forget.

Knowing that up to a third of its population had HIV or AIDS, and that about one hundred thousand people were in urgent need of drugs, the government of Botswana announced in 2001 that it would offer free antiretroviral treatment to every citizen with AIDS. It was a dramatic declaration of intent, unprecedented in sub-Saharan Africa. By the time the drugs had hit the shelves and health personnel were ready to administer treatment, just about every soul in Botswana knew of it.

And yet, on the last day of 2003, more than two years after the launch of the program, only about fifteen thousand people had come forward for treatment. The rest -- over eighty-five thousand people -- had stayed at home. The majority would now be dead.

Why did they not go to get the drugs?

"Stigma," is Cameron's answer. "People are too scared -- too ashamed -- to come forward and claim what their government is now affording them:...the right to stay alive...In some horrifically constrained sense, they are 'choosing' to die, rather than face the stigma of AIDS and find treatment."

Does this foreshadow an entire region's response to AIDS? When the history of this great epidemic is written, will it be said that an untold number of people died, not because the plague was unstoppable, but because they were mortally ashamed? Will it be said that several successive generations of southern Africans were decimated by a sense of disgrace?

About 2.1 million people died of AIDS in sub-Saharan Africa in 2006. Another 25 million are living with HIV. In South Africa, where I was born and bred, nearly 6 million in a population of 46 million are HIV-positive: more than one in eight people. Some eight hundred South Africans die of AIDS on an average day. And the epidemic is spreading at a rate of more than a thousand new infections a day in South Africa. That death could keep accumulating on this scale despite the presence of lifesaving medicines is chilling beyond description.

A certain intellectual temperament greets such spectacles with excited fascination. The moral of Cameron's story, it may be tempting to conclude, is that human lives are not sunny and progressive projects, but the sites of blunt, blind tragedy. Not just the world, but even our own natures are indifferent to our programs of betterment.

I am not one of those fascinated souls. When I read a story like Cameron's, my gut response is that something is wrong, something that might be fixed. This is not to say I subscribe to the proposition that, at core, our natures are healing and life-giving. There is a surfeit of shame and envy and destruction within us, quite enough to go around. But it seems to me that what becomes of this darkness is not a question of fate but of politics. When people die en masse within walking distance of treatment, my inclination is to believe that there must be a mistake somewhere, a miscalibration between institutions and people. This book is a quest to discover whether I am right.

When I finished reading Cameron's book I began to look for the most successful antiretroviral treatment program in South Africa. I wanted to find a place where poor villagers lived within walking distance of well- administered drugs, and where nobody need die for lack of medical care. I wanted to go there and find people who were staying at home and dying, and I wanted to know why they were doing so.

The closest thing I found to what I was looking for was the rural district of Lusikisiki in Eastern Cape province. It is not quite true that everybody there lives within walking distance of antiretroviral (ARV) treatment, or that nobody need die for lack of medical care. It is a chronically poor place, where people have been dying for want of decent care since long before the HIV virus. But extraordinary work was being done there. The international nongovernmental organization Médecins Sans Frontières (MSF, and called in English, Doctors Without Borders), in partnership with the Eastern Cape Department of Health, was using the district's rickety and neglected primary health-care clinics to administer antiretroviral treatment. When MSF arrived in 2002, nearly one in three pregnant women was testing HIV-positive. At least one person a day was dying of AIDS at the hospital on the outskirts of town. Most of those infected with the virus were still asymptomatic; in the absence of a medical intervention, an avalanche of death was to come.

MSF was putting out very good news indeed. Staffed by a cohort of laypeople and ordinary government nurses, the clinics were up and running, the organization said. Thousands of villagers were cramming the waiting rooms to test for HIV. And the shelves were stocked with drugs. By the time I made contact with MSF in mid-2005, a thousand people were on ARVs.

The program was run by an MSF doctor called Hermann Reuter. He is to occupy quite a few of the pages that follow. Reuter's guiding proposition was quite simple: If you provide treatment that works, people will come and get it. If you provide poor treatment, make people stand in lines, or shunt them from one institution to another, they will look elsewhere for succor, or they will stay at home and die. His work was that of a medical missionary: he wanted to show that you could provide decent AIDS treatment anywhere, even in places that had long ago been routed, and that if you did so, people would come forward.

I went to Lusikisiki deeply skeptical of Reuter's evangelical simplicity. While I wanted to resist the stance of the morbidly fascinated, I suspected that things in Lusikisiki were a lot more complicated than he made out. And it did not take long to find people who lived close to a clinic staying at home and dying. The question was why.

If the brochures produced by the area's negligible tourist industry are to be believed, Lusikisiki owes its name to the sound of the wind moving through reeds. According to locals, the word does not mean anything, or if it once did, its meaning is lost to memory. In any case, they say, Lusikisiki refers to two things: the town center with its commercial street and its smattering of suburban-like homes, and the thirty-six or so villages scattered around it in a forty-mile radius.

It is not an easy place to describe. Were you to read its economic data off a spreadsheet without seeing it in the flesh you might think it was a depressed inner-city zone. The majority of adults are un- or underemployed, and most households get their income either by cheap, unskilled labor, or survivalist self-employment, or government grants.

And yet its physical setting is anything but urban. Lusikisiki's 150,000-odd people live in about three dozen villages spread liberally over a spirited, temperamental landscape. Streams and rivers run through villages flanked by wild forests; cows, horses, and goats graze off deep green grassland; the villages along the seaboard stand on high cliffs and command breathtaking views of the ocean. Wandering through this place, it takes dogged labor to remind oneself that its political economy is no longer rural, that almost everyone you meet is either unemployed, or in a job that earns less than a thousand rand a month (roughly equivalent to 140 U.S. dollars), or is the recipient of a grant.

You know it, however, when you leave the villages and make your way to Lusikisiki's town center. There you see what transpires when a single market street becomes the focal point for 150,000 residents of a rural district who must come to one central throughway to purchase everything in their lives, from the food in their stomachs to the tin roofs over their heads. There is no place to move -- not in a car, not on foot, not inside the massive warehouse stores. The rows of hawkers push the pedestrians off the pavements and into the streets, leaving a narrow tunnel for the cars. And there are too many cars. Five days a week, eight hours a day, the street is dense with people, metal, noise, and a cloud of carbon. By seven in the evening it is quiet and empty.

At first I thought that this anomaly between the rural landscape and the urban profile was simply a symptom of my outsider's incomprehension. Yet I soon discovered that the villagers were as confused as I was, that they themselves felt the place to be in a painful and extended interregnum, and that it was this state of affairs that shaped the meaning of the AIDS epidemic.

More than a century ago, Lusikisiki was the capital of Eastern Pondoland, the last independent black polity in these parts to surrender its independence to the British. Political defeat spawned economic defeat; its economy hobbled by its political impotence, the men of Eastern Pondoland began working nine or ten months a year in Johannesburg's gold mines some six hundred miles away, beginning a pattern of circular migration that would persist throughout the twentieth century.

The kingdom's subjugation took a new and cynical form in 1963, when it was incorporated into the northeastern reaches of the Transkei, one of apartheid's notorious old bantustans, the separate "homelands" in which black South Africans could claim citizenship and whose sovereignty was recognized only by South Africa and its most credulous allies. Until the early 1990s, the Transkei was run by a succession of small-time dictators, among them callous and expedient men, their regimes heavily underwritten by the apartheid government.

As a reservoir of cheap labor for Johannesburg's gold mines and a dumping ground on the margins of South Africa's economy, Transkei districts such as Lusikisiki are no strangers to chronic illness. For the last eighty years, at least three out of four residents have incubated the tuberculosis bacillus, a disease that plagued South Africa's gold mine workers and their rural families throughout the twentieth century. Yet during the final decade of apartheid, the annual maintenanc...

Customer Reviews

Brilliant
The fundamental question that Mr Steinberg wrestles with is why people may choose not to take drugs that may preempt death. His honesty, sensitivity and tenacity enable him to explore the dynamics of a rural South African community in a way that I've not encountered. And yes, the man can write.

Should be required reading for all world leaders!
Heartwrenching account of the conflicts between modern medicine and daily life in Africa in the midst of the worlds most horrific AIDS epidemic. A stirring call for action and compassion. Should be required reading for all world leaders.