Thursday, October 30, 2008

The Condom Fairy...

They generally accept the condoms I offer them in the waiting area of the clinic, wrapped in packets of 12 (no baker’s dozen here.. despite being used to prevent not only STI’s but also to avoid a bun in the oven) in the news of the past weeks (it takes a while for printed news to arrive in Seronga). It’s mostly women at the clinic, occasionally for themselves but mostly for their children of which it’s common to see one in the belly, one on the back and one at their heel.

Some reach out and grab one or two packets from the boxful I carry, eager to get their hands on the thing that may stave off the virus that is slowly killing their village, their country, their continent. Some grab them as a statement to others, much in the vein of “setting a good example”, or to take advantage of something, anything being given to them by a white person. Others giggle bashfully, reluctant to admit that they may be having sex despite the bulge in their middle. Some are hesitant to accept them, not immediately understanding my strange accent exclaiming “dikondom” (the Setswana plural for condom) in a language that still may not even be their own. Some defer, as they have a small baby in their arms and by traditional custom are not supposed to be having intercourse until their child is of a certain age. I offer them some to “give to their friends”. They usually take them.

I have made tentative friends (although my white presence can never truly be trusted at face value; especially not as I hawk the implements for sexual activity- safe or otherwise) with the women who run (although not own) the businesses of this village. I have attempted to make a habit of taking up what Kagiso left off, encouraging the women to come to the clinic to get boxes to have available at their shops. They keep returning for more boxes, claiming at least to have run out.

My colleagues at the clinic seem to think my increased emphasis on condom distribution is ridiculous, standing by their belief that the people of the village are not actually using them. To this I innocently ask, “Well whatever are they using them for after they take them?” while readying my logic for an endless battle of reasoning and theorizing that may never get through to my coworkers. They seem to think that people are using them to decorate their houses or their health cards, or blow them up for their children as balloons, or worst of all, leaving them lying around. I demand to be shown these alleged atrocities, quite certain it’s not happening, and they laugh and shake their heads knowingly- silly Lorato…I respond, slightly irritated, that perhaps what they say is true, and is happening, but if of every 1,000 condoms distributed 1 box (100 condoms) are misused, that is still 900 that are potentially used correctly and are preventing HIV. My math does not impress them. Trying to convince a rural area with limited resources that some condoms may go to waste in order for some to be used is unfathomable.

My counterpart still doesn’t understand why condom distribution should be part of his job. I try again to lead him down the long path of explanations as to how it is relevant to his job as the PMTCT lay counselor. I establish that it is indeed his job to try to lower the number of HIV + women who become pregnant, and to encourage people to be tested and know their status. We get lost around the bend of trying to make his job of testing easier by helping to prevent people from having unprotected sex in the first place, with the main avenue of this being increased condom use.

I try to explain that at least when people have easier access to condoms, if they can grab them when they stop at the co-op or the bottle store as they are out doing other errands; at least they have less chance of forgetting them. Easy access means at least they’ll have them. What happens after that point is anyone’s guess.

Maybe a woman takes some condoms, holding them in a secret place, hoping for the courage to bring up the topic of safe sex to her husband, who may very well beat her for insinuating that one of them can’t be trusted or is sleeping around. Perhaps the woman with three children under five will wearily say “enough” and demand her husband use them so as to avoid yet another pregnancy. And perhaps that husband will leave her, easy enough to do in the land of lebolla and common law marriages and small houses, to sleep with someone more willing to have sex without one of those “wrappers”. Maybe the woman who is HIV+ will mention the idea of using a condom to the man who is paying her for sex, but doesn’t really press the issue, as he will pay more for sex without one. Perhaps a man knows that his small house is HIV+ and is attempting to protect his wife, but is unable to admit to her that he’s been with someone else and cannot bring up the topic of condom use. Maybe having condoms in hand could change the fate of these people, perhaps they’ll use them to protect themselves and live happily HIV free ever after.

I’ll never know which of these scenarios plays out, if all of them or none at all actually occur. They are all equally likely. I’m increasingly realizing the futility of changing the outlook of the entire village on sexual health, but I know that one of the keys to changing behavior is having the means to make a change. I have a hard time trying to press the Abstain, and Be Faithful elements of the ABC trinity of HIV prevention- to convince them of the virtues of monogamy when I know of no one whom has successfully lived the tenants of this theory. It’s a hard pill to swallow, much less distribute in this small rural village, I a culture that doesn’t necessarily seem up for it. Which battles am I choosing here? What are my best chances to make a difference?I choose to be the condom fairy, and hope that like all things magical in the mind of a child, it works.

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