In the face of death

The funeral industry is booming in South Africa. In fact, South Africans spend more time going to funerals than getting haircuts or going shopping, according to a 2004 study by the South African Advertising Research Foundation.

This is a troubling reminder of the pandemic sweeping the nation, dooming millions to a lifelong disease that has no cure and only one foreseeable outcome: death.

South Africa officially has the fifth highest incidence of HIV in the world, but given the more than 5.6 million people infected in 2004 and the alarming rate at which the disease spreads, the country is considered to have the worst epidemic in the world, according to AIDS Foundation South Africa (AFSA). "It's almost like one in three people is infected," says Debbie Mathew, the executive director of AFSA, in a phone interview from AFSA headquarters in Durban, South Africa. She says that about 330,000 people die from AIDS every year - "healthy, prime-age people that shouldn't be dying."

The numbers are staggering, but for five Blair students who traveled to South Africa this summer, statistics mean nothing compared to the actual faces of the AIDS crisis.

"Intoxicated Barbie"

Even so, it was a shocking statistic that took seniors Ajolique Jude and Soulyana Lakew, sophomore Marc Smith and freshmen Nesreen Butler and Esaite Lakew to South Africa in the first place.

They learned that the rate of HIV and AIDS in the Washington, D.C., metropolitan area is equivalent per capita to that of South Africa, says Dr. Yvette Butler, Nesreen's mother and the executive director of the GapBuster Learning Center (GBLC), a Montgomery County program working to close the achievement gap between black and Latino students and their white and Asian peers.

A year ago, Dr. Butler recognized the need for local HIV/AIDS awareness education and decided to incorporate it into GBLC. She initiated a six-month HIV/AIDS program for a select group of students that culminates in a two-week trip to South Africa, during which students act as HIV/AIDS peer educators. Jude, Smith, Nesreen and sisters Soulyana and Esaite were selected through the GBLC Leaders In Training program to join several students from across Montgomery County on the trip to South Africa this past June and July.

While there, they visited a series of South African schools, where they led hands-on demonstrations and interactive games to simulate the effects of HIV/AIDS and to explain proper methods of prevention. One demonstration, named "Intoxicated Barbie," shows the effects of alcohol on judgment, especially when it comes to safe sex and the transmission of HIV, while another uses a dildo to explain the proper procedure for putting on a condom.

Garlic and oranges

Although the demonstrations themselves may elicit awkward giggles and outright shock, this peer education is important because of the misinformation and, in some cases, complete lack of information on HIV and AIDS, explains Esaite.

Myths and misconceptions about HIV and AIDS abound in South Africa, often with disastrous results. Esaite and Nesreen list several common rumors, like the erroneous beliefs that oranges and condoms contain the virus, that have only aided in the spread of the epidemic.

One of the most horrifying myths is that sex with a virgin can cure HIV/AIDS, says Nesreen. Partly as a result of this misconception, South Africa has the highest incidence of rape and infant rape in the world, with 37,000 adult rapes and 21,000 child rapes reported in 2001, according to "Science in Africa," an online magazine. However, according to the same magazine, only one in 35 rapes is reported, meaning the actual number of rapes might be in the millions.

Even the South African government contributes to these misconceptions, laments social studies teacher Patricia Anderson, who spent a month touring South Africa this summer as part of the Fulbright-Hays Seminar Abroad program. "The health administration was recommending traditional remedies, like, 'Eat garlic, and you'll be fine,' and meanwhile, millions of people are dying," she says. "A lot of times, the government is at odds with the crisis."

This misinformation stigmatizes the HIV/AIDS-infected population. Misconceptions, such as that the disease can be transmitted through any physical contact with an infected person, contribute to the social isolation and rejection that frequently accompany open disclosure of HIV status, says Nesreen. Fearing ostracism, many people refuse to get tested, explains Dr. Butler. "If you are HIV-positive, you are abandoned," she says.

In an extreme case, an HIV-positive woman was famously stoned to death in 1998 by a mob of her own neighbors, says Mathew.

Jude believes this stigma is partially due to the role South African society plays in the crisis. "They don't talk about it because the spread of the disease has so much to do with their own culture," she says. For example, the popular practice of polygamy in South Africa compounds the problem, since polygamous men who do not practice safe sex can easily transmit the disease to their multiple sexual partners, explains Jude.

Furthermore, because of the stigma associated with HIV/AIDS, older generations often refuse to discuss the disease at all, says Nesreen. "They don't want it to exist. They think if they don't talk about it, it doesn't exist," she explains.

The silence is taking its toll.

Not just numbers

Even six months of training and education with GBLC could not prepare Esaite for a visit to an AIDS hospice in South Africa. "Regardless of how many statistics and numbers you see, it's not the same as seeing it yourself," she says. "It was unreal."

The patients in the hospice were in the last stages of AIDS, on the verge of death. They lay in hospital beds in the cramped quarters of the hospice huts, their covers pulled tight around their gaunt faces. They were emaciated and weakened by the disease: Their eyes drooped, their hair thinned and fell out and their skin hung in folds off the frames of their frail skeletons. "They were withering away," says Nesreen. "It just hit me and made me feel there's so much suffering from AIDS. They were dying right before our eyes."

Jude was hesitant to approach the patients because she didn't want to take whatever time they had left. "Any minute, any day, they were going to die. I've never seen anyone that sick," she says. "It made AIDS more real."

Dr. Butler planned the trip with that very purpose in mind. "You got to see the face of HIV in its last stages, getting ready to die," she explains. "It was painful to see, but I wanted the kids to see that."

The "lost generation"

The effects of HIV/AIDS in South Africa are pervasive, ranging far beyond the actual death count. From a faltering economy - due in part to the dwindling workforce - to an exponential increase in the number of orphaned children, the pandemic affects all of South Africa.

Hundreds of thousands of children are orphaned every year by the deadly disease. About 1.2 million children have lost a mother, says Mathew. She calls them the "lost generation."

On a visit to an orphanage and daycare center, the students of GBLC spent time with several South African children, many of who were orphaned by the HIV/AIDS pandemic. Nesreen was particularly struck by their apparent optimism in spite of their circumstances.

However, as soon as the orphans started sharing the stories of their pasts, "their smiles faded away, and their eyes got wet," says Nesreen. The orphans told the students of GBLC their tragic stories with tears streaming down their cheeks, clutching small mementos of the parents they had lost to AIDS. One little girl held tightly to a bottle of cleaning spray that her mother had once used to clean the television. It was the only thing of her mother's that she had left. As she told her story, she began sobbing so furiously that she was unable to continue. Since the trip, Nesreen and Dr. Butler have been considering adopting an AIDS orphan from South Africa.

Mathew's biggest concern is the future of these orphans. In a country where the unemployment rate is about 41 percent, and 61 percent of the 18 million children live in poverty, according to AFSA, the millions of AIDS orphans only compound the situation. Without support, many of these children become "dysfunctional, drop out of school, become unemployed" and contribute to the high crime rate, she explains. "Many of them cannot find jobs because there are no jobs."

As a result, poverty is one of the biggest concerns with regard to HIV/AIDS, not only because the disease disproportionately affects the impoverished, but also because without money, there is no clothing, no housing, no food and certainly no medication.

Disturbingly, because the government offers financial support to some HIV/AIDS patients, some people willingly contract the disease. "People feel being HIV-positive has advantages because they get government checks so they can feed their children, have a house over their heads, have water to drink," says Dr. Butler. "That was most alarming."

By the year 2012

According to AFSA, the total number of HIV/AIDS-related deaths in South Africa is still seven years away from peaking. "If HIV/AIDS isn't stopped, it's going to claim more lives until there are no more lives to claim," says Smith.

The first thing to be done in the fight against HIV and AIDS, says Anderson, is to increase overall awareness. "Once you know what's happening, you can't ignore it anymore," she insists. "It's the responsibility of every person on the planet to fight the epidemic."

Dr. Butler is confident that the peer educators of GBLC are making a difference. Already, as a result of this year's trip, GBLC has "formalized a partnership" with a South African peer education program, with both groups eager to educate each other in a long-term cross-cultural exchange. "It makes me feel like I have a purpose," says Nesreen. "I can teach people, and I can learn from them."

While hopeful about the prospect of change and the efforts being made by groups like GBLC, Mathew emphasizes the enormity of the HIV/AIDS pandemic. "We've got a long way to go," she says.

Because if nothing is done, South Africa may become awash in an endless sea of the faces of AIDS.