SAR, Vol 10, No 3, March 1995
AIDS, EDUCATION, THEATRE:
A ZIMBABWE EXPERIENCE
BY DAVID POTTIE
David Pottie is a member of the SAR editorial collective.
In 1993, the World Health Organization estimated that eight million of the 13 million HIV positive adults world-wide are found in sub-Saharan Africa. According to Tisa Chifunyise, a Zimbabwean AIDS educator and the director of the Children's Media Trust in Harare, there are now 100,000 AIDS cases and one million HIV positive Zimbabweans. Out of a population of 11 million, one in ten are HIV positive. Young adults are most at risk and young women in particular.
While southern Africans are no strangers to enormous hardship, faced as they have been with war, famine, structural adjustment and trade liberalization, the human dimensions of AIDS across the continent threaten to raise these hardships to a new level. The size of the HIV positive population means that countries already squeezed by poverty now face further economic deprivation borne by higher health costs and the loss of productivity. AIDS in Africa is not only a health problem, it is a development problem.
Southern Africa Report recently had a chance to speak with Chifunyise when she was in Canada visiting other AIDS organizations on a tour coordinated by OXFAM-Canada. Through her work in community theatre and the Women and AIDS Support Network, Chifunyise has encountered many faces of the AIDS epidemic in Zimbabwe. For Chifunyise, the AIDS explosion has its basis in several factors. The scale of the problem was underestimated in the past, and the population was often not given the right figures. This initial state of denial was, she feels, a decision not to alarm the population. But the proportions of the crisis can no longer be ignored and AIDS workers now have to treat the health problems of a large HIV positive population even as they confront the sexual attitudes that perpetuate unsafe sex in the first place.
But Chifunyise also cites the structural factors of poverty and male migrant labour for the spread of AIDS: thirty per cent of the workforce is HIV positive; the necessity to earn cash income coupled with the development of the sex trade in Zimbabwe has meant that AIDS in Zimbabwe, as in most of Africa, is not simply a "gay disease," it is a "family thing." Chifunyise had little to say about the gay population in Zimbabwe and her work does not directly address the gay community; instead she spoke about divided families, declining health resources, and education about practising safe sex.
Each of these priorities is evident in Chifunyise's work with the Women and AIDS Support Network. The situation of rural women with AIDS is most severe and the rate of infection among rural mothers and their children is growing faster than in any other comparable population. According to Chifunyise, the rural cycle of AIDS transmission comes full circle when male migrant labourers return home from the cities, rural women are infected and pregnant women in turn infect their newborn. Rural women also face a host of other barriers to adequate care: the rural areas lack access to health clinics, women still retain prime care-giver responsibility, the value of women's work is consistently undervalued and most families are divided as men migrate to the urban areas for employment. Chifunyise finds that all too often rural women lack the economic infrastructure to support themselves without males. The Women and AIDS Support Network thus seeks to lend both material and moral support for women who have lost their jobs, been kicked out of their homes, or need child-minders.
To reach these women the Women and AIDS Support Network organizes at the community level through a variety of established women's organizations: churches, co-operatives, workplace associations and so on. For Chifunyise the community approach works because, "Women are much more organized in Zimbabwe than men, groups of women are more accessible." They do try to reach men at the workplace, but she added wryly, "We have to try to reach them before they get drunk!"
Chifunyise also works with youth in the schools, dealing with groups of boys and girls at the same time. She adds that within some workshops, they might set aside separate time for boys and girls, but that as a group, youth lack the inhibitions of adults when discussing condom use. This is encouraging since the demographics of AIDS in Zimbabwe make success with youth imperative (25 per cent of recorded HIV positive cases are children under five). All the same, many parents often accuse AIDS education workers of encouraging young people to be promiscuous.
Chifunyise added that they still attempt to work closely with health personnel, because many clinics are in schools, but cutbacks in the health sector make this work more and more difficult.
Declining health resources
As one indication of the crisis in health care, between the financial years 1990/91 and 1992/93, real per capita expenditure on health in Zimbabwe fell by almost 30 percent. Chifunyise has noticed this erosion of national health service and the introduction of clinic fees: "Three years ago, you paid one dollar per visit at urban clinics, now you pay 15 dollars, so this has meant that fewer people can afford to go to clinics. The clinics used to have queues; now they don't have any queues." And with fewer resources at their disposal, the danger is that health officials will shift their attention from prevention (less expensive, but longer to produce results) to cure (more expensive, but easier to quantify).
Chifunyise offered a stark illustration of the net result of this cost-cutting: "A lot of people are being sent away from hospitals to go and die at home because they want to use the facilities for those who can benefit from them." This route will only serve to exacerbate a worsening condition. Chifunyise admits, "I'm working in the field, I'm doing AIDS education and I don't know what drugs they are using. It seems that here [in Canada] everybody knows about AZT [one of a host of drugs used in AIDS treatment]. So there are not many of us who have access to those drugs."
Equally troublesome, although there has been blood screening for transfusions since 1985, there is an absence of widespread access to HIV testing. Says Chifunyise, "It's just not possible for me when I'm feeling healthy to go and say I want an HIV test. It's expensive and you are tested when there is a reason for it."
Against this backdrop, most of Chifunyise's energies are channelled into AIDS education and community theatre to generate discussion about AIDS and safe sex. Given the severity of the AIDS epidemic in Africa, Chifunyise was overly modest about the nature of her work: "We do low profile work. It's not the kind of work that makes people raise their eyebrows." But Chifunyise was perhaps being too polite, because she later related that she still encounters many for whom there is still a tendency to protect the families by saying that someone died of TB or of pneumonia and not as a result of AIDS. Breaking such taboos through AIDS education is always the first priority for Chifunyise.
One measure of the enormous challenge in changing sexual attitudes centres around introducing condom use by husbands and wives: "That is something that we really have to discuss at every meeting that we organize, but condom use is involved in cultural attitudes. I mean, let's take an example of the woman whose husband works in town and he comes home every month or every six weeks or whenever he gets paid enough to bring supplies home. Women in Zimbabwe don't get married just to get married, they get married to have children and so at a lot of meetings we try to discuss the conditions for condom use. A lot of women will say, `What impression will I give my husband if I suggest we use a condom? What am I saying: that I don't want to have your children, and what does that make me? Am I suggesting that you have been sleeping around or that I have been sleeping around with other men in the village?' So we suggest that they organize meetings with men when discussing their husbands. In terms of changing their behaviour it is a very difficult thing. Attitudes take a long time to change."
So changing men's sexual attitudes and privileges is not only about health, but opens up a complex range of social and political issues for Chifunyise and other AIDS education workers. Says Chifunyise, "The typical male view is that STDs are a `women's disease' they are therefore a women's responsibility, and this attitude accounts for men who sent their wives away when they found out they were HIV positive; women lost their homes, their families." Chifunyise thinks this attitude is changing slowly, but it is still difficult to find men with a positive attitude towards the prevention, education and treatment of AIDS.
Chifunyise recognizes the danger that the very success in reaching women through AIDS education runs the risk of further reinforcing women's traditional roles as care-givers and nurturers. All the same, she maintains that it is the women who have been more willing to learn and to change their attitudes than the men. At one writer's workshop, some women recognized the nature of the problem, but stated that they have no choice as they are the ones watching people die. Chifunyise added, "For them, it is difficult to see how it could be any different." Strong words then from someone who faces these issues everyday.
Education and community theatre
But Chifunyise not only encounters these attitudes, she sees them animated in the community theatre she coordinates. "We don't just perform a play. We help them find out who is in the community, what is their attitude to life, what do they think about themselves, about HIV. We try to find out who makes up the community and what information they have."
She has found that theatre is extremely successful at circumventing some of the resistant attitudes towards AIDS. "Then we use that information to create a play and in the process people explore their attitudes about AIDS."
Community theatre also brings Chifunyise to the streets and the gender divide typical of much daily life exposes itself. "We do a lot of our plays on the street and we use music and dance to get people's attention. At one of the plays there was a group of sex workers there and a group of young men. After performing the play the men were shouting across to the women, `it's you women who are not careful enough', and the girls were shouting `but its you who are leaving your wives at home and then coming to see us'. So that kind of exchange at the plays is very common."
Zimbabwe needs more of this kind of exchange; Chifunyise knows this better than most. There is a growing awareness that AIDS is not only a health problem but also a crisis with its roots in the very structures of Zimbabwean social and economic life.
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