South African Reality.

AIDS is often a disease of gender inequality. Particularly in Southern Africa, young women frequently don't have the power to say no to unprotected sex. Teenage girls, for example, often become the baubles of middle-aged men, and so HIV spreads relentlessly. As Stephen Lewis, the former UN ambassador for AIDS, puts it: "Gender inequality is driving the pandemic."

One test of a program should be how it handles the challenge of a fourteen-year-old girl like Thabang, who lives in the village of Kwa Mhlanga in the northeastern part of South Africa. Tall, flirtatious, and liberal with makeup, Thabang is a rebellious adolescent who would be a challenge for any program. Thabang's father, an electrician, died after a protracted battle against AIDS that consumed the family savings. Thabangs's others, Gertrude Tobela, tested positive, apparently after getting the disease from her husband, and than infected her youngest child, Victor, during childbirth. Gertrude had been the first in her family to go to high school and college, and the family had enjoyed a middle-class standard of living. But soon Gertrude was too sick to work, and the family had to survive on $22.50 a month government payments. The atmosphere in the shack in which they lived was despairing.

Thabang is smart and talented, and like any teenage she yearned for fun and warmth and love. She dreaded the misery of the shack, so she began to hang out in town. She had her hair done fashionably and wore sexy clothes, seeking the diversions of boys to escape the claustrophobia of her home. She also wanted more independence, yearned to be a grown-up, and resented her mother's efforts to rein her in. Thabang also has the misfortune of being strikingly attractive, so men flattered her with their attentions. In South Africa, successful middle-aged men often keep young teenage girls as mistresses, and many teenagers see such "sugar daddies" as a ladder to a better life.

When Thabang began flirting with men. Gertrude screamed at her and beat her. Thabang was the only member of the family who didn't have AIDS, and Gertrude was aghast at the possibility that Thabang would contract the virus as well. But Gertrude's beatings infuriated Thabang, confirmed the girl's suspicion that her mother hated her, and promoted to run away. Thabang also seemed to feel embarrassed by her AIDS-ridden mother, weak and frail and poor and all their fighting left Gertrude even more exhausted and depressed. Gertrude spoke in a composed way about her own imminent death and Victor's, but she broke down completely when she spoke of Thabang.

"My daughter left me because she wants liberty," Gertrude said, sobbing. "She is so sexually active, and she stays in bars and rental rooms." Gertrude looked upon Thabang's fondness for makeup and tight clothes with horror and couldn't bear the thought that the cycle of AIDS would be repeated in the next generation. For her part, Thabang insisted that while her friends slept with men for cash or gifts, she herself did not. 

"I'm a virgin, whatever my mother says." Thabang said, and she began to cry as well. "She never believes me. She just yells at me."
"Your mother loves you," Nick told her. "The only reason she scolds you is that she loves you and cares what happens to you."
"She doesn't love me!" Thabang replied fiercely, tears trickling down her cheeks as she stood outside her home fifteen feet away from her mother, who was also crying.
"If she did, she would talk to me instead of beating me. She wouldn't say these things about me. She would accept my friends."

There is no question that the local schools should encourage abstinence for girls like Thabang. But those programs shouldn't stop there. They should explain that condoms can dramatically reduce the risk of HIV transmission, and they should demonstrate how to use condoms properly. Governments should encourage male circumcision, which reduces HIV risk significantly, and should encourage free screening and treatment for sexually transmitted diseases. Testing for HIV should become a routine, requiring people to opt out instead of opt in.  That way, nearly all adults would know their AIDS status, which is crucial, because it's impossible to contain an epidemic when people do not know whether or not they have been infected. That kind of comprehensive approach to prevention would be most effective in reducing the risks to a girl like Thabang. And these prevention methods are much cheaper than treating and AIDS patient for years.

Half the Sky
 page 136-138

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