Can we use electricity to kill HIV?

AIDS prevention in South Africa "they'd rather die than use condoms"

By Leonie March

Women pack up condoms: They do educational work in Ntuzuma, a twonship in Durban, South Africa. (March)

South Africa has one of the highest HIV infection rates in the world. It is estimated that over six million South Africans are positive. Educational work is not easy: there are still many myths surrounding HIV and many men refuse to use condoms.

It's loud, hot and has a strong smell of ammonia. But you get used to it, says Brandon Kohrs. The production manager stands in the middle of the huge hall where the only condoms "Made in South Africa" ​​are made. It all starts with a milky, viscous natural latex soup in a metal tub.

"The latex is preserved with ammonia. It also prevents the liquid from coagulating and forming lumps."

Because even the smallest irregularity can lead to the condom getting a hole or tearing. Little by little, glass flasks dip into the latex tub. They are attached to a kind of cog railway. Long tubes that end in characteristic tips. Covered with a fine layer of rubber, they reappear with a milky sheen and disappear in a metal box.

"After the bath, they are dried in an oven. This process is then repeated again. The condoms therefore consist of two layers. Here in the upper part of the machine, they then pass through several hot air chambers for what is known as vulcanization, which makes them elastic and resistant. Then they cool and get streaked from the mold. "

Brandon Kohrs stops in the middle of the ten meter long production chain. There the condoms are removed from the glass flasks with soft brushes. The machine spits out almost 200 million pieces every year. Much less than the approximately 55 million South Africans need a year to protect themselves against the rampant HIV epidemic. Even so, RRT Medcon is the only manufacturer in the country and the largest in all of Africa. The lion's share is imported. For one simple reason, says company chairman Sikhulu Mtshali. A stylishly dressed man, slim trousers, jacket with pocket handkerchief, who is just entering the otherwise shirt-sleeved production hall.

RRT Medcon is the only one in South Africa that makes condoms. (RRT Medcon)

"The hurdles are very high, on the one hand because you have to invest enormous sums of money for such a production, and on the other hand because you need a lot of specialist knowledge. These big machines that you see here are all imported. You need a lot of money to buy them to ship here and wait. In addition, there are extremely high quality and safety standards in this industry. The condoms undergo 20 to 30 tests during manufacture. "

In the room next door, the freshly produced condoms are washed in large washing machines, coated with silicone and powder so that they do not stick to each other and are dried again. Angel Bull dumps a load on a side table. This is the first security check, says the petite woman with the hairnet with a smile, while she routinely eyes every condom critically.

"People's lives are in our hands"

"We first check whether there are any visible defects. Holes, folds or sticking. Then further tests follow: Every single condom is tested for the smallest holes. We also carry out a whole range of other material checks in random samples I also bear this responsibility. Because in a certain way the lives of people are in my hands. "

The young employee concentrates on sorting the condoms, pulls them out and places them in two plastic tubs - the flawless ones in one, the faulty ones in the other. It's so easy to use it to protect yourself, she says after a while. And it would be so important. Like every South African, Angel has neighbors, friends or relatives who are HIV-positive or who have even died of the effects of the immunodeficiency disease AIDS. Your home country has one of the highest infection rates in the world. It is estimated that over six million South Africans are positive.

"It makes me angry when I see that people just throw away condoms that they were given in the clinic, for example. It costs a lot of money to manufacture. Nevertheless, people get the rubbers for free. But they still don't understand how it is important to use them too. "

Angel Bull shakes his head in annoyance. She grew up in a township in the north of Durban. In these densely populated districts, the three "A" s determine people's everyday lives: poverty, unemployment and AIDS.

Ntuzuma is one of those townships. Tin huts and stone houses stand side by side on the hills, as far as the eye can see the corrugated iron roofs reflect in the sun. On the veranda of one of the many small houses, a couple of women are packing condoms in plastic bags. From a large box they fish a strip with six red and six gold strips. And think about it briefly: a dozen condoms should be enough for a week.

"We put six red and six gold per person for a week. We just want to make it look nice and attractive, so that young people will be attracted to them, start taking and using."

Poverty, Unemployment and AIDS

The condom packs should look attractive so that young people can also use them, emphasizes Mandisa Dlamini. The 30-year-old has been an AIDS activist in her home district for years. Once a week, she and her fellow campaigners distribute condoms in the neighborhood, which aid organizations make available to them.

"We found out that people reject the old government condoms; the ones with the dark blue packaging. They have a real stigma. Some claim that these condoms give you HIV or other STDs. Of course we try this one To refute the myth. But as long as it still exists, we'll be relying on other colorful brands. It's absurd, but the packaging seems more important to people than protection. To put it bluntly, they'd rather die than use the dark blue condoms over them anything is said. "

The women are ready to go. Several dozen condom packets are neatly packed in two boxes. One for each group heading in different directions on their mission.

"Hurry up, you don't need to put on make-up to hand out condoms," Mandisa shouts to one of the women, who then stowed her make-up back in her handbag, a little shyly. Mandisa herself is more of the sporty type: black jeans, striped shirt and sneakers. Instead of the long extensions that are much sought after by many young South African women, she has braided her hair in pigtails that lie close to the head.

Slowly and increasingly out of breath, the women follow the steep, unpaved road up the hill. At the edge of the path, a couple of tethered goats pluck between plastic bags and rubbish on barren tufts of grass. A woman washes laundry in a plastic tub in front of her poor tin shack. A man opens the door of one of the many outhouse toilets, small sheds that are a bit apart from the one-room houses and corrugated iron huts. Above it hangs a jumble of cables, tapped and unsecured power lines. A rat is balancing on one of the straight stretches.

Mandisa and her colleagues approach a shipping container. A typical township kiosk. The seller looks skeptically through the barred opening on the long side. Barricaded in this way, he protects his daily income from raids. Because here in Ntuzuma, crime is rampant, as in many townships in South Africa. Behind him, a modest assortment is piled on narrow wooden shelves: soap, candy and cornmeal.

Mandisa wants to know whether he also sells condoms. The seller nods hesitantly. Whether he would also distribute some to his customers for free. Another nod. The red ones are really good, she adds, and pushes a few parcels under the grille for him.

The women go on. They confidently greet the people they meet. Even if some look away, embarrassed. We haven't been embarrassed about condoms for a long time, says Mandisa. We cannot afford that given the high rate of HIV infection. When they reach the main road, they call to a passing minibus taxi. How about a couple of condoms? The driver stops and leans out the window.

"These guys don't use condoms"

Mandisa talks to the father of the family. But despite all the persuasion, he doesn't want to know anything about condoms. I'm married and don't need one, he says with a defensive gesture. Besides, it is improper to talk about such a thing in public, especially with young women. The cross on his rearview mirror rocks hard as he drives away, honking his horn.

"Religious and elderly people like him still do not understand why they should protect themselves too. They ask us why we are addressing them in particular. And what to tell their wife when they come home with condoms."

Just a few steps further, another endurance test awaits Mandisa. On the side of the road, she appraises a whole group of young men, some wash their minibus taxis, others lounge around with their cell phones in the back seats or just stand around. Her eyes study every inch of the women who come towards them, uncomfortably slowly. But they are not intimidated by it.

Someone wants to know whether they also have chocolate-flavored condoms, or which ones are extra-large. How do you even know if these rubbers are really good? Have you tried it yourself, asks someone else? And his buddy adds with a grin: If not, we could do it right now. But nothing can upset Mandisa and her colleagues. You stay matter-of-fact and friendly, despite the lewd-stupid sayings.

He doesn't need condoms anyway, says a beefy guy who sits with his legs apart on the bench of one of the minibus taxis. Because I have blood type A, he adds, almost triumphantly. This makes me immune to HIV infection! Mandisa tries to convince him with facts. But the attempt at clarification fails. In any case, the man does not want to show himself naked in front of his assembled friends. If you want to know what it really is like with HIV, just come over, Mandisa offers him, says goodbye in a friendly manner and continues.

"These guys don't use condoms. And talking to them shows how many myths still surround the disease. We often hear such nonsense as the blood type. These minibus drivers are a real risk group. They are young, mobile, have Money and therefore success with women: They pick up their changing friends from school, take them to work, sometimes even pay them pocket money and make them feel like they belong to an important clique - and that is particularly attractive to young women . "

On the way back, the AIDS activists have a little more success. Some passers-by accept the condom pack with thanks. The last stop is a dim pub, in front of which a group of clearly tipsy men is already sitting in front of their liter bottles of beer in the morning.

"I will not die, I will live a long time"

Just take a couple of condoms, Mandisa says gently. It's better if you have it in your pocket. You don't want to stand here tonight with a beautiful girl and then realize: Oh dear, I don't have anything with me. With a mock worried face, Mandisa turns the inner lining of her trouser pockets over. Everything empty, she says with wide eyes. The little sketch is well received.

What's your name again? Asks one of the men after he has pocketed two condom packs. Mandisa repeats her name. So you're Gugu's daughter, he says. She nods. I'm very sorry about what happened to your mother, says the man, who suddenly appears completely sober, with a serious expression on his face. Mandisa thanks for the nice words and then says goodbye quickly.

The three women make their way home in silence. The past has caught up with them. Shortly before Christmas 1998, Mandisa's mother Gugu Dlamini was brutally murdered nearby. A group of men attacked them with knives, clubs and stones. Then they threw the unconscious seriously injured woman down a slope and told a neighbor that the family could literally pick up their "dog". The violence was triggered by a public confession just a few weeks earlier.

"My mother broke the silence of many people, not just in this neighborhood, but all over South Africa. She was the first woman to admit on public radio and television that she was HIV-positive. That was a taboo break at the time. On the main road from the township to Durban there was a huge poster with a skeleton on it with the slogan: HIV kills. People were terrified of anyone who was infected. I remember my mother with me shortly before Talked to me about her illness. She said: I will not die, I will live a long time. Unfortunately it turned out differently. Not HIV, but our own people have wiped out their lives. "

At the time, Mandisa was just 14. But hardly anyone wanted to help her. The neighbors even refused to take their seriously injured mother to the hospital, fearing they would never get the deadly virus out of their car again.

My own aunt threw me out of this house, Mandisa continues, as she re-enters the veranda, where she and the other women left an hour ago. She lived here with her single mother until the brutal murder. A pub owner took the traumatized girl in at the time. But not just out of pity.

"I lived there for about three years. It was a tough time. This woman really hurt me. But today I wonder what would have become of me without her. I had no one else. At least she gave me food and a roof Even if I had to work hard and pay a high price for it. I could go to school even if I slept through most of the class because I was always so tired. My classmates called me Sleeping Beauty. But at least I wasn't entirely penniless. "

The now 30-year-old lets her gaze wander over the poor neighborhood pensively. Like many girls in the area, she also experienced sexual violence at the time. A little later she is pregnant. After the birth of her son, she couldn't take it any longer and fled to the capital, Pretoria, a good 600 kilometers away. Your hope for a better life is actually being fulfilled there. She is adopted by a loving family who also gently get her to be tested.

"It was hard for them to say: Your mother was HIV positive, so you should get tested too. Instead, the whole family went to the test. It was a shock when I heard the result: I was negative. I didn't have that Because I had had unprotected sexual intercourse a number of times before. To be on the safe side, I did a second test right away. "

After the diagnosis, Mandisa draws new courage to face life. Supported by her new family, she graduated from high school and is even studying. Not many are so lucky in adversity.

"After graduation I asked my adoptive mother how I could ever thank her for all that she did for me. She replied: It would be best if you go back and help all the other mandisas in your old homeland. And That's how it turned out. The first thing I did was to meet up with the murderers of my mother and their families and to forgive them. That was very important for me in order to be able to really start over. Then I went looking for girls and boys Made women in a similar position to how I used to be to educate them about the disease and make them strong. "

Her mother's house is now the seat of her own foundation, the Gugu Dlamini Foundation. A white shipping container serves as an office. Boxes of condoms and educational materials are stored next to a small desk. Vegetables that are prepared directly in the kitchen grow in the small, steep garden. The women chat happily while they peel carrots, stir up corn porridge and wash spinach. After school ends, dozens of children from the neighborhood, including many AIDS orphans, come here to have lunch and do homework, Mandisa proudly explains. But until then it will take a few hours.

More and more people are talking about HIV

Together with a few other young women, she puts the plastic chairs in a circle on the veranda. Once a month, all of the foundation's volunteers come together to talk about their own worries and hopes. Some are HIV positive themselves, others are indirectly affected by the disease. For example through the death of the parents or an infection of the partner. The social stigma has decreased significantly since my mother's murder, says Mandisa, while the women gradually sit down.

"I would say that about half of the people here are now openly about the disease. Instead of remaining silent, they talk about HIV. But the other half are still hiding their infection. They fill their medication into multi-vitamin vials, Because they are afraid of being marginalized. The stigma not only comes from outside, but people stigmatize themselves. They despise themselves for being HIV positive. They don't believe in themselves. They stop listening to the future dream. They drop out of school, blaming the whole world for their misery. Many young people still think HIV is a death sentence. "

"What life do you dream of? Who would you like to be?" Asks Mandisa when everyone has sat down. You cannot work for my foundation forever for free. It should only be a stepping stone for your own, self-determined future. HIV infection is not a reason to give up all of your goals.

In turn, the women introduce themselves: A young mother, whose baby fell asleep in her arms, would like to be a successful business woman. An HIV positive woman in her thirties studying social work. And a long-haired, slender beauty dreams of a career as an actress.

And why haven't these dreams come true, Mandisa wants to know? Most women look at the floor in embarrassment. Some accidentally became pregnant and had to drop out of school. Others lost their parents and had to take care of their younger siblings. Still others got sick themselves. And of course there is also a lack of jobs and money. Typical fates in South Africa's townships.

Together, the women consider how they can get closer to their dream despite all the challenges. Help each other instead of being jealous of the other's success, stresses Mandisa. Use the courses that we offer here at the foundation to educate yourself. Start making decisions about your own life instead of just drifting. Have the courage to insist on condoms during sex. Even if the men don't like it. Do not have another baby if you cannot feed it. Be an example to your children; otherwise they will repeat your mistakes.

Mandisa's tone is strict and cordial at the same time. The women nod, some smiling encouraged. Others look serious, lost in their thoughts, when Mandisa says goodbye to them.

The next morning the women meet again on the porch. In addition, there are gradually a dozen neighbors and even a few men. Some greet those present loudly, others sit quietly on one of the plastic chairs.

"Quacks are our biggest problem"

Mandisa enters the veranda with a young man who is wearing a t-shirt that says "HIV positive". Sandile Khumalo visits the foundation once a month for a kind of educational hour. He is an activist for the Treatment Action Campaign, the organization that has campaigned against stigmatization and for the rights of HIV-positive people in South Africa for almost 20 years. She has successfully taken to court several times against the government, which had long played down AIDS; attributed the disease to poverty rather than the virus, and promoting garlic and beetroot rather than life-saving antiretroviral drugs.

It is thanks to activists like Sandile Khumalo that South Africa today has the world's largest treatment program. But the fight doesn't end there, he says as he tapes three large blank sheets of paper to the wall.

"It is a milestone that 1.6 million people are now receiving medication in the province of Kwazulu-Natal alone. However, we are concerned that many do not take their pills regularly or stop treatment. This leads to resistance, among other things - and so do we don't have a lot of choice here in South Africa when it comes to therapies. "

Strong side effects, but also the feeling of being healthy again are only two reasons why people stop taking their medication on their own, Sandile continues.

"Here in Durban, quacks are our biggest problem. Preachers and healers who claim to be able to cure AIDS. It is important to keep making clear that HIV cannot be washed away with holy water or ritualistic acts. We still have to emphasize that AIDS is so far incurable. "

"Good morning comrades", Sandile Khumalo greets the group in the old freedom fighter tradition. Today we're going to talk about prevention, what is known as post-exposure prophylaxis, and new treatment options. He writes the three terms on the posters on the wall. Some of the women are taking notes.

Mandisa also listens attentively during the education hour. (March)

Sandile explains what to do after a rape that there are drugs that can prevent HIV infection immediately after unprotected sex. He talks about new drugs that have far fewer side effects. They are still very expensive, unaffordable for poor township residents. But we are working to ensure that the patents fall and that South Africa gets inexpensive generics, promises Sandile. Some women ask questions and Mandisa Dlamini also listens carefully to the committed activist.

"The drugs have a great effect: Life expectancy has increased significantly. In many HIV-positive people, the viral load is now below the detection limit. They no longer look sick, they also feel healthy and can go to work. In view of the progress made in treatment hope now that there could soon be a cure too. "

Despite all the progress, however, condoms are still the best protection, emphasizes the AIDS activist towards the end of his educational session. He sits with the group for quite a while. The women bring each a paper plate with chicken and white bread, and a glass of juice. The morning slowly ends with the common meal. It's good to hear that AIDS research is making progress, says Mandisa Dlamini. But there is still a long way to go from an HIV-free generation that the United Nations has set itself the goal of.

"Maybe it will be in 20 or 30 years. We are all working towards this goal. But if you listen to the people here on the street, you know that there is still a lot of work ahead of us. Above all, we need a change in awareness: It is crazy to risk your life just because the condom is not attractively packaged. Millions of children in South Africa are still growing up without parents who could still live today. But they were selfish and have given up a condom Reason because it doesn't smell pleasant. "

Success with strawberry flavor and color

Mandisa Dlamini shakes her head wordlessly. But shortly afterwards, her mine brightens up again: It is a good sign, she says, that the government has now also recognized the problem with the condoms.

Just a few kilometers further in the condom factory, production manager Brandon Kohrs is working on a new major government contract. Instead of conventional rubbers, she recently started using colorful condoms in different flavors and smells. There is an intense smell of strawberries in the hall. A worker puts one red condom after the other on the assembly line. They are impregnated with the scent and shrink-wrapped in bright red packaging.

Strawberry aroma against AIDS: Until now, condoms have been unpopular with many men in South Africa: rubber is supposed to change that with color and taste. (RRT Medcon)

"It's actually the same product, only the name and packaging have changed. Add to that the color and smell. But the condom itself is no different from the condoms we used to make for the government."

So it's all about perception, adds Kohrs. He hopes that the new condoms will actually be more popular. Especially among the young South Africans in townships like Ntuzuma. So that the utopia of an HIV-free generation could still become a reality.

Deutschlandradio author Leonie March. (private) "Anyone like me who lives in South Africa cannot ignore the topic of HIV and AIDS. Everyone knows someone who is HIV-positive or who has died as a result of AIDS. Me too. That is why it surprised and shocked me, as many others There are still myths surrounding HIV. And how many men still refuse to use condoms. "