Angells iin tthe Dustt is an award-winning documentary by Writer-Producer-Director, Louise Hogarth Ange s n he Dus

that tells Marion Cloete’s story of personal sacrifice and passionate activism in the face of the tremendous health 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 founded Boikarabelo - a community consisting of an orphanage, school, medical clinic, and organic farm - in an effort to provide a haven for vulnerable children and AIDS orphans. The AIDS crisis in South Africa had been exacerbated by the government’s denial about the extent and cause of the HIV/AIDS pandemic, but more recently the government has adopted substantial and realistic policies to prevent the spread of the disease. The purpose of this supplement is to provide the viewer with some background about South Africa and the AIDS crisis there, as well as to discuss some aspects of the film which may be at variance with current public health thinking.

The Regiion The Reg on
Magaliesburg, where Boikarabelo is located, is typical of many black South African communities whose capacity to respond to the HIV/AIDS crisis has been hampered by the legacies of colonialism, racial segregation, and poverty. The town is situated at the foot of the Magaliesburg mountain range in the West Rand district of Gauteng province in South Africa. Named after Chief Magali (or Mogale, meaning “brave one”) who lived here during the 19th century, Magaliesburg is part of the greater Johannesburg metropolitan area of present-day South Africa. Almost 80% of West Rand’s population is black South African, 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 to the region and settled in Witwatersrand. Often referred to by the Afrikaans term “Rand” after which South African currency is named, Witwatersrand is famous for being the source of about 50% of the gold ever mined from the earth. The Blaauwbank Gold Mine and Museum near Magaliesburg is a testimony to this activity. The wealth generated from such mines contributed to the establishment of Johannesburg,1 now South Africa’s largest city. The seizure of indigenous land for white use and control of South Africa’s vast mineral wealth (including diamonds) through exploitation of black labor were the means by which the minority settlers prospered. Their prosperity was enforced and sustained under a brutal system of political, social, and economic repression against indigenous Africans known as apartheid.

Aparttheiid Apar he d
“Apartheid” is an Afrikaans term meaning “separateness”. It was officially instituted in 1948 to separate the governing white minority population from the non-white majority population (classified as Bantu/Black Africans; Colored - mixed-descent Africans; and Asians - Indians and Pakistanis), prohibiting social contact between 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. Antiapartheid activists (including whites like Marion Cloete who were beneficiaries of this system of white privilege) were considered “communists” under the security legislation enforced by the police state.

1

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 in cities 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 (South Africa’s judicial capital), Pretoria (South Africa’s executive capital), and many of the industrial and mining towns of the Witwatersrand. The underdeveloped townships and shantytowns on the peripheries of these cities 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 rural areas.

HIIV//AIIDS iin Soutth Affriica H V A DS n Sou h A r ca
HIV/AIDS has been labeled “the new apartheid” by Archbishop Desmond Tutu, who was one of the leading opponents 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-Saharan Africa where it is projected that by the year 2010, 100 million people will be infected and 40 million children will be orphaned as a result of the virus. Global patterns of poverty and HIV/AIDS follow a 500year-old pattern of slavery, colonialism and foreign competition for Africa’s wealth, prompting some to blame a system of “global apartheid” for the disproportionate concentration of HIV infection among black people.2 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 health sector 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 stay healthy. Throughout South Africa and the rest of the continent, international and local charities, church groups, non-profit organizations, and the business community have been working with limited resources to enhance local community responses to the HIV/AIDS crisis. Their efforts are being felt, but they need much more help to turn the tide on this epidemic and its devastating impact, especially on the vulnerable.3 Those most vulnerable to acquiring HIV/AIDS are women and children, as revealed in the personal testimonials from Lillian, Maki, Betty, Virginia, Tami, and others showcased in Angels in the Dust. WriterDirector-Producer Louise Hogarth met these children at Boikarabelo while conducting her own investigations into the prevalence of child rape. In the film, Cloete asserts that child rape occurs in South Africa due to a myth that having sex with a virgin cleanses one of AIDS. Cloete further asserts that this is a widespread practice that has “cost hundreds or thousands of lives,” an opinion that places her at odds with health experts such as Dr. Rachel Jewkes, Director of the Medical Research Council’s Gender and Health Research 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.4 Those who commit child rape based on this myth probably do so out of their own desperation for treatment, which is still largely unavailable.

2 3

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 affected countries. Almost $400 million was contributed to South Africa AIDS relief in fiscal year 2007. 4 http://www.aegis.com/news/irin/2002/IR020406.html

Orphans Orphans
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. The responsibilities she shoulders within her family often clash with her ability to get an education. Betty most likely contracted HIV from her ex-boyfriend, whom she hasn’t seen since their unprotected sexual encounter. Condom use would have made a difference. Virginia probably contracted AIDS from having to have sex with men who paid her mother when she ran a shebeen.5 (Both Betty and Virginia are on antiretroviral treatment at Boikarabelo.) Tami struggled to run the household when his father, mother, and younger brother died from AIDS. He became his sister’s caretaker until she too died from HIV/AIDS at the age 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 reporting 1 million or less.6 The approach to addressing the problem of AIDS orphans includes the provision of care for existing orphans; the prevention of new adult HIV infections; and keeping HIV-positive parents alive through treatment. On the issue of provision of care, community support is called for in reducing stigma and discrimination against AIDS orphans while increasing their access to essential care and services such as nutrition, 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 dramatic confrontational 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? Experts advise that the orphanage model, which came about through efforts by well-meaning non-governmental organizations 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-scale problem. From a social standpoint, studies that have been conducted in sub-Saharan Africa demonstrate that family environments in which siblings are not separated benefit the children far more than institutional care facilities, which are recommended only as a temporary option or last resort.7 Care of orphans in extended family settings furthermore helps to preserve the fabric of societies which need to be empowered to meet the challenges of the HIV/AIDS pandemic in particular, and more generally those that come with poverty and underdevelopment.

Polliicy P o cy
Prevention remains key to South Africa’s fight against HIV/AIDS. The country’s new National Strategic AIDS 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 AIDS8 (which was
5

A drinking house set up in black townships which, under apartheid, served alcohol illicitly because black Africans could not get licenses nor enter pubs or bars that were reserved for whites 6 UNAIDS/WHO (2006, December), AIDS Epidemic Update 7 http://www.avert.org/aidsorphans.htm 8 Health Minister, Dr. Manto Tshabalala-Msimang came under heavy criticism from researchers, doctors, and activists (some featured in the film) for advocating a diet of garlic, beetroot, and olive oil to combat HIV/AIDS

referenced in the film). South Africa’s AIDS plan focuses on the 15-24 year-old age group; addresses the prevention of mother-to-child-transmission rates for children under five by providing antiretroviral therapy for HIV-positive pregnant women; and offers a strategy to expand community-home-based care and palliative care programs for orphans and vulnerable children. The immediate determinant of the spread of HIV is acknowledged to be behavioral (e.g. unprotected sex / multiple sex partners) or biological (e.g. sexually transmitted infections). However, the “fundamental drivers” of the epidemic in South Africa “are the more deep-rooted institutional problems of poverty, underdevelopment and the low status of women, including gender-based violence, in society.”9 The US Secretary of Health and Human Services, Mike Leavitt, praised South Africa’s new National AIDS Plan in August, 2007. Lastly, while Angels in the Dust depicts the dedication of the Cloetes to assisting HIV-affected people in South Africa, it is important for viewers to remember that many South Africans across racial, economic, gender and age demographics have been involved in these kinds of endeavors. Black, colored and Asian South Africans have been notable in advocating for AIDS prophylaxis for rape survivors, condom promotion, universal treatment of people living with AIDS, and a reduction of AIDS stigma. While South Africa has an extremely serious AIDS problem, many ordinary citizens from all walks of life are trying to ameliorate the situation of victims of this pandemic, such as these orphans.

Resources for further HIV/AIDS information and involvement:
• Participant Productions - http://www.participate.net/ • Boikarabelo - http://www.boikarabelo.org/ • AIDS Healthcare Foundation - http://www.aidshealth.org/nh/index.html • Treatment Action Campaign (TAC) - http://www.tac.org.za/ • Africa Action - http://www.africaaction.org/index.php • KNOW HIV/AIDS. The “Get Involved” section of this website has links to advocacy organizations and ways to become involved in your own community - http://www.knowhivaids.org/get_index.html • AVERT (AVERTing HIV and AIDS) - http://www.avert.org/ • UNAIDS (Joint United Nations Programme on HIV/AIDS) - http://www.unaids.org/en/ • Black AIDS Institute - http://blackaids.org/ • Africare - http://www.africare.org/aids/aids.html • Doctors Without Borders/Medecins Sans Frontieres - http://www.doctorswithoutborders.org/news/hivaids/index.cfm • President’s Emergency Plan For AIDS Relief (PEPFAR) - http://www.pepfar.gov/

Angels in the Dust Educational Supplement - written by Malaika Mutere, Ph. D.
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http://www.southafrica.info/ess_info/sa_glance/health/aidsplan.htm

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