AIDS in South Africa.

DATE May 11, 2000 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Charlene Smith, freelance journalist, discusses her
rape experience and the need to end discrimination in South Africa
when dispensing AIDS drugs
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

One year ago South African journalist Charlene Smith wrote an article which
began like this: `Every 26 seconds in South Africa, a woman gets raped. It
was my turn last Thursday night. Before I began writing this, I took AZT, 3TC
and Crixivan. They are antiretroviral drugs. They will hopefully help lessen
the potential of my getting AIDS from the rapist, assuming, of course, that he
is HIV-positive. In a country where 1,800 people contract HIV every day, it's
a gamble I refuse to take.'

Smith's article in the South African paper, the Mail & Guardian, made quite an
impact. It helped inspire a movement that she is quite active in to reform
how the country's legal and health-care systems treat rape victims. I asked
Charlene Smith how aware she was of her risks of being raped and what
precautions she took before she was attacked.

Ms. CHARLENE SMITH: I had a friend that I went to school with. He was
always frightened that you'd be raped at some stage in your life, but
foolishly I thought that I didn't fit the profile of what a woman raped would
be like. I'm not entirely certain what I thought that profile was. I thought
that I was successful and very independent, very together. I thought, you
know, people like me don't get raped. And then on the 1st of April of last
year, I found that that was simply untrue.

GROSS: Tell us your story. What happened to you? A man broke into your
house. What happened?

Ms. SMITH: I'd gone out to a business meeting and returned home at half past
eight in the evening. I'd been out for two hours. Ten days before that, I'd
received a phone call from a man who said that his name was Aaron and told me
he loved me. I put the phone down. And when I got back from lunch later that
afternoon, there was a message from him, saying that, `If you will not speak
to me, I will F-you.' I phoned the police. They said there was nothing they
can do about such messages. However, I was sufficiently concerned that I put
a copy of the tape from my answering machine in a box and I noted it down in
my diary and told my son about it.

And when I returned home that evening, I did the typical South African thing,
looking out for hijackers, checking the gate. I've got three dogs. They
weren't reacting at all, and I always thought that they would tell me in some
way if someone was in the house, but they were just sitting on the patio. I
walked into the house, I locked the door, and locked myself into the house
with the rapist. I noticed that there were more lights on than when I had
left but thought that my son, who had gone to movies with friends, had
possibly come back.

I went into my bathroom, and as I turned around and was flushing the toilet,
he appeared in the doorway with the knife. And a million things flash through
your head, and I thought, `Well, my gosh, he's come to rob the house.' And I
started screaming. I thought that was the thing to do. And he said, `If you
scream, I will kill you,' and grabbed me and pulled me out of the room,
demanded money. I didn't have any money with me.

He then moved me to the middle of room, said, `Is anyone coming home?' And I
realized that if I said someone was coming home soon, he would realize quickly
that I was lying and that I had to play for time. So I said, `Someone will be
coming home in an hour or two.' And he said, `Is it your husband?' And I
said, `Yes,' although I'm not married. He then said, `Where is your son?'
And that worried me because I realized that he knew that I had a son. And I
said, `No, he's not coming home tonight,' which was also untrue. I said,
`He's sleeping at a friend's,' and that helped focus me because I realized my
son was coming home at 11, that this thing had to be over regardless of what
happened before my child came home.

He then said he was going to tie me up and went to my bedroom cupboard and I
thought, `Well, he's going to use stockings or scarves or something.' But he
took thick masking tape out of the cupboard which I usually kept in a cupboard
in the kitchen. And I then realized that he'd planned this, that he'd been
waiting for me. I still didn't think that I'd be raped. He tied my hands
behind my back and he then said, `And now we're going to have sex.' And I was
interested that he didn't use foul language. I'd always assumed that people
who rape you would use foul language, but he didn't.

I remember reading a story about two women who were attacked and the one woman
said that she had AIDS and they let her alone and they raped her friend, so I
said to him, `I have AIDS.' And he said, `Well, then I'll use a condom.'

GROSS: Did your rapist use a condom?

Ms. SMITH: No. No. He then undid my clothing, pushed me on to the bed,
undid his clothing and began raping me. And that was when I learned first of
one of many interesting lessons from being raped. The laws all over the world
talk about rape as though it's an assault using the penis as a weapon.
However, what I realized with the person who raped me and what I've
subsequently realized with many, many women and children that I now deal with
is that he was sexually dysfunctional. He had erectile problems. And I think
that's the reason why many women get badly beaten up or they use objects in
women.

And he started having problems, and I was also very dry. And he started
swearing. And I thought, `Gosh, if he loses his temper, if he feels that I'm
judging him in any way, I'm in trouble.' And I was very calm, very calm right
the way through the rape, and I said to him, `It's not your fault. It's not
your fault. It's my fault. It's my fault.' I took the blame upon myself.
And I think that in some way that that soothed him because after he was
finished--he raped, or attempted to rape me three times.

And after he was finished, he set me up on the bed and he said, `Now I'm going
to tie you up some more.' And he started putting masking tape around my eyes.
a very thick masking tape, about two inches thick, and then started putting it
around my nose. And I said, `Not my nose. Not my nose,' because I realized
that if it went around my nose, I'd be dead in a few minutes. And he listened
to me. And I think the only reason he listened to me was that he'd felt that
in some way I was cooperating with him, that the really interesting thing
about many rapists--not all of them but many of them--is they have this
perverted desire for us to like them, for us to accept them and acknowledge
them.

And I obviously didn't know that. Maybe instinctively I knew that, but he
didn't put it around my nose, put it around my mouth. Put more around my
hands, around my ankles, around my knees. Then said that he was going to go
the bank and draw money out but that he'd be back in 15 minutes; that if I did
anything, when he came back, he would kill me.

GROSS: How did you decide whether you were going to try to escape in that
15-minute interval, or whether you would be the kind of obedient victim and
just, like, wait for him, not trying to get out of the bonds that he had tied
you with?

Ms. SMITH: I don't know if anyone decides to be obedient victim, and
definitely if you decide to be obedient, when you have the opportunity to
escape, then you certainly will become a victim in my belief.

I didn't fight at all during the rape, but I was determined to survive. And
I'm now very strong about calling myself a rape survivor and other women rape
survivors. He, first of all, tried to trick me. He closed the door and he
put me in the bathroom. He closed the door, and I was listening very
carefully. I hear that he hadn't locked the door. And I thought, `He's not
going. He's not going.' And he came back after a few minutes, and I hadn't
moved at all. And then when he finally went, he locked the door. And then I
listened carefully and I heard him go out the front door and lock the front
door. And then I even waited some more until I thought I heard him go out the
gate.

And that's when I started struggling. I realized--I thought, `Well, I've got
15 minutes and I have to free myself.' And it was unbelievably difficult
because at first I started panicking and tried to free all parts of me, and
then I thought to myself, `Calm down. Calm down. Focus. You've got to
focus,' and focused on my hands. Couldn't free them at all. And then focused
on my feet and managed to free my feet and my knees. So I was standing up,
but I couldn't really see which room I was in and my hands were still tied up.
And I realized I would never be free unless I could free at least one of my
hands, and finally managed to do that, although at one stage, I can remember
leaning against the wall and just thinking, `I don't have the strength for
this.' I'm a small woman and I'm not physically strong, and I thought, `I
don't have the strength for this.'

And then a thought flashed into my head that my child would come home, and he
would see blood everywhere, and I would be dead and that this person might
still be in the house and might attack my child. And I thought, `I can't let
that happen.'

GROSS: You were finally able to undo the tape that he had placed around your
body to keep you bound. Were you able to scream for help? Did any neighbors
respond?

Ms. SMITH: Well, finally neighbors did respond. Two of my three neighbors
closest to me had gone away for the Easter weekend, and the woman next door,
at 10:00 at night, she decided to go out and get her ironing board and do some
ironing, which I think was nothing short of miraculous because I don't know of
many people who do ironing at 10:00 at night. And she heard me screaming.
And I had also picked up an object in the bathroom cupboard. I was only able
to get one hand free; the other one was still tied up. And I was breaking
glass to try and increase the sound of the noise level. And she heard me and
her husband came. She contacted the police, and her husband and another
neighbor came and they found me. They got me out of the bathroom.

GROSS: If you're just joining us, my guest is Charlene Smith. She's a South
African journalist who was raped a year ago. She reported on her rape and
then became an activist in trying to reform the health and legal systems to
better help rape victims in South Africa.

Charlene, let's take a short break here and then we'll talk some more about
some of the changes that are under way in South Africa. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is South African journalist Charlene Smith. A year ago she
was raped. She reported on her rape in a newspaper article, then became an
activist in trying to reform the health and legal systems to better help rape
victims in South Africa.

When you were raped, what was the procedure that you went through? Did you
call the police first, the hospital first? What was the first thing you did?

Ms. SMITH: Well, fortunately my neighbors had called the police, and the
police arrived. I was a very difficult rape survivor in terms of the police
and everyone, quite frankly. When my neighbors let me out of the bathroom,
the first thing that I did was I apologized that I wasn't properly dressed,
and I also said to them--I said, `I've got to get hold of my doctor. I've got
to AZT. I don't want to get AIDS.'

And we couldn't get hold of my doctor; he'd gone away for the Easter weekend.
And one of the young police officers, in fact, a police reservist, a part-time
weekend police officer, said he would take me to the district surgeon. And I
said, `I don't want to go to the district surgeon. I've got to go to private
hospital; government hospitals won't give me the drugs to stop HIV. I've got
to go to private hospital.'

And so began a process that was absolutely unbelievably difficult to try and
get the drugs to stop me getting HIV. We ended up going to three hospitals
that evening. I was treated mostly in an appalling manner, particularly by
women that evening, until I got the drugs.

GROSS: Now what made you think about getting AZT?

Ms. SMITH: For some years, I'd been reporting on the AIDS epidemic in South
Africa and, in particular, had been reporting on mother-to-child transmission.
I think it's a disgrace that we don't give the drugs to stop mother-to-child
transmission in this country. We're losing approximately 100,000 babies a
year to HIV. And two weeks beforehand, I was at Chris Hinni Baraquanith
Hospital(ph) in Soweto where they've got a large program, a trial run by the
United Nations looking at mother-to-child transmission. And one of the
doctors there said to me--the very last thing that the doctor said to me was,
`You know, Charlene, we need AZT for women who are raped as well.' And I
said, `Gosh.' I said, `That's interesting. I must do a story about it at some
stage.' And that was the last thing that I wrote in my notebook, and two
weeks later, I was raped.

GROSS: So you did end up doing a story about it, but you didn't realize it
would be your own story.

Ms. SMITH: Yeah.

GROSS: So were you not given the AZT because of financial reasons or what?

Ms. SMITH: Yeah, I didn't have medical insurance and so they wouldn't give
me the drugs at the private hospitals. I knew that if I went to a government
hospital, because government doesn't give AZT to anyone other than prisoners,
I wouldn't get AZT from a government hospital either, so that's why I was
going to the private hospitals until finally I had limited medical emergency
insurance from a company called Medical Rescue International here. And I
finally phoned them and said, `Look, I've been raped. I need AZT. I need it
fast. It's been five and a half hours since I was raped. I need those drugs
and I need them fast.' And they said to me, `We've never had a call like this
before.' And I said, `Darlings, you've got the call now. I need the drug.'

And it was a young black man who took the call and I could hear him consulting
with other people, and he said, `Fine. We can give you the drugs.' They gave
it to me for six days. `This is the hospital you must go to; they'll have the
drug there.' But even once I went to that hospital, it was a battle. In
fact, the hospital that I went to was a private hospital. And they were
giving me problems about getting the drugs, etc., etc. And I said, `You know,
if, by some miracle, I'd managed to injure the person who raped me, he would
have been wheeled into this hospital past me. He would have received the best
medical treatment in the country at the cost of the government including, if
he had HIV or AIDS, he would have received the antiretrovirals. And yet I am
raped and I can't get that medication.'

In 1998, the government spent 54 million rand treating prisoners in private,
not government, hospitals who had HIV- or AIDS-related illnesses. However, if
you are a woman who's raped or if you're a pregnant woman who has HIV, you
cannot get that medication from a state hospital.

GROSS: Have many women contracted AIDS because they've been raped by men who
had it?

Ms. SMITH: Oh, yes. Many. Many. Many. I deal with many of them. For
women who don't get the antiretrovirals in this society, there's approximately
a 40 percent zero-conversion rate, which means that approximately 40 percent
of women who are raped will get HIV afterwards in this country. However,
there's an extremely high incidence of HIV in our population. Approximately
1,800 people get infected each day. Thirty-six percent of pregnant women are
HIV-positive. Approximately 40 percent of men aged in the 20 to 29 age
bracket--your primary age bracket for people who usually rape--are
HIV-positive, so we have a very high incidence in our society.

But the other thing that makes it very dangerous for youth who're rape in this
society is that 75 percent of rape in South Africa is gang rape. You are more
likely to be raped by anything from 3 to 30 perpetrators than by a single
individual. Now if you're raped, for example, by four people, and two of them
are HIV-positive, you're getting a double viral load of the virus, so it's
almost as though you're being infected twice. And your risk factor shoots
right up, and that's what we're finding.

Particularly, there's a myth that if you rape a virgin in this country, you
will lose your HIV status. And the children, in my experience, are dying very
quickly. On average it takes a child anything from eight months to 18 months
to die after being infected; whereas an adult--we've got subtype C in this
country, which is the most lethal form of the virus. An adult takes
approximately five years to die.

GROSS: How confident are you that taking antiviral drugs will help stop AIDS
if you've been raped by somebody who has it?

Ms. SMITH: Since I was raped, a whole lot of research has begun into the
relationship between rape, HIV and antiretrovirals. I was basing some of my
belief that it would help me on research done by the Center for Disease
Control in Atlanta that was done in September 1998, that briefly looked at
rape, primarily looking at needle stick injuries but reflected on the fact
that, in the instance of rape, they believed that it would be similar success
rate if you used antiretrovirals, namely an 81 percent success rate.

The doctors that I'd spoken to at Chris Hinni Baraquanith have extensive
experience in dealing with mother-to-child transmission. In fact, some of
them have co-authored the World Health Organization guidelines on
mother-to-child transmission. And they were extrapolating the use of
antiretrovirals for rape. And I think it's a disgrace that there hadn't been
any research solely and primarily looking at the relationship between rape and
HIV beforehand and the use of antiretrovirals.

At the moment, there are approximately five studies that are going on in South
Africa. What they're finding with those studies is for those women who do go
on to the antiretrovirals after rape, none so far have sero-converted, or in
other words, none so far have become HIV-positive. However, you know, nothing
is perfect. And I have no doubt that at some stage some unfortunate woman
will probably sero-convert.

GROSS: How available now are antiretroviral drugs to rape victims, and what's
preventing them from becoming more available?

Ms. SMITH: It's still basically only the wealthy or people who have access
to medical insurance that can have the antiretrovirals after they're raped.
And government is still refusing, despite being offered the lowest prices in
the world, to give those drugs to stop the virus spreading in women and
children who've been raped. And it's a great shame because last year, as an
example, the wife of the deputy president was gang raped. Thugs kicked down
the door of her home and gang raped her and she was immediately put on the
antiretrovirals.

A number of daughters and wives of other top politicians in government for the
ruling party have been raped and they immediately put their children, their
wives on to those drugs, but they're refusing to give them to the majority of
our people, and I think it's scandalous.

GROSS: Charlene Smith is a freelance reporter in South Africa. She'll be
back in the second half of the show. I'm Terry Gross and this is FRESH AIR.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross.

Back with South African journalist Charlene Smith. She was raped a year ago.
The article she wrote about the attack helped inspire a movement to reform how
the country's legal and health-care systems treat rape victims. For example,
she wants rape victims who may have been infected with HIV to have access to
anti-retroviral drugs as soon as possible after the attack. South Africa has
the fastest-growing rate of HIV infection in the world.

The reason why you had such trouble getting anti-viral drugs was that you
didn't have health insurance that would cover them. They're very expensive,
and that's part of the reason why they're so hard to get in many countries
now. I understand that South Africa recently became the first country to have
rape insurance. Tell us about how that works and how that's affecting things
like access to anti-viral drugs.

Ms. SMITH: I think in approximately June of last year, an insurance company
approached me and said that they will waive the fact that it was very
difficult to get the anti-retrovirals. They wanted to have an insurance
policy around it. I welcomed that and assisted the work on the policy.
Initially, they only wanted to give the anti-retrovirals, and I said, `You
know, we have other things that we can't deal with after rape. We need to be
touched,' and so they also gave money for alternative therapies, anything from
rakei(ph) to aromatherapy to facials to encourage people to know that touch is
healing and not dangerous after. But that particular insurance policy I
walked away from when they refused to give the insurance to women who were
prostitutes, and I said, `I refuse to support a policy like that.'

However, we now have approximately five insurance policies in this country.
I've helped with all of them. And the one policy that I do support not only
gives the money for anti-retrovirals, as well as alternative therapies, they
also give a certain amount of money for security upgrades around a woman's
home or vehicle or her person, depending on what she wants. And it also has a
package where if you do seroconvert--and this is very important--and if you do
become HIV-positive, they will put you on an HIV management program. If you
get on to one of those programs, if you monitor the HIV, if you change your
lifestyle, if you eat properly, you can extend your life expectancy. And I
think that's a very, very important clause in that.

I don't know how widely used the insurance policies are. The particular one
that I supported cannot, at this stage, be bought by individuals. It's very
cheap. I do believe they are apparently going to be bringing it out on the
market sometime soon for individuals, but it's mostly sold to medical
insurance companies or to big business who want to protect their work force.

GROSS: Now your rapist was apprehended, tried, convicted and sentenced to how
many years?

Ms. SMITH: Thirty years, 15 of which were for raping me and the other 15 of
which were for stealing a CD player and 10 CDs from my home.

GROSS: Now I understand that the legal system is seldom that effective in
apprehending rapists in South Africa.

Ms. SMITH: It's extremely ineffectual, and I think that that's part of the
reason why you have such a high, high incidence of rape in this country,
because people who rape know that, in very many instances, women do not report
or don't want to report. And part of the reason why women don't want to
report is if and when they do, in most instances they're not treated very well
by police officers, or if they're treated well by them on the night that they
are raped, subsequent to that, the level of disinterest and apathy and lies
and the loss of dockets--in my own instance, within five days they had managed
to lose the entire file with all the evidence collected up to that time, and
it was just a continual saga. And my case, I had an article published that I
wrote about the rape a week after I was raped, so it very quickly became a
high-profile case. But the level of the loss of evidence, of police officers
treating me very badly, of the prosecutors treating me badly was quite
unbelievable. And here I am, white middle class, I have access to the doors
of power. My situation was a whole lot better than the average woman in this
country, who is poor, who feels she doesn't have rights anyhow, who's
intimidated by the entire system and she gets an absolute raw deal. She is
lucky if the docket is opened at all.

GROSS: I think one of the changes under way now in South Africa is this:
There have been, I think, about 20 special rape courts that have been created.
Were you involved in the creation of those courts?

Ms. SMITH: I sat on some of the committees looking at--setting up those
courts and some of the needs for those courts. There's a wonderful woman and
a team of four women from the Office of the National Directorate of Public
Prosecutions, a woman called Toka Machuquani(ph), who's hitting the
establishment of these rape courts. But I wrote in a recent article these
rape courts is a little bit like building a house and putting the windows in
first without building a foundation or without building walls. They're
closing district examiners' offices in this country, which means the very few
forensic examinations that take place in rape at the moment will become almost
non-existent. And as all of us know, in very many instances, a rape case
stands or falls on the forensic examinations and particularly DNA. And the
police investigations are appalling now. A prosecutor with the best will in
the world can only try a case according to how good the information that has
been produced by the investigating team and the medical examiner is. If that
is substandard or not up to speed, there's nothing that the best prosecution
in the world can do.

GROSS: Now your rapist was black. Are there a lot of racial issues
surrounding rape in South Africa? Are white women, are black women more
frequently victimized? Is rape often considered to be a racially involved
kind of crime? You know, is it usually people of--do rapists more often rape
someone of the same color or not? You know, what are the racial issues
surrounding rape in South Africa now?

Ms. SMITH: I don't think that rape in South Africa is an issue around race at
all. I think it's strictly according to demographics. Most people raped are
black because most people in this country are black. Most rapists are black
because most people in this country are black. There are white people who
rape. There are white people who rape white women. There are white people
who rape black women. I think that rape is a very peculiar creature. I
really have serious problems in saying that it's an issue of race. Maybe in
some countries it is. Maybe in a very, very few isolated instances it is
about race, but I don't think that an individual who's going to rape
necessarily looks at the race group of the person that he's going to rape.
He's motivated to rape and he, actually, quite frankly, doesn't care, in most
instances, what her race group is.

GROSS: If you're just joining us, my guest is Charlene Smith. She's a South
African journalist who was raped a year ago. She reported on her rape, then
became an activist in trying to reform the health-care and legal systems to
better help rape victims. Let's take a short break here, and then we'll talk
some more. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Charlene Smith. She's a South African journalist who was
raped about a year ago. She reported on her rape and then became an activist
in trying to reform the health-care and legal systems to better help rape
victims in South Africa.

Was your rapist tested for HIV? You were so worried about getting it,
understandably.

Ms. SMITH: No. Unfortunately, in this country, the police are using the
constitutional right to privacy not to test people who rape, which is
exceedingly unfortunate because it means that there's a year in which we could
seroconvert, and we never know whether or not he is positive or negative or
they are positive or negative, so we live with tremendous fear for a year
while we continue going for our tests. And I can't understand the
interpretation of the law because a rapist, by raping us, has invaded our
privacy. He's also threatened our right to life, our constitutional right to
life.

In South Africa, if you are arrested for suspected drunken driving, the police
can, without asking your consent, take a blood sample to test whether or not
you are, indeed, drunk. And yet, they won't do it with women who are raped.
It's quite an extraordinary situation, and it's one that we're campaigning
against. We had a 14-year-old child in one of the black townships near
Pretoria, as an example, who was raped on New Year's Day in 1998 by three
people. They arrested them not long afterwards. They didn't test her and
they didn't test them. And when she started getting flulike symptoms awhile
later, nobody tested her for HIV. When she developed tuberculosis, nobody
tested her for HIV. By April of last year, they had postponed the case 17
times, and her mother was having to carry her to court on her back because the
child was so weak. She died in May of last year, and the three rapists were
released because the complainant, who was this child, was dead.

GROSS: You wrote your newspaper article about your own rape just a few days
after it happened. You describe in the article that you were taking how many
drugs was it at that time?

Ms. SMITH: Oh, I think it was 28.

GROSS: Right. And some of the drugs were, you know, anti-retroviral drugs,
some of the drugs were anti-nausea drugs. Plus, you took a morning-after pill
to make sure you wouldn't get pregnant.

Ms. SMITH: Antibiotics to prevent sexually transmitted diseases.

GROSS: And you even describe in the article how, in the middle of writing the
piece, you had to take a break so you could go the bathroom and throw up.

Ms. SMITH: Yeah.

GROSS: How did you find the strength to write that piece so shortly after the
rape happened?

Ms. SMITH: On the night that I was raped, I was treated so badly that I said
to the young police officer that I've got to turn this around, that I've got
to make something good come out of this; that even if I help or save the life
or protect just one woman, then I have to do it, and that all I knew how to do
was to write. So I had to write about my experience, and I wanted to be very
clear that I broke the silence, so there's nothing that I won't write about or
won't talk about. However, I approached my children and I said to them, `This
is what I want to do. I want your permission because it'll have an effect on
you. There might be some sympathy for the fact that I was raped. However,
there will probably be prejudice around the fact that I might be HIV-positive,
and you have to be ready for that.' And I made them go away and think about
it, and they both came back to me and they said, `Mommy, if you think it'll
help even just one person, then do it.'

And that's what I did. And I have almost overwhelmingly been treated with
love and respect by all South Africans. At first, I really didn't think the
story would have the impact that it did and I thought, `Well, this will just
be a seven-day wonder,' and here I am a year later, about 70 percent of what I
do is work around rape and HIV. But I think it's important. I think that we
have a battle, that we got rid of apartheid. There's no reason why sexual
violence should be more difficult.

GROSS: The last time you were tested, you were HIV-negative. Are you
convinced that you're in the clear on that?

Ms. SMITH: Well, I have to go for my one-year test. I'm already a month late
for my one-year test. I was six weeks late for my six-month test. You don't
get less anxious about becoming positive. You become more anxious about
becoming positive. Yeah, I think I probably am. Yes, my doctor, who's an
AIDS specialist, he says that there's about a 1 in 10,000 chance that I'll
seroconvert. I think that I've already made up my mind that if, by any
unfortunate twist of fate that I am positive, then I'll deal with it in a
positive way. It's a death sentence, but, you know, everything's a death
sentence if you choose it to be; that there are ways to live in a good,
positive, healthy way that influences other people in a good way.

GROSS: Why are you six weeks late for the test? Is it that you're afraid to
face it or you've been really busy?

Ms. SMITH: I think it's both. No, but I think most of all, I hate these
tests. I really, really hate them. And I think that's what everyone
underestimates, is that we're convinced we were going to be killed during the
rape, and afterwards, we'll do anything to survive. And you're on those
anti-retrovirals for 28 days, but your first test is only at six weeks. And I
found that after those 28 days were over, I crashed badly, went into profound,
profound depression until a friend sent up a herbal immune booster, because I
realized my body was on its own, and I couldn't protect my body anymore, and I
can remember on that day thinking, `I've got such a strong mind, but my body
is going to do exactly what it chooses to do, and I can't stop that,' and that
was terrifying.

GROSS: The person who raped you broke into your house. When you tried to
resume your life after the rape, did you change your personal security system
or change anything about where you went or how you went there? I guess what
I'm wondering is, you know, you've been so effective, I think, in trying to
reform the South African court and health systems; what about safety and
personal protection?

Ms. SMITH: Certainly, initially, I was very, very worried, if not paranoid,
and I think a lot of that is post-rape trauma syndrome where you just fear
everyone and everything, and you're constantly checking doors and windows and
that sort of thing. I had an alarm installed in my house. I bought a German
shepherd to protect me because my other three dogs were very sweet dogs, and
I'm afraid the German shepherd's adopted their sweetness, so he'll never
protect me. But, you know, you have to be really careful that you don't
become so paranoid that you stop living. One of the things about post-rape
trauma syndrome is you don't like going out at night afterwards. There's lots
of areas in which you'll circumscribe yourself, and I think you can continue
doing that and fear everyone and everything, and then you will always be a
victim, or you have to make the decision that, OK, this happened to me. It's
a terrible thing. It's, hopefully, the worst thing that will ever happen to
me. I'm very, very wounded inside, because we all are, but I have to get up,
I have to move on. I have to recreate my life. I have to make it a better
life.

GROSS: Charlene Smith is a journalist in South Africa. Her story about being
raped was published in the South African paper the Mail & Guardian last year.
She's now working to reform how South Africa's health and legal systems treat
rape victims.

We contacted both the Center for Disease Control and the National Institute of
Allergy and Infectious Diseases in the US to find out what their
recommendations are on the use of anti-retroviral drugs for rape victims who
may have been exposed to HIV. They directed us to a 1998 Public Health
Service study on possible sexual, injecting drug use or other non-occupational
exposure to HIV. The study concludes that data have not yet been
systematically collected in the US. Therefore, the Public Health Service is
unable to definitively recommend for or against the use of anti-retroviral
agents for rape victims. The study stresses the need for more research in
this area.

In Canada, however, the British Columbia Center for Excellence in HIV/AIDS has
published a report on accidental exposure to HIV, which does recommend
anti-retroviral agents for rape victims. That study suggests that the
anti-retroviral therapy be initiated quickly after exposure.

Coming up, more HIV-related controversies in South Africa. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Phillip van Niekerk of the South African paper the Mail
& Guardian discusses the political controversy surrounding AIDS in
South Africa
TERRY GROSS, host:

One of the reasons it's difficult for rape victims in South Africa to get
anti-retroviral drugs relates to a current political controversy surrounding
AIDS in South Africa, a controversy that is getting a lot of attention because
in July, South Africa will be the site of the next International AIDS
Conference. The president of South Africa, Thabo Mbeki, is worried about how
his country is being ravaged by AIDS. He decided to do some reading of his
own. He was intrigued by the work of two American biochemists who believe
that HIV is not the cause of AIDS. This has led him to be skeptical of
anti-retroviral drugs as a treatment for people with AIDS. We phoned the
editor of the South African paper the Mail & Guardian, Phillip van Niekerk, to
find out more.

Mr. PHILLIP VAN NIEKERK (Mail & Guardian): President Mbeki, obviously, is
aware we have a huge problem, probably the biggest problem that this country
and this continent faces, which is large numbers of people are infected with
HIV and probably 1 out of 10 of the South African population at the moment,
and large numbers of people are dying. So there's, obviously, a great element
of concern. But equally concerning to a lot of people in this country has
been President Mbeki's attempts to get involved in debates on the science of
AIDS, where what is really required now by a lot of people is that we get
ahead with implementing strategies of prevention and dealing with what is the
biggest public health disaster in the history of this continent and the
history of this country.

We are spending a lot of money having futile debates about whether or not HIV
leads to AIDS, and the president appears particularly enamored with a group of
scientists who are fairly discredited within mainstream sciences in the world
and believes it's his task or his role to somehow get a debate going amongst
these scientists and to restart this debate. It's not easy to say exactly why
he's gone off at this tact, but he has been severely criticized by scientists
and by other people in this country at the very least for dabbling in science
and politicizing the science of AIDS, which is an issue, in a sense, that is
best left to scientists, whereas policy-making is really the arena of
politicians.

GROSS: I'm wondering how this AIDS controversy is affecting Thabo Mbeki's
popularity in South Africa now.

Mr. VAN NIEKERK: Well, I think it's the kind of thing which is very much a
debate within the elite. I don't think that a lot of ordinary South Africans
there are really up to date with the whole issue of the science of AIDS and
why it's problematic for the science of AIDS to be politicized in this way.
So I don't think that there's actually a response amongst the masses. You
know, the broad appeal of Mbeki and the ANC probably remains the same. I
think that where he has suffered probably something of a setback is that there
are a number of people within the intellectual community who have questioned
the way he's gone about it and, in particular, the contempt with which he
seems to have treated many of those within the scientific community in South
Africa. And I think that, if anything, if at the end of the day one was to
weigh up the damage to him politically, it's in those kind of intellectual
circles.

GROSS: The anti-retroviral drugs are not available now at public hospitals.
How much of that has to do with the government skepticism about HIV being the
cause of AIDS and how much of that is just an economic issue that these drugs
are pretty expensive?

Mr. VAN NIEKERK: I don't think you can really separate out the skepticism
from the economic issues in the sense that you have the skepticism both about
the efficacy of the drugs and about the general consensus science of the link
between HIV and AIDS. The two things are very much interlinked. If, for
instance, you say, well, part of the reason why we can't dispense these drugs
is because it costs something like 4,000 rand a month. That's $800 a month
for poor people in rural areas. And the question then becomes, well, once
these babies are born, if they're born with HIV-AIDS, there are going to be
economically a drain on the public health system in a couple of years time
when they start suffering and dying from AIDS-related diseases. So the
question of the economics is something that we've always sort of argued within
a framework or within a context, and if you have an inherent skepticism to the
drugs, then it's much easier to make the economic arguments, which say that
we just can't afford it.

On the other hand, if you're convinced of their efficacy and if you are really
concerned about saving the lives of those children, then you will find a way
to pay for it. We've just spent 30 billion rand on buying new military
hardware and naval ships, and a very, very small percentage of that money
could have been used to save the lives of children who are now probably going
to die at an early age of HIV-AIDS.

GROSS: Do you think that Mbeki's statements about AIDS and his skepticism
about HIV is serving any larger political purpose for him? Does he have any
larger political motivation?

Mr. VAN NIEKERK: A lot of people are questioning what the motivation is for
this. I think that he's genuinely concerned about an enormous problem and
that he's grasping and he's finding ways of coming to terms with it. I think
anybody who is in responsible positions of office on this continent right now
must be terrified when they start to see the figures that are coming in and
the fact that it's spreading and that policy so far has not been able to stop
it. There's talk that he spends a lot of time surfing the Internet, and that
a lot of the theories, a lot of the things that he's come up with are from Web
sites that he's encountered, and that has been written about and has also been
raised as problematic. I don't think that there's anything malicious or that
he's doing it out of any kind of need to exploit politically the situation,
and I don't think anybody's saying that in South Africa either.

As I said, it's an enormous problem and I suppose that when one tries to come
to terms with it, when one tries to address, how do you stop it, how do you
stop this tide of, you know, death and disease, that you might very well start
to jump around and try and find extraordinary solutions or try and question
the conventional wisdom because the conventional wisdom so far doesn't seem to
be working on the African continent.

GROSS: Well, I want to thank you very much for talking with us.

Mr. VAN NIEKERK: OK.

GROSS: Phillip van Niekerk is the editor of the South African paper the Mail
& Guardian.

(Soundbite of music; credits given)

GROSS: I'm Terry Gross.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.