Loving a Man with HIV. 23/8/10
"Please don't leave me. I've tested positive.”
On his 35th birthday Wynand Griesel*, inebriated from one too many celebratory drinks, got behind the wheel of his car. For the first few hours of what should have been a happy birthday, he ended up behind bars in Sea Point police station.
Standing in his cell, the only thing he could think about was how he could get off the hook.
Outside dawn was breaking. On the cell wall, he could just make out "Nice to kill'', scratched into the powder-blue paint with a fingernail. "Next time, think,'' someone had written centimetres away, while a faint message on the opposite wall read: "My wish was to be happy and try to start over''.
Seeking sanctuary in a holding cell
While Wynand tried to keep his mind occupied, his partner Neil Strydom (42)*, was locked in another holding cell, desperately trying not to lose his mind and to live through the pain.
"Time heals,'' was just visible to Neil, scratched into the wall before him. He kept repeating it while seven co-detainees took turns raping him.
The situation in the country’s prisons and holding cells are a direct public health issue, experts have warned. In its latest report, the organisation Just Detention International paints a gloomy picture, saying the way people are detained has a direct link to the country’s HIV epidemic.
The HIV-prevalence in South African jails and holding cells is twice that of the infection in the general public. By not preventing sexual violence amongst detainees, the government is sentencing people to the lifelong management of a disease, before they have even been found guilty of anything.
Neil was locked up an hour after Wynand. For "interfering" with a peace officer. To calm him down after Wynand's arrest. To shut him up.
"Jou mond is mos lekker los. You've got a big mouth. Let's see what happens to someone like you. We'll speak tomorrow,'' the policemen told him.
As soon as he entered the cell, he knew he was in trouble. He could smell it in the damp and the detainees’ sweat.
A night full of pain
The police had removed his belt and rings, but he still had a silver bracelet. The police hadn’t spotted it, but one of the men in the cell did
"If you give it to me, I’ll protect you," the faceless voice whispered, when the door had clanged the cell into darkness. Neil handed it over.
"We are going to f*** you till you bleed,'' one of the other detainees growled. Someone grabbed his arms and ripped at his clothes.
"Don’t fight.’’ There was no chance of that. His 42-year-old, 60kg body was no match for the men. They took turns ripping him open. He stopped counting after the seventh man took over. He tried to focus on something else, but he felt the blood trickling down his leg.
He screamed, but no-one came. A policeman later joked that if they had to open a cell every time someone screamed, they wouldn’t get any sleep.
Finding out you’re positive
Rain drops trickled down the pub's window. More than three months had passed. Wynand had been waiting patiently for almost an hour for Neil to open up and tell him the result of the test. He had gone to the doctor on his own without letting Wynand know.
Neil drained his third Castle draft and stretched his hand across the bar to touch Wynand's. The waves crashed onto the Bantry Bay rocks throw up wisps of foam. The sky was steely grey.
"I'm sorry, so sorry. Forgive me,'' Neil broke the silence at last. "Please don't leave me. I've tested positive.”
After a couple of drinks they walked home, Wynand’s arm hooked through Neil’s. It smelt clean, with the rain pouring down. Every time Wynand tried to speak, Neil's face became a mask of agony.
Wynand was crying, but no-one would notice – his face awash with early spring rain. At their flat in Victoria Road he had to carry Neil up the stairs.
"Will you ever touch me again?'' Neil asked. "I don't want to infect you.''
"I won't leave you. Just give me a chance.''
Pulling Neil towards him, trying to envelope him, Wynand added: "I wish I could have protected you. I wish I had been there.''
The meeting of the lovers
They had met at a crossroads in both their lives. Neil was still coming to terms with his dad's death from a heart attack. And he had just lost his job, after the owner of his interior design company died of cancer. He was a white, middle-aged man without a job in South Africa.
Wynand was coming to terms with his sexuality. They met in Manhattans, a gay-friendly bar and restaurant in De Waterkant, the “pink village”.
Wynand did everything possible to resist being drawn deeper into a serious relationship with Neil. But Neil made him feel that he'd been missing out on something. He'd been missing out on his second half.
After the test, Wynand watched for signs of the virus breaking down his lover’s body. But all he wanted to see was the smile, and that returned a little more slowly.
Neil noticed that he looked 'hollowed out’. His body reminded him of death, he said. But it made it easier to know that Wynand loved him.
His feet hurt. They couldn’t go on hiking trips, as they’d done before. It was too painful.
Peripheral neuropathy made his feet, hands and back to go into spasms. The human immunodeficiency virus (HIV), which causes Aids, causes extensive damage to the central and peripheral nervous systems.
A rapidly progressive, painful polyneuropathy affecting the feet and hands is often the first clinically apparent sign of HIV infection. The pain never goes away.
After work, it became a ritual. Neil would take his socks off and Wynand massaged each toe, the bridge of each foot, each heel.
Eating was hard labour to Neil. Once he started ARVs, his appetite became almost non-existent. Wynand kept his bedside table stocked with tempting snacks: nuts, biltong and his favourite soul food, Chipniks.
Safe sex was always an obsession to Wynand. Twice a year he went for an HIV test.
One of the first things Neil noticed about Wynand, when he paid for a meal, was the free clinic visitor’s card in Wynand's wallet.
Sleeping with the enemy
Until Neil's test result, Wynand had never been close to anyone with the virus. Now he was sleeping with the enemy - and he’d never been happier.
The love was more than the fear. But he still got tested every six months – just to make 100% sure.
Every night before getting into bed, Neil sorts four types of medicine into two small heaps of pills -one for tonight and one for tomorrow morning. One Combivir tablet in each pile. One Virimune in each. That takes care of the virus.
Half an Epilim 500, an anti psychotic, tonight. The other half tomorrow. And a yellow and white Venlor XR 150mg in the morning. An anti-depressant. There are side effects: he lost his appetite, lost 10kg in two years, has constant headaches and feels drained and tired.
Sometimes Neil wonders why he keeps on taking the medicine. Then he repeats his mantra to himself: "You don't want to die. You don’t want to die.''
* Pseudonyms used
Treatment: the earlier the better.
HIV treatment starts too late, was the overriding message at this year's International Aids Society (IAS)’s conference in Cape Town. The South African government’s policy until now has been to only provide free ARV treatment to patients with a CD4 count lower than 200.
"There are cases where the immune system at a CD4 count of 350 are already compromised and the possibility of opportunistic infections become much more likely," said Professor Prashini Moodley, head of the Department Infection Prevention and Control at the University of KwaZulu-Natal.
"HIV drives TB."
Neil was lucky. After he tested positive he was put on ARVs straight away. Would he still be as healthy as he is now if his doctors waited for his CD4 count to drop below 200? Would his partner still be HIV negative if treatment was postponed until he was at death’s door?
"Treatment saves lives and puts people back to work and makes them productive as soon as possible," says Julio Montaner, director of the IAS.
"The use of ARVs inhibit HIV transmission. For discordant sexual partners with a different HIV status it is important to start the treatment way above a CD4 count of 350 to keep the HIV negative partner virus free."
In 1996 the IAS issued treatment guidelines recommending combination therapy containing three or more antiretrovirals. This type of regimen called highly active antiretroviral therapy, or HAART.
Multiple drugs given concurrently were more effective, however this increases the potential for side effects. That is why clinicians were reluctant to start throwing handfuls of pills at people living with HIV.