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is an award-winning documentary by Writer-Producer-Director, Louise Hogarththat tells Marion Cloete’s story of personal sacrifice and passionate activism in the face of the tremendoushealth challenges and losses faced by her fellow citizens in South Africa. In 1990 with the help of her husband, Con, and twin daughters, Leigh and Nicole, university-trained therapist Cloete foundedBoikarabelo - a community consisting of an orphanage, school, medical clinic, and organic farm - in aneffort to provide a haven for vulnerable children and AIDS orphans. The AIDS crisis in South Africa hadbeen exacerbated by the government’s denial about the extent and cause of the HIV/AIDS pandemic, butmore recently the government has adopted substantial and realistic policies to prevent the spread of thedisease. The purpose of this supplement is to provide the viewer with some background about South Africaand the AIDS crisis there, as well as to discuss some aspects of the film which may be at variance withcurrent public health thinking.

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Magaliesburg, where Boikarabelo is located, is typical of many black South African communities whosecapacity to respond to the HIV/AIDS crisis has been hampered by the legacies of colonialism, racialsegregation, and poverty. The town is situated at the foot of the Magaliesburg mountain range in the WestRand district of Gauteng province in South Africa. Named after Chief Magali (or Mogale, meaning “braveone”) who lived here during the 19

century, Magaliesburg is part of the greater Johannesburgmetropolitan area of present-day South Africa. Almost 80% of West Rand’s population is black SouthAfrican, speaking various indigenous languages including Setswana, Xhosa, Sesotho, Zulu, and Tsonga.In 1886, following the discovery of gold, white South Africans speaking English and Afrikaans flocked tothe region and settled in Witwatersrand. Often referred to by the Afrikaans term “Rand” after whichSouth African currency is named, Witwatersrand is famous for being the source of about 50% of the goldever mined from the earth. The

Blaauwbank Gold Mine and Museum

near Magaliesburg is a testimony tothis activity. The wealth generated from such mines contributed to the establishment of Johannesburg,

now South Africa’s largest city. The seizure of indigenous land for white use and control of South Africa’svast mineral wealth (including diamonds) through exploitation of black labor were the means by which theminority settlers prospered. Their prosperity was enforced and sustained under a brutal system of political,social, and economic repression against indigenous Africans known as apartheid.

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“Apartheid” is an Afrikaans term meaning “separateness”. It was officially instituted in 1948 to separate thegoverning white minority population from the non-white majority population (classified as Bantu/BlackAfricans; Colored - mixed-descent Africans; and Asians - Indians and Pakistanis), prohibiting social contactbetween the races (including segregated public facilities) and determining where each could live (e.g.“Bantustans” for Blacks), what jobs they could hold, and what type of education each could receive. Anti-apartheid activists (including whites like Marion Cloete who were beneficiaries of this system of whiteprivilege) were considered “communists” under the security legislation enforced by the police state.

The historic Sesotho name for Johannesburg is “Gauteng”- meaning “place of gold”.

Although apartheid officially ended in the 1990s, minority white privilege and affluence remains evident incities like Johannesburg, Durban, Pietermaritzburg, and Cape Town (South Africa’s legislative capital)which have more English speakers; and in the predominantly Afrikaaner areas of Bloemfontein (SouthAfrica’s judicial capital), Pretoria (South Africa’s executive capital), and many of the industrial and miningtowns of the Witwatersrand. The underdeveloped townships and shantytowns on the peripheries of thesecities are still where many black South Africans live (often single black men and the migrant work-force)with long distances to travel to work and shop in the city and, for some, to their families living in ruralareas.

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HIV/AIDS has been labeled “the new apartheid” by Archbishop Desmond Tutu, who was one of the leadingopponents of the apartheid system that brutalized blacks in South Africa. Out of a population of 47 million,some 5.5 million South Africans are HIV-positive, with HIV-related death rates reported to be in excess of 900 per day. Ninety-six percent of people with HIV live in the developing world, mostly in sub-SaharanAfrica where it is projected that by the year 2010, 100 million people will be infected and 40 millionchildren will be orphaned as a result of the virus. Global patterns of poverty and HIV/AIDS follow a 500-year-old pattern of slavery, colonialism and foreign competition for Africa’s wealth, prompting some toblame a system of “global apartheid” for the disproportionate concentration of HIV infection among blackpeople.

Poverty is a cruel reality for the vast majority of HIV-infected people in recently-liberated South Africa,which has among the highest infection rates on the continent. The government-sponsored public healthsector to which they must resort provides little or no access to quality medical care, testing, or medications.This contrasts with the rich and better educated who have access to HIV care and treatments to stayhealthy. Throughout South Africa and the rest of the continent, international and local charities, churchgroups, non-profit organizations, and the business community have been working with limited resources toenhance local community responses to the HIV/AIDS crisis. Their efforts are being felt, but they needmuch more help to turn the tide on this epidemic and its devastating impact, especially on the vulnerable.

Those most vulnerable to acquiring HIV/AIDS are women and children, as revealed in the personaltestimonials from

Lillian, Maki, Betty, Virginia, Tami,

and others showcased in

Angels in the Dust.

Writer-Director-Producer Louise Hogarth met these children at Boikarabelo while conducting her owninvestigations into the prevalence of child rape. In the film, Cloete asserts that child rape occurs in SouthAfrica due to a myth that having sex with a virgin cleanses one of AIDS. Cloete further asserts that this is awidespread practice that has “cost hundreds or thousands of lives,” an opinion that places her at odds withhealth experts such as Dr. Rachel Jewkes, Director of the Medical Research Council’s Gender and HealthResearch Group. Jewkes advises that although some men may act on this myth in South Africa, the"evidence suggests that this is infrequently the case" in child rape.

Those who commit child rape based onthis myth probably do so out of their own desperation for treatment, which is still largely unavailable.

http://www.africaaction.org/resources/globalapartheid.php

The United States government has been the major international contributor to AIDS relief in the world’s fifteen most severely affectedcountries. Almost $400 million was contributed to South Africa AIDS relief in fiscal year 2007.

http://www.aegis.com/news/irin/2002/IR020406.html

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In the film, the children’s stories are compelling. However, the viewer should be cautioned that their plight is not the norm in South Africa.

Lillian

was raped at a young age and has difficulty obtaining her mother’s legally-required consent to be tested for HIV.

Maki

’s poverty led her to prostitution. Theresponsibilities she shoulders within her family often clash with her ability to get an education.

Betty

mostlikely contracted HIV from her ex-boyfriend, whom she hasn’t seen since their unprotected sexualencounter. Condom use would have made a difference.

Virginia

probably

contracted AIDS from having tohave sex with men who paid her mother when she ran a

shebeen.

(Both

Betty

and

Virginia

are onantiretroviral treatment at Boikarabelo.)

Tami

struggled to run the household when his father, mother, andyounger brother died from AIDS. He became his sister’s caretaker until she too died from HIV/AIDS at theage of 9.South Africa’s AIDS-related orphan population was estimated at 1.2 million in 2005, followed by Tanzania,Zimbabwe, and Kenya at 1.1 million, and Uganda, Nigeria, Zambia, DR Congo, and Malawi each reporting1 million or less.

The approach to addressing the problem of AIDS orphans includes the provision of carefor existing orphans; the prevention of new adult HIV infections; and keeping HIV-positive parents alivethrough treatment. On the issue of provision of care, community support is called for in reducing stigmaand discrimination against AIDS orphans while increasing their access to essential care and services such asnutrition, health care, education, and legal and human rights protections.Policy issues surrounding orphan care and custodial responsibility in South Africa are not addressed in

Angels in the Dust,

leaving viewers without an appropriate context for evaluating the film’s dramaticconfrontational scenes between caretakers and parents, in which the children are caught in the middle.Are there community structures or governing protocols that are being enforced or followed here? Expertsadvise that the orphanage

model, which came about through efforts by well-meaning non-governmentalorganizations during the early days of the AIDS orphan crisis, should be the exception rather than the rule- in part because there are cheaper, more effective forms of care when dealing with this large-scaleproblem. From a social standpoint, studies that have been conducted in sub-Saharan Africa demonstratethat family environments in which siblings are not separated benefit the children far more thaninstitutional care facilities, which are recommended only as a temporary option or last resort.

Care of orphans in extended family settings furthermore helps to preserve the fabric of societies which need to beempowered to meet the challenges of the HIV/AIDS pandemic in particular, and more generally those thatcome with poverty and underdevelopment.

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Prevention remains key to South Africa’s fight against HIV/AIDS. The country’s new National StrategicAIDS Plan places greater emphasis on treatment and prevention than in the past, and makes no mention of the dietary recommendations previously cited by the health ministry as a key to fighting AIDS

(which was

A drinking house set up in black townships which, under apartheid, served alcohol illicitly because black Africans could not getlicenses nor enter pubs or bars that were reserved for whites

UNAIDS/WHO (2006, December), AIDS Epidemic Update

http://www.avert.org/aidsorphans.htm

Health Minister, Dr. Manto Tshabalala-Msimang came under heavy criticism from researchers, doctors, and activists (some featured inthe film) for advocating a diet of garlic, beetroot, and olive oil to combat HIV/AIDS