It is the middle of a summer morning deep in the KwaZulu-Natal countryside, and the heat is intense. Beside the road that leads to Durban, 60 kilometres away, stands a sprawling acacia tree. Beneath it, women and children are gathering.
'We walked since before five to get here.' says Sabahle, 34, who has come with her sister and her young niece. 'It is a long way. We don't have money to take a bus.'
Sabahle and her family are just a few of the hundreds of women who come every month to the Tree Clinic, which meets beneath the acacia and distributes medicine, contraceptives, advice and information to women from rural communities. On this particular Wednesday, there are perhaps seventy attendees. Some, like Sabahle, have brought young children. Others have come in large, chattering groups. Gathered beneath the sparse shade of the tree, they create a rootless but deeply connected community, all bound by the fact that here, their voices will be heard.
In KwaZulu-Natal, more than sixty percent of the population live in poverty, with inadequate access to food, clean water, education and healthcare. The provincial HIV infection rate, at 39%, is the highest in South Africa. The relationship between these statistics is no coincidence; in this community, poverty and HIV go hand in hand.
International HIV and AIDS charity AVERT reports that there is an 'evident link' between the socio-economic background of a person, and the likelihood that they will take an HIV test. The report states that 'those who have taken an HIV test and know their result are more likely to have a higher level of education, be in employment, and have accurate HIV knowledge than those who don't.'. People who live in poor and rural areas are half as likely to be tested for HIV as those who live in wealthier provinces.
In South Africa, real work is being done to combat the epidemic. The HIV Testing and Counselling (HTC) Campaign, launched by the State Health Department in April 2010, aims to improve awareness of HIV and encourage discussion of the disease and through the use of television and radio. They want to reach fifty percent of South Africa's population with the campaign, and research has shown a positive impact on those who have heard the message.
South Africa also has the world's largest anti-retroviral programme; according to the 2009 UNAIDS progress report, forty percent of adults and ten percent of children needing treatment for HIV are enrolled in anti-retroviral therapy. Ninety percent of public health facilities now offer voluntary counselling and testing services. President Jacob Zuma has committed himself to improving access to treatment, and education about HIV.
But this work, while positive and necessary, is failing to reach those most in need of help. According to Grace, who has been running the Tree Clinic for three years, the people she meets have different needs and different problems.
'It is good that there are stories on the television and the radio, but what about the people who don't have those things? The women I speak to live in villages where there is only electricity if they steal it. They don't have radios. They don't hear that they can get free testing.'
Lack of education is not the only concern Grace sees. The women who come to the Tree Clinic travel for hours on foot because, once there, they will receive food and medicine. Volunteer nurses will check their children for signs of illness. Medication, vitamins, soap and clothing – things they cannot otherwise afford – are given out. Sabahle is making peanut butter sandwiches that will be handed out at lunchtime. She shoos away her niece, who leaves to play with the other children who have come.
'In my village, when you have HIV it is hard to tell anybody.' She says. 'People will call you "Living Dead" and not talk to you. Nobody has time to go to hospital and take medicine, or people in the village ask why you are not working. It is very hard. To get anywhere takes time and money. We don't have those things.'
HIV treatment is time-sensitive and ever-present. It requires multiple drugs to be taken at specific times. It requires a nutritious diet and a healthy lifestyle. If medication is interrupted or abandoned, the disease becomes resistant and new combinations of drugs must be found. Regression can happen quickly.
'Why do you think we make sandwiches?' asks Grace. 'Nobody has enough food. Nobody wears a watch. They don't know what time to take their medicine. They don't have time to go to hospital. They are scared that people will find out. There are good drugs and there is good help, but not for these people.'
Her message is clear; without addressing the fundamental problem of poverty, South Africa cannot hope to overcome the HIV epidemic. The work done by the Tree Clinic is, she says, a call to arms.
'Things have to change. If the government wants to stop AIDS, it will have to stop poverty first. It is the only way.'