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HIV/AIDS & HCV
Written by Veronique Faure   

South Africa
what connection between drug addiction and AIDS
Veronique Faure
Research Fellow Centre d'étude d'Afrique noire
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The AIDS pandemic is spreading across South Africa with frightening speed, mainly via the sexual transmission pathway. The wave of violence which has engulfed the country does not facilitate preventive efforts. In addition, although the drug injection rates are still fairly low, they are increasing steadily.

Black South Africans generally hold AIDS like cancer, to be a shameful disease which should not be spoken about.

One of the starting points for studying the connection between drug addiction and AIDS in South Africa is how drug addiction links up with violence in African cultures, where the use of psychotropic substances* was traditionally the prerogative of the sages and elders.

The distinction should be made here between the long-used traditional drugs, which are usually less expensive and locally produced, and the latest drugs, which are harder, more expensive and imported.

The country is a major producer of hashish, which goes under the various names of dag, ganga, DP (which stands for Durban Poison) or grass. During the apartheid years, the National Party government, which was conservative, Christian and racist, was obsessed by the idea of guilt and deviance from Biblical teaching and Christian morality. Hand in hand with institutionalised racial segregation and the economic exploitation of the black work force, officials saw to it that dagga consumers were severely punished. Young white draftees in the army were also expected to confess their drug addiction, if any.

Gradually, the use of dagga spread to younger people, whatever their class and colour. The trade and consumption of drugs are still illegal, in spite of requests that the Rastafarian community has submitted to Parliament in the name of religious freedom, which is mentioned in the new 1994 constitution.

The abuse of alcohol is taking its toll at all social and professional levels, especially the poorest ones. In some remote townships and villages in the former Bantoustans (1), many people go to sleep drunk, after binges of debauchery and/or violence. Alcoholism also greatly affects women and younger people. Incidents involving adulterated alcohol made with battery acid and other toxic waste are frequent and cause several hundred deaths every year. Among the wealthier sectors of the population and in highly selective night-club circles, recreational drug use has boomed since the mid-1990s. But this has not led to any real violence among users. On the streets, however, the dealers belong to highly organised Mafia networks and fiercely defend their market prerogatives. This extremely lucrative trade is connected to organized crime, criminal networks and international trafficking. Illegal trading, procuring, rivalry between crime gangs are common occurrences. Since the end of apartheid and the opening of the country's borders, these practices have gained even greater impetus.

The conclusions of published reports are quite clear, however: the South African consumers are often keen to try the latest drugs, but they do not usually practice intravenous injection.

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AIDS AND OTHER TABOOS

Like cancer, tuberculosis and STDs, black South Africans feel AIDS is a shameful disease which should not be spoken about, or which should be referred to only in euphemistic terms: "He has got the four letters", for example. The causes of death are never openly explained, or only explained in terms of fate or an evil spell. Sexual and religious taboos, as well as some cultural practices, form a thick screen which the message sent out by prevention and awareness campaigns has no chance of getting through.

AIDS is regarded as a women's disease. Polygamy means that wives are not allowed to refuse to have sex with their husbands, or to ask them questions about their sexual habits. Dry sex (2) and other social sexual habits mean that women are still sex objects. In some neighbourhoods, tests have shown that 30% of all the 17-year old girls are HIV positive. The myth according to which having sex with a virgin cures illness is difficult to dispel and results in many victims among young girls and adolescents.

The decades of apartheid that followed centuries of colonisation and violent exclusion have left deep scars on every level of society.

A culture of violence cannot simply give way overnight to peaceful negotiations for sharing power and resources. Urban and rural crime, which once had political roots, became more of an economic issue as from the mid1990s. This is what has often been referred to as the paradox of the end of apartheid. Rivalries have grown sharper and security problems are on the rise. Xenophobia and suspicion are not decreasing in the least. It has been estimated that 20,000 murders are committed every year and one rape occurs every 28 seconds. Locally-produced or imported drug trafficking, like procuring (prostitutes are legion in a country where 45% of the black African population are unemployed), are much sought-after sources of easy income involving only minimum legal risks.

The AIDS pandemic* increases risk-taking behaviour, however. People with the HIV virus or AIDS will tend to be more depressed and more prone to erratic or desperate behaviour. If they go in for prostitution, there is a risk of contaminating customers, if the latter are not already ill themselves.

FROM HEROIN TO CRACK

Drug injection practices are still quite rare in Africa. They occur mainly in the homosexual community, where ' there is a heroin* tradition, but these practices have not really gained much momentum in comparison with other countries. They seem in fact to be levelling off as the result of heightened awareness of the risks involved. On the other hand, South Africa, where the heroin market is very limited, serves as a point of transit for the traffic between Thailand and the United States. Since 1995, the demand for cocaine, and particularly for crack, has been spreading from the Johannesburg neighbourhoods known as Little Lagos because of the number of Nigerian dealers who work there.

Crack is associated in this area with the highest addiction rate of all known narcotic substances, and destroys both families and entire social structures.

PROSTITUTES RUN HIGH RISKS

Female and male prostitution often go hand in hand with taking crack, which tends increasingly to replace mandrax (or "wheel caps", which cost 30 rands a pill). Crack triggers violent behaviour, even during sex, which promotes the propagation of viruses that are transmitted either sexually or via the blood.

After being first introduced into the country in 1994 by the Nigerian immigrants (3), crack is now spreading fast through the underworld of prostitution. To such an extent that according to studies carried out among prostitutes, the price of one dose of crack (50 rands) has become the prostitutes' basic rate in the red-light districts (which means that the rates have actually gone down). 50 rands is the price of one night in the cheapest hotel room, and some prostitutes prefer one last dose to having a roof over their heads for the night. Prostitutes "hooked" on crack take less money and cannot afford to be too fussy about using condoms if they want to keep their customers. Competition is tough and prostitutes who are not on drugs are also obliged to decrease their prices. Lowering the prices means that the prostitutes have to take on more customers.

A United Nations Development Program report in 1998 confirmed that "drug injection seems to be limited in South Africa, and sharing infected needles does not appear to be a significant cause of transmission of the AIDS virus". In the study previously published by Carelse in 1994, intravenous use was rated at 5.4%. This figure is relatively low, but it is probably nevertheless liable to change, since the young people questioned were only between 12 and 18 years of age.

It is therefore not unreasonable to predict that intravenous drug addiction may well increase in the years to come, especially among the most vulnerable members of the population, namely the unemployed and/or delinquent youths and prostitutes. Whatever the case may be, AIDS has already taken a considerable toll, since sexual transmission is incomparably more deadly than taking heroin. In 2005, AIDS will kill 600,000 people before the year is out, unless a cure has been found by then.

1 Land that was arbitrarily allocated to black people during apartheid.

2 The vagina must be as tight and as dry as possible to provide the male partner with maximum pleasure. Women therefore use abrasive products, including chemical detergents, which make the mucous linings of the vagina extremely susceptible to infection with the virus. (See the research carried out by the anthropologist S. LeclercMadlala, University of Natal, Durban, 2000).

3 The first Nigerian cocaine trafficker was tried in South Africa in 1992; six years later, Nigerians accounted for two thirds of the illegal immigrants in South Africa's penitentiaries.