NEW YORK TIMES
November 29, 2001
Rare Condoms, Deadly Odds For Truck-Stop Prostitutes
By DONALD G. MCNEIL JR.
In the 13 years that Thandi has been a prostitute, she has seen a few changes in the attitudes of the truckers at the stop where she works.
''Now maybe 7 men in 10 will agree to use a condom,'' she said. ''When I started, it was 2 in 10.''
She has little power to improve the odds. There is a bouncer in the truck stop's bar and pool hall, but it is not his job to make sure that the men pay the women, let alone practice safe sex.
''If we have made enough money, we try to tell him that he must wear one,'' she said. ''But if we do not, we try to ask him.'' If he still says no? ''I will think twice, and then I will do something with him.''
If she does not, another woman at the truck stop probably will, she said.
At least a third of the adults in rural KwaZulu/Natal Province, which has a population of eight million, have H.I.V. This is the worst infection rate in a country that has more people infected with the virus than any in the world. It is assumed that the disease spread rapidly here because truckers from all over southern Africa pass through on their way to the port at Durban. Conversations with Thandi, who did not want her full name used, and some of the other women waiting for truckers along the roadsides, make it clear how hard it would have been to stem the spread, even if the government had been making a concerted effort -- which it has not.
Thandi was one of 10 sex workers who gathered data at five truck stops for a 1999 study by Dr. Gita Ramjee, a professor at the Medical Research Council, the South African version of the National Institutes of Health.
Thandi, a big woman with a pretty face, purple nails and a sense of dress -- red jacket and jeans -- was chosen because she spoke English well and understood the research protocols. For her help, she earned a salary of about $35 a week; as a sex worker, she said, she can earn up to $65.
Thandi asked clients to fill out a short questionnaire and to spit in a small jar, which she kept on ice for a saliva H.I.V. test.
The 10 women interviewed 320 men. Some asked to be sent their test results, Thandi said, because they had no time to go a doctor. Of those who refused to participate, she said, some had a question that shows how far public education still has to go.
''Why do you want our saliva?'' she said they asked, suspiciously. ''You're going to give it to a nyanga and spell us.''
A nyanga is the Zulu word for what was once called a witch doctor -- a herbalist who casts and removes spells.
The saliva test is not used much in the United States, but it is considered highly reliable by researchers here. The results were shocking. At four truck stops here, 50 to 57 percent of the men were infected. In Newcastle, up the road, 95 percent were.
''We still don't know why Newcastle is so bad,'' Dr. Ramjee said.
About 37 percent of the truckers who filled out questionnaires said they stopped for sex on every trip; 66 percent said that they had shown symptoms of a sexually transmitted disease in the last six months. Only 47 percent said they always used condoms with prostitutes; 29 percent said they never did. Only 13 percent said they had ever used condoms with their wives. Anal sex was practiced by 42 percent; of those, only 23 percent said they used condoms.
Anal sex and venereal disease sores make transmission of the H.I.V. virus much easier, but it is very hard for sex workers to protect themselves. In 1987, when Thandi started working as a prostitute -- she was unemployed and the mother of twins -- the term ''AIDS'' was practically unknown in South Africa, but she still feared syphilis and gonorrhea.
Back then she judged a man's riskiness by determining ''if he was clean, if he liked water,'' she said. ''If he was dirty, if he smelled, it was difficult to trust him.''
Asked if she could demand to see if he had sores, she blushed and said, ''No, according to our Zulu culture, it's such an embarrassing thing to see a man's private parts.''
Her only weapon was persuasion -- she would tell a prospective client she might be sick, or he might be.
''Sometimes he would say, ''You are lying, you look healthy -- come, let's do it, and I will pay you,' '' she said. Sometimes if she requested that he use a condom, she said, ''They would say, 'You are following the white rules to reduce the number of children.' ''
Sometimes a man would use one, but then refuse to pay her, or pay only $4 instead of the usual $6.
Nowadays, she said, more men are changing their minds because they have seen people dying.
In 1994, she said, health workers began coming to the truck stop, counseling women and leaving condoms. One good result, she said, was that most of the women stopped using ''chemicals to tighten ourselves'' -- she mentioned Dettol and Savlon -- common antiseptics used to clean wounds, and other household products. Some African men insist on women providing them with what they call ''dry sex,'' and Zulu healers sell desiccating herbs for that purpose. AIDS specialists say the practice can result in vaginal tears that help transmit the virus.
In 1994, Thandi also took an AIDS test, and learned that she was H.I.V.-positive. She treats herself with herbal medicine and a cheap commercial pill called Moducare, made from potatoes, which some doctors say strengthen immune systems.
Still, she developed shingles, which is sometimes a sign of the onset of AIDS.
Asked about her future, her eyes filled with tears. ''I think that I will die so soon,'' she said. ''It's over now.''
It is unclear whether the few women who sell sex in Mtubatuba, a sugar-producing town in the Hlabisa Health District have more hope or are better at deluding themselves.
Nosipho and Phindile , make most of their meager incomes selling bottled beer at the town's minibus-taxi station. They have no other home; they sleep under their counter top, and on cold nights they build fires on the asphalt.
But they will also go into the bushes if a man pays; they say they charge soldiers $25 and other men $6.
They claim that all their customers agree to use condoms. ''If they refuse, I say, 'No, you can't get me,' '' Phindile insisted. But ''other girls,'' she said, were willing to have sex without one for $30.
Nosipho , and Phindile live and work a block from the town's clinic, which provides free condoms. If a man wants to use his own, Nosipho said, ''He must bring it sealed and open it in front of me.'' Some men, she said, poke holes in their own condoms to trick her.
Asked why a man would do something so foolish, she shrugged. ''They want to use their own body,'' she said.
Both women claim they have had multiple H.I.V. tests, all negative.
Another woman, Faith, also says she ''is confident'' that she is H.I.V.-negative, having taken a test three years ago. She has her own home on a dirt road outside town. She has worked as a prostitute at the Lido, a Durban club popular with sailors, where she earned $50 per half hour, and the owner enforced safe-sex rules and held staff meetings about AIDS.
Tall and bold, with gold chains and gold front teeth, Faith said, ''No man gives me trouble about condoms.''
''If a man doesn't want to use one, I say he can't sleep with me,'' she added.
''I don't care how much he wants to give me. Life is more important than money.''