Hope in a shipping container clinic

When Margaret Ndinisa came to Freedom Park, the inappropriately named squatter camp that surrounds Impala Platinum mine in South Africa's North West Province, the settlement consisted of little more than a few shacks which the police regularly dismantled.

"That time, eish, it was so dangerous. We slept outside and when it rained we slept under plastic," she recalled. "There was no job; I was selling cold drinks and liquor to people at the mines."

Twenty-five years later, an estimated 25,000 people have flocked to the informal settlement from impoverished areas all over South Africa and its neighbouring countries, hoping for a share of the area's platinum wealth, but little has changed.

Shacks like the one Ndinisa and her family live in, made of colourfully painted scrap metal, look almost cheerful under a clear blue sky, but living in them is far from easy: the local government still considers the settlement illegal, so there is no electricity, sewage system, roads or even water.

Some of the men find work at the mines, but opportunities for women are almost non-existent. For many, survival depends on finding a man, or several men, to provide the basics in exchange for sex.

"They come here thinking that they're going to get a job, but there's no jobs," said Thembi Maboyana, who followed her brother, a mine worker from Vosloorus, a Johannesburg township, to Freedom Park in 1990. "If they don't have money to [buy stock so as to] sell something, they get four to five boyfriends to get money to buy water, paraffin and clothes."

According to Maboyana, most of the men have wives in their home villages, "so when you get ill, he just runs away and leaves you in the shack".

By the mid-1990s, residents of Freedom Park were starting to sicken and die from AIDS-related illnesses. Impala and other mines in the area began implementing HIV/AIDS policies and programmes for their workers, but most people living in Freedom Park and other informal settlements in the area had no access to them.

"There were many people suffering in this place; no money to go to hospital and, if it's raining, no car could get in and take them, so people were dying inside the houses," Ndinisa told IRIN/PlusNews.

Freedom Park's first clinic, set up in 1998 by Kevin Dowling, the Catholic Bishop of Rustenberg, confirmed the scale of the HIV problem and the lack of response. Dowling's HIV/AIDS organisation, Tapologo (meaning "peace and rest" in Setswana), recruited local women like Ndinisa and Maboyana to start providing home-based care, but their task was a difficult one.

''If they don't have money...they get four to five boyfriends to get money to buy water, paraffin and clothes''

"The stigma and the discrimination were dreadful. The caregivers were in danger, and women were getting beaten up on their way to the clinic; we had to close down for six months at one time because lives were being threatened," recalled Dowling. "But that team of home-carers, they kept at it, and it's very different now."

The shipping container that housed the first clinic has expanded to a cluster of containers, where support group members start the day with loud hymns as nurses criss-cross the dusty compound and patients congregate on benches outside.

Treatment lifeline

Since 2004 Tapologo has also been providing antiretroviral treatment (ART) through a grant from the US President's Emergency Fund for AIDS Relief (PEPFAR). About 1,090 people are now receiving the drugs at eight clinics, including the one in Freedom Park.

"There's only one [government] place in the whole of this area - Rustenberg Hospital - that provides ART, and the extremely poor can't afford to go there," said Dowling. "So a community programme like ours - which is in the settlements so that the people can reach it - that's our idea."

Mine employees needing treatment can access it through the mines' medical facilities, but contract workers, who make up a significant portion of the workforces, are generally excluded.

Tapologo is a lifeline for people like Phatheka Goenze, an HIV-positive contract worker from Lesotho. "If you're a contractor they don't help you at the mine," he told IRIN/PlusNews. "I knew this clinic [Tapologo] because everyone who comes to it is alive."

Impala Platinum has supported much of Tapologo's work in Freedom Park, providing the containers, HIV testing equipment and drugs to treat opportunistic infections.

"They focused on the mine workers and financially empowered Tapologo to reach out to the communities," said Dowling. "It's been a very sustainable partnership."

Prevention failing

While Tapologo has transformed the HIV/AIDS response in Freedom Park and a number of other squatter camps, the organisation has had less success in changing the socio-economic conditions driving infection rates in the area.

About 52 percent of pregnant women attending Tapologo's Freedom Park clinic test positive for HIV, compared to a provincial average of 29 percent, according to a 2006 antenatal survey.

Caregivers incorporate education about HIV prevention into their work, but Dowling said many women were in no position to apply what they had learned in their relationships with the men who supported them.

"There's no way women are going to be saved from a certain death in this area unless they're economically empowered," he said. A skills development programme has had limited success, with few outlets to sell the items the women make.

Denial and misinformation about HIV/AIDS is still common among the men. "They still don't want to use condoms," Maboyana said.

''There's no way women are going to be saved from certain death in this area unless they're economically empowered''

Johannes Tsinyene, who came from Lesotho 15 years ago to work at Impala, had heard of HIV but did not believe it was a real disease until he became sick and tested positive. "I just slept with women without condoms, so that's why I got this disease," he told IRIN/PlusNews.

Tsinyene's girlfriend, who shares his shack in Freedom Park, has tested negative for the virus but will need to be tested again after the three-month window period, during which a new HIV infection is undetectable.

His wife, who stayed in Lesotho with their four children, died a few weeks ago. "Something was wrong with her heart," he said.

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