South Africa is one of the safest African countries to visit as far as health risks go. Except in the most remote regions, good health care is never far away, and the city of Durban itself (where the International AIDS Conference will take place in July), in the KwaZulu-Natal province, is not a malaria zone. (Conference organizers plan to provide on-site medical facilities in case of emergencies.) But diseases like malaria and bilharzia still pose threats, especially in the eastern part of the country. No vaccinations are required for entering South Africa.
Malaria is a no-nonsense disease that can kill within days. Fortunately, only one type of mosquito carries malaria, and if you’re traveling during the country’s winter months (June through August), you’re less at risk. There is no vaccine for malaria, but there are several pills that ward off the disease. You should talk with your doctor about which regimen is best for you. But note: You often have to start the pills a week or two before leaving.
The best way to avoid malaria is to not get bitten in the first place. Wear long pants and long-sleeve shirts, and cover your clothes with mosquito repellent. For exposed skin, use repellents containing 30 percent to 35 percent DEET, but wash it off once you’re back inside. (If you have skin problems, check with your doctor.) You may want to bring along your own mosquito net impregnated with repellents. Some hotels provide netting.
Bilharzia is a disease passed through water by worms that hitch rides on freshwater snails. To avoid it, don’t get into streams or touch pools of standing water. Tap water in most major South African cities is fine to drink but elsewhere drink only sealed bottled water or water boiled for at least two minutes.
Some tour operators such as Travelsafe offer special packages for HIVers, which include trips into national parks and other rural areas with a doctor or nurse in the group. For more info call 011.082.571.2838.
As you fly over Africa, you notice that the earth, due to droughts and lack of irrigation, is a dusty brown. Then you hit South Africa, and as if you’re Dorothy landing in Oz, you switch to color -- from the air, South Africa is so green! Once you land in Johannesburg, what you find most shocking, as an American, is that this isn’t Tarzan’s Africa. You don’t see jungles or seaplanes; you see a fully functional international airport in an industrial city.
I often describe South African cities by comparing them to American cities: Capetown is like San Francisco, if San Francisco had the climate of LA; it’s beautiful, hilly and temperate. Johannesburg is like post-auto industry, post-white flight Detroit, without a single major hotel left downtown -- if Detroit were in some hot place like Dallas. And Durban, where the International AIDS Conference will take place this July, is a developed resort town like Miami, with long strips of white sand beaches and high-rise hotels.
But what really makes this country familiar to me as an African American are the race dynamics. Just as there are two Americas, one black and one white, there are two South Africas: a white one getting wealthier and healthier, and a black one that continues to become poorer and less healthy. Political and legal apartheid are dead at last, but cultural and economic apartheid are alive and well.
South Africa has the most sophisticated tourist infrastructure in Africa -- multilane highways that are better maintained than many in the United States, all the major rental car companies, a comprehensive train system. But that infrastructure was built on apartheid logic, to constrict the lives of black people and to provide white people with plausible deniability about the inhumanity of apartheid. Roads were built with high walls or low in valleys to block white motorists from viewing black areas; the beltways were routed around, not into, the townships to limit black mobility. So in my many trips to South Africa, I’ve always followed the roads less traveled.
One reason I’m drawn here is the very real possibility that these inequities will be overcome. America has largely ignored the lessons of the civil rights movement of the ’50s and ’60s, but in South Africa there’s a chance that justice and equality might actually prevail. Traveling to South Africa reminds me of my obligation to contribute to a more just planet and reinforces my faith in the human spirit.
I’ve been told that during apartheid protests of the pass laws (a system that controlled the movement of black South Africans), black women would gather at transfer stations in townships and sing, over and over, “We are the ones we’ve been waiting for.” A remarkable image: They understood that if apartheid was going to be defeated, they couldn’t wait for some outside force to save them. They had to do the defeating themselves.
On one visit to South Africa in 1996 for an AIDS training, I met Mercy Makhalemele, a tiny fireplug of a woman who was infected by her husband. When he found out that she was HIV positive, he physically attacked her, kicked her out of the house and exposed her to her employer so that she lost her job. She was disgraced; she had the perfect excuse to give up. But she didn’t. She knew that her life and the lives of other South Africans facing these challenges depended on her not giving up. She knew she was the one she’d been waiting for.
South Africa is the revolutionary place of our times. But it’s a fragile revolution. So I come here partly to do my little bit to help it succeed -- to contribute my knowledge about AIDS, to provide moral support and to bear witness. I also come to absorb some of the revolution’s power -- so I can work on keeping our own revolution alive, back in the United States.
Over the years I’ve learned that one of the most transformative things you can do as an HIV positive person is tell your own story. Nowhere is this more true than in South Africa, where the stigma around AIDS is so severe that many HIV positive people live in total isolation, and where the hope you can give as an openly HIV positive person is overwhelming. I remember participating in the first rally by PWAs in Soweto. When it was my turn to speak, I simply told my story, mentioning that I’d been living with HIV for 19 years. Once I said that, there was this rush to the stage -- it happened so quickly that I couldn’t move! So many people wanted to touch or hold me, to gain hope from saying, “I met someone who’s lived with the disease for 19 years.” To them my presence meant that such a thing was possible.
I’m afraid that as the world turns its eye to South Africa during this summer’s International AIDS Conference, they’ll see Durban, this modern city, gussied up in its Sunday best, and they’ll get a false picture of what AIDS is really like in Africa. In the townships, almost every one lives in poverty -- people don’t have indoor plumbing, they have to travel to get water -- and even within that general poverty, there are these cardboard-box cities. Walking through them, you pass structures that look like flea-market stalls, but they aren’t places to buy things; they’re places where people live. In stall after stall, you see children too sick and too weak to bat away the flies. But you also come upon children who have crafted toys out of wire and tin cans and are able to find enough joy that they have astonishingly hopeful faces.
South Africa is physically so beautiful -- and so diverse: amazing mountains; green, green rain forests; gorgeous coastlines, like at the Cape of Good Hope, where the Atlantic and Indian Oceans meet, and you feel like you’re at the end of the world. It’s so rich in agriculture and natural resources, you truly understand that it’s a place worth fighting for.
My many trips to South Africa have taught me that you don’t really know this place until you take in both this majestic beauty and the country’s horrible political legacy -- and still understand its promise. That is the continuing story of South Africa: horror, majesty, but most of all promise.