Soweto Hospital Provides Comprehensive HIV/AIDS Care

Map of Soweto indicating Johnson & Johnson program sites
(click to read insert about Johnson & Johnson program)

People outside of South Africa may not recognize the name Soweto, unless they have seen or heard about the recent Oscar Award-winning film Tsotsi. The movie focuses on a South African gang member living in the township of Soweto, which sits on the southwestern edge of Johannesburg. Soweto was originally created to house black Africans during the white-ruled apartheid era so that they would be close enough to Johannesburg to be used as cheap labor. Townships such as Soweto played an important role during the struggle against the apartheid government, which routinely imprisoned blacks without trial, used torture, and executed men, women, and children.

Presently in South Africa, the mention of Soweto, which covers 150 square kilometers and houses 4.2 million people, summons stories of carjackings, murders, rapes, and other horrendous crimes. The Lonely Planet guide book says, "Caution is needed. The townships are still in a state of acute social trauma, and violent crime is commonplace. Visiting without a companion who has local knowledge is likely to be disastrous." As Sean and I prepared for our journey into Soweto, we came to the realization that it was not even listed on the majority of the maps in our possession. We had to use a computerized map to get directions. Fourteen hours after we had been robbed at knifepoint by a gang of men, we drove into Soweto, a bit apprehensively. However, the Soweto witnessed by the African AIDS Awareness Campaign was not violent and dangerous. Instead, it seemed to be giving life and hope to those devastated by HIV/AIDS.

At the entrance to Soweto, coming from Johannesburg on the N12 highway, one comes immediately face to face with one of the world's largest hospitals, the Chris Hani Baragwanath Hospital (aka Bara Hospital). After passing through a large security gate manned by four guards, the road branches off in numerous directions, leading to various multi-story buildings that deal with ailments ranging from cerebral palsy and psychological problems to digestive ailments and HIV. The vast property contains a wooded area which makes it seem as though you have left the hospital, and on its far side is a whole new set of buildings focused on yet more sicknesses. There are houses, several cafeterias, and even basketball courts. The hospital compound is so overwhelming that we spent 45 minutes searching for the building in which our meeting was to take place.

Our destination was the Perinatal HIV Research Unit (PHRU), one of the largest AIDS research centers in all of Africa. PHRU's early research focused on preventing mother-to-child transmission, but it has now expanded into conducting treatment trials in adults and children, treatment research, prevention research, psychosocial research, policy development, and HIV vaccine clinical trials.

PHRU is located in a multi-story building called the New Nurses Home, which contains a number of different departments housing the various NGOs that work under PHRU. The main clinic is comprised of a reception area, two waiting areas, eleven consulting rooms, one phlebotomy room, three counseling rooms, and a children's play and therapy area. The pediatric section has seven consulting rooms, a phlebotomy room, an immunization room, and two counseling rooms. All examination rooms are equipped with couches and diagnostic and other essential equipment. A fully equipped emergency cart with defibrillator and oxygen is maintained in the clinic, which now logs over five thousand patient visits monthly. The magnitude and professionalism of this unit is striking in contrast to many of sub-Saharan Africa's other health centers.

Sean and Michael with HIVSA facilitator Neo

Under the umbrella of PHRU, a plethora of NGOs are focusing on specific areas of HIV/AIDS prevention and treatment. One such organization is HIV South Africa (HIVSA), which runs a broad range of social support programs primarily for people with HIV/AIDS in the greater Soweto area. HIVSA supplements PHRU's research with psychosocial support programs including HIV education and community support programs.

Neo, a HIVSA support group facilitator who is in his mid-twenties, aided us in exploring the various programs run by HIVSA. We spent three hours with Neo, as he escorted us through the intricate pathways of the New Nurses Home, stopping at each department for a brief overview as provided by the busy workers of the different projects.

We began our tour in Neo's office, where he gave us an overview of some of the services provided by HIVSA. He explained that education is key to the fight against HIV/AIDS. He said that you must "prepare yourself first and know the facts." In order to equip people with the knowledge necessary to prevent the contraction and spread of HIV, HIVSA provides "Info Hours" which are conducted at Bara Hospital by trained facilitators. This is done on a daily basis and community members, irrespective of their HIV status, are encouraged to attend.

In addition to providing information, HIVSA employs cutting-edge, creative therapeutic methods to help clients acknowledge, cope with, treat, and disclose their HIV status. One such program is the Tswelopele Art and Drawing therapy program. This program prepares adults who are HIV-positive (parents, guardians, or caregivers of children who are HIV-positive) to disclose their status to their children and also to inform the children about their own HIV-positive status through art. The process is facilitated by counselors and is geared toward children between eight and thirteen years old. The same counselors also work with another group of HIV-positive guardians/parents who have already disclosed their HIV status in order to learn how they disclosed their statuses to their family members and what sort of reaction they received. This helps the counselors to have a clearer picture of what children understand about being HIV-positive and how best to communicate with them about the disease.

Another project, known as "Memory Box," is done for the purpose of giving people a chance to express their feelings about being HIV-positive or having a loved one who is HIV-positive. Participants produce drawings, make body maps, take video recordings, and select items with special significance for placement in decorated memory boxes. According to Neo, "The Memory Box is meant to reach people on a deeper level." A facilitator begins the exercise by guiding the client through the drafting of letters that are intended to be given to people whom they trust and to whom they would like to reveal their HIV-positive status. This guided writing is carried out in groups of eight to ten people during six weekly sessions. This resulting diary, along with the other contents of the memory box, is shared with others either before or after the client passes away.

Corporate Sponsorship of Palliative Care

Products provided by Johnson & Johnson for the home-based care of the terminally ill

HIVSA has interested corporate sponsor Johnson & Johnson in its growing palliative program. This program is intended to provide hygiene products for those who are terminally ill. Hygiene packs containing Johnson & Johnson products such as soap, shampoo, mouthwash, lotion, Tylenol, and Imodium are distributed by care workers throughout the region.

The program currently serves 3,590 clients in the Soweto area with the help of 507 care workers, and is moving out to rural areas, where it provides for 497 clients. Clients may continue the program as long as they are considered "bedridden" by the care worker. When clients obtain a satisfactory state of health, they are discharged from the program. To date, the program has successfully helped 621 people return to a satisfactory level of health.

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On a more traditional level, HIVSA organizes daily one-hour support groups which are assisted by trained facilitators. Groups discuss issues such as prevention, disclosure of status, discrimination, and anti-retroviral treatment. Neo confessed that the majority of the support group participants are women. He says this is due to "the cultural belief that men have to be strong. Men can be unwilling to discuss their struggles and weakness, especially in the presence of women." To combat this stigma, HIVSA has created Imbizo Men's Health Project, which provides support groups specifically for men, while encouraging men to be more emotionally supportive both as fathers and husbands.

The lack of men involved in co-ed support groups became evident when the African AIDS Awareness Campaign attended a support group session. The group included seven women and one man, along with the male facilitator. The discussion was in Xhosa, a local language, and was later translated for us by Neo. The portion of the session that we observed focused on a thin, frail woman who recently learned that she was HIV-positive. She was probably no older than thirty-five, but could easily have been mistaken for sixty. She was asking for the group's advice on how to disclose her status to her family. Several members of the group recommended that she take her time and first engage in discussions with her family that will educate them about HIV/AIDS before revealing her status.

After the session, Neo commented that the lone man in the group was a very strong man. The man once told him, "Every Thursday I get excited because I know that Friday I'll be with positive people, not HIV-positive, but positive-minded." Neo also said that on another occasion the man discussed how before going to his weekly support group, he chats with his male friends in his neighborhood to get their views on various HIV/AIDS-related issues.

The Perinatal HIV Research Unit is situated on the frontlines of one of the hardest hit areas in the world and appears to be standing strong. Hopefully the efforts of these collaborating organizations can serve as a model for other suffering areas around the globe.

For more information about HIVSA, you can visit their website at  http://www.phru.co.za/hivsa/index.stm.


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