Nozuko's Story

Fall 1999, Singisi, South Africa

It’s an ordinary autumn day. The chilling wind announces the impending arrival of winter, snapping like a flag, rustling silvery mealie stalks. Outside her home, Nozibile prepares a supper of mealie pap and potato soup on a fire for her daughters and their children. Tomorrow, she thinks, she’ll continue construction on the partially built addition to her house. It’s a slow process of building frames from long, thin sapling poles, and filling the cracks with mud made from water carried in buckets from the river 30 meters below. She hears the sound of a vehicle approaching on the red sandy road that meanders through the steep slopes and valleys of the village, a path better suited for livestock than machines. The sound of the straining engine grasps her attention like a spotlight. This is not a place one stumbles upon in the course of regular travel. It’s a destination, the end of a journey.

In this peaceful community, news trickles in via single voices, usually from the one available radio station or from visitors. The occasional newspaper is of value only to those who can read. Like the news, danger also comes from the outside.

Surprised when the vehicle pauses at the bottom of the hill to her home, Nozibile stops to look more closely, worried that the van might be bringing bad news. "I was curious about what they were coming for, and I was happy to see it was Nozuko and the children because they are beautiful," she says.

Nozuko Ngcaweni, Nozibile’s eldest daughter, has been in the hospital for over a month with her two children. "I thought of the sickness of the children when I saw the vehicle," Nozibile says. "I especially wanted to know how the children are."

The hospital is nearly 100 kilometers away. Nozibile knows diseases are found there—tuberculosis, typhoid, gastroenteritis—and she has heard about other diseases sweeping through the country. There are no such epidemics here. If there were, there would be bodies all around, people crying in pain.

Instead, the baby-blue van that contains her family is loaded down with a motley, merry assortment of strangers. Nozibile wipes her sooty hands on a cloth and smoothes her skirt before meeting the unexpected guests piling out of the parked van. She focuses on her grandchildren, embracing them, clucking over them while she receives the strangers into her home where the rooms are warmed by the smell of smoke. Nozuko is mobbed by her five sisters.

Nozuko is a down-to-earth, what-you-see-is-what-you-get kind of woman. No pretense. Round face. Chirrupy and loose-jointed, she prefers scooting to walking. At 23 she has two children. The first-born is Nqobile, five, whose father works in a shop in Durban. It was a traditional marriage that didn’t work out. "I moved to Durban with him but returned home again because of misunderstandings between us," Nozuko explains, but it’s hard to imagine this mellow young woman having differences with anyone. Since 1997, Nozuko has lost contact with him.

Nqobile has been sick on and off since 1995. She has just been treated for TB at the hospital. Nozuko’s son Azola, two, has been healthy but has been staying in the hospital with his mother and sister. Nozuko met his father, her longtime partner, in 1996 in Mt. Ayliff. They were both looking to return to school then.

Instead, she had their son, then returned to her mother’s home in the village while Azola’s father continued his schooling, and they met on holidays. "He knows his son even though he has a wife in Ixopo and three children by her. I am accepted by the wife who allows me to sometimes visit the home with the child," Nozuko says.

Nozibile sits on one of the beds against the wall with a grandchild in each arm. The unusual guests—representing four nationalities—sit on a bench on the wall opposite the happy granny. Nozuko stands center stage and makes the introductions in both English and Xhosa.

These are people she has met at the hospital, Nozuko explains to her mother and sisters, and everyone smiles. Then one of the visitors, Babalwa, a young Xhosa woman, crosses the room and sits down next to Nozibile.

She begins to tell Nozibile her own story; her words become a long, whispered song, about where she was raised, about her mother, and about how she became very ill and had to go to the hospital for a long time, as Nozuko had just done. Nozibile listens closely, her head tilted toward Babalwa’s.

Babalwa says that while in the hospital she received positive results on her HIV test. "At first I thought to kill myself," Babalwa continues, "because the nursing sister who counseled me told me I was going to die from this HIV. Then I realized that God has a purpose and I have to find my own cure. The first part of the cure is learning to accept this illness. The second part is to know love, which I have received from my mother, and I have learned to love God. My mother accepted me and that’s why I’m here today. I’m not an animal, I’m a human being."

Then Babalwa tells Nozibile that Nozuko has HIV.

Nozibile does not indulge in denials or tears. Holding her grandson in front of her she remains still, her head still cocked toward Babalwa. Nozuko has already slipped out of the room, summoned by her sisters, who have missed her. Babalwa continues to talk for a long time and Nozibile continues to listen. She’s heard the disease is deadly and there’s no cure, but right next to her is a robust, young netball queen who also has HIV, and who declares she plans to continue to live an active life for a long time.

Nozibile is thankful for Babalwa’s words on that day. "I was very worried when I heard, but when Babalwa explained it I felt better. She told me how my daughter can live longer. . . . I felt brave facing the need to help Nozuko."

As the sun falls low, Nozuko’s sisters pile into the vehicle for a joyride to the other side of the valley. As the bulging van pulls away, Nozibile stands alone in front of the house, barely visible in the dusk, and waves goodbye.

Part of Nozuko’s conversion to activism came from the counseling that she received with her test results. She and Nqobile were in the hospital for TB when they learned that the trouble would not end there. "When Sister first told me I was surprised and worried but she explained to me that I must do what I must do, and I can tell someone if I have to talk about it. I must not feel I’m going to die right away."

Then two volunteer women from National Association of People with AIDS (NAPWA), Mandisa and Babalwa, visited. "Mandisa told me about how the virus [HIV] had already become the disease [AIDS] in her, but when her mother gave her love, the right food, and good care, she was able to push the disease back."

Babalwa encouraged Nozuko to tell her mother about her illness to get the support she would need. She also counseled Nozuko that any sexual partners she has had should also be informed. Often, a woman is afraid to tell her partner she has HIV for fear of his reaction. Many women fear physical violence. Most expect denial, rejection, and scorn. Nozuko admits she is not ready yet. When the time came to tell her mother, Babalwa volunteered to accompany Nozuko: "At first I said I could go alone, but Babalwa said she should go with me so my mother can believe it and understand."

Nozuko plans to become an active NAPWA member. "I will stand up; I’m not afraid of that because I want other people to know about this. There’s so much more to learn. It would be a good thing because I must tell them to take it as it is, to comfort and to love." Nozibile agrees. "I would be happy to see Nozuko help other people, to bring them together so people cannot take their dignity away."

Nozuko finds herself in a position where her efforts can make a profound difference. It’s a job requiring sensitivity, intellect, and a willingness to serve. She already has good examples to follow in Mandisa and Babalwa. Many people who do this kind of work must study for years. For Nozuko, it’s the disease she will strive to survive that gives her the credentials to do this job, as well as an opportunity to develop some of her own latent gifts.

April 2000, Singisi

Nozuko discovers her talent for public speaking. Last December she disclosed herself to over 200 strangers at a funeral in Flagstaff. She explains, "When the man died, he told his family he did not want them to hide the reason that he died." So his family asked NAPWA for a person to talk and answer questions about AIDS at the funeral.

Nozuko’s doctors supported her decision to disclose her condition. "I was nervous sometimes about doing this," she says as she pats her heart, "but when I started my speech I didn’t get afraid again. I told them that people must not be afraid, they must know all about it. Parents must not deny how their sons and daughters die, they must not say it was poison or other things. We have to talk about it because it is killing our nation."

Yet, her own community remains in denial about her status. "They said, ‘You’re joking, it’s a lie.’ They say I can’t be like this with HIV." Nozuko invites eyes to acknowledge her healthy frame. "I told them they can’t see it unless they go for a blood test." Her challengers reply, "There is no AIDS here, in our community. It’s in Umtata and Joburg, or Durban, but it’s not here." Nozuko shakes her head in amazement at their disbelief.

Nozuko and her family do their best to protect her health. There is little money for store-bought foods, but they grow their own vegetables. Nozuko’s mother and sisters provide essential spiritual and moral support. "My mother is still calm. I can’t hide my status [feelings] from them, they are all open. They support me. Sometimes when I’m not feeling well, I worry; maybe the time has come. When I’m afraid the time has come, I worry that I don’t have the money to go to the doctor. I worry about what will happen to my children; who is going to look after them? My mother and I, both of us together, we can cope. If I fall down, who is going to help my mother? They see I am worried and say, ‘It is not yet, don’t worry about it.’ They remind me that I am still looking very well."

Nozuko is not the only person with HIV in that household; Nqobile also has HIV. The child "is on and off; she gets sick and then she gets right," explains Nozuko, looking down to her daughter, who hovers at her side. "She now gets the sores on her skin and she gets diarrhea."

Soon Nozuko will return to the hospital. Her tummy bulges with a child who may or may not be infected with HIV. Although accidental, this pregnancy is a happy event for Nozuko and Azola’s father, the man with whom she has shared the past few years. Clare Hoffman, Nozuko’s doctor, is not so thrilled.

Pregnancy stresses a woman’s body and Nozuko’s system doesn’t have the resilience, plus there is more than a 30-percent chance that the baby will have HIV. In 2000, the government has yet to approve the use of antiretroviral medications for treatment of HIV/AIDS, so the medications AZT and nevirapine are not available in the clinic and not affordable for Nozuko on the open market. Either drug could reduce the chance of transmission to the baby by up to 40 percent.

Sympathetic readers of Ubomi, a magazine about people living with AIDS, plan to have nevirapine available to Nozuko at the time of birth. Unfortunately, the baby arrives before the medicine. Nozuko, thrilled with the appearance of the fat baby girl, is not concerned. She names the baby Yanga, which means "may God be with us."

July 2000, Singisi

Nozuko has no warning her lifeline is about to snap. Although she has been sick with diarrhea for the past week, there has been no reason to be concerned for her baby daughter Yanga. Sheltered by the care of her mother, sisters, aunties, and granny, she has enough support to know the fat and easy-going baby is cared for no matter what. Every day Nozuko’s sisters squabble over who will be the one to look after the baby. They all want the honorable task.

The only thing the sisters cannot provide for Yanga is Nozuko’s milk. Doctors have instructed Nozuko that Yanga should receive no other food or fluids for the next three months, to ensure the baby’s health. This is because recent research has shown that babies of HIV-positive mothers do best on an exclusive feeding program; whether it is breast-feeding or bottle feeding, the most important thing is to keep it exclusive for at least three months. Nozuko is being diligent about the breast-feeding.

She is so diligent that even though Yanga is sleeping peacefully in her midday nap, Nozuko insists on waking the six-week-old infant for her next feeding. Nozuko remembers, "I awoke before Yanga. My sister Zaba was keeping house outside. I talked to her, we made jokes. She told me I should allow Yanga to continue to sleep but I wanted my baby to have her feeding."

Nozuko returns to the bed to awaken Yanga in her customary way, to kiss her on the mouth. But on this day, Yanga does not give her customary yawn and stretch in response. Nozuko rubs the infant’s hair and feels her face. It is cold. She listens to Yanga’s heart. It is silent. She feels the hands, the toes. They are cold. Nozuko picks up her baby and gently shakes her. Still, there is no response.

That something would creep into her home and, like a thief, snatch this life, is impossible to comprehend. Doctors will never know the name of that thief. Unable to afford mortuary fees, Nozuko’s family buries the baby in the vegetable garden. The grave is a mound of freshly turned soil surrounded by dry winter grass and harvested mealie stalks.

Nozuko eventually releases her daughter to God. "I give all things to God. I see the grave, but nothing has happened. God knows what he has done. I give this to God."

Susan Winters Cook is a former member of Mullica Hill (N.J.) Meeting. From 1981 to 1997 she was a staff photographer for the Philadelphia Daily News. She traveled to South Africa several times between 1988 and 1994 on her own, partially funded by Philadelphia Yearly Meeting, to document Quaker development and empowerment activities as a response to apartheid and then during the intense time of transition from apartheid to democracy. She began documenting the HIV/AIDS situation in 1995, then returned to South Africa in 1997 permanently. She started a provincial-based AIDS education periodical Ubomi (Xhosa for "Life") in 1997 out of a realization that "the people who needed the information the most were those most at risk—and that was the rural poor." She writes: "The real tragedy of AIDS in South Africa for me was, having seen what the parents endured and sacrificed to ensure a better future for their children, to discover that many of those young people would not live to accept that gift of freedom."

August 2000, Rietvlei Hospital

Although Nozuko’s spirit is able to touch the heavens, her body caves in. Her family’s care proves no match for the return ofTB. Fever, cough, and diarrhea weaken her until she can barely walk. In the biggest fight for her life, Nozuko contemplates death. "I think about going to heaven. It seems like a big castle, I can see, maybe made of gold. To sing and pray, and to live with joy. I believe my baby is there. Maybe one day I’ll meet her. I’m not afraid. When the time comes I’ll see God."

Though she spends weeks in a hospital bed, too weak to sit up, Nozuko does not lose her appetite. Her notorious devotion to food resounds through the Isolation Ward corridors. In a voice diminished by virus, the trademark refrain can still be heard, "I’m sooooo hungry!"

Before leaving the hospital, Nozuko renews her commitment to education. Six female employees from a local farm are so plagued by anxiety about HIV that they have requested a visit with Nozuko. The day of the meeting is not one of Nozuko’s good days; she is so weakened by fever that walking down the hall to the meeting room with her walker exhausts her. For well over an hour Nozuko does what she does best, providing an example and information for those most in need. Her frail condition is not much of an inspiration. The real lesson for her audience will come later, when Nozuko is healthy and cheeky again.

However, when Nozuko’s health does return, it is fragile. Her involvement with HIV is a roller coaster ride with opportunistic infections. A minor ailment could bring about a major crisis. She knows this.

Meanwhile, she contemplates income-producing options. She’s realistic about the weaving cooperative that has been built up by her mother, auntie, and granny, which would not produce viable income for some time. Recently she has been encouraged to open a counseling office near her community. The need for a quiet place for residents to visit and receive information and counseling is dire. Nozuko is a natural for the post. But there would be no salary.

Nozuko decides to fall back on another skill, the operation of a casual hair salon in her home. With a few basic supplies, she can style hair. Meanwhile, she decides to contact NAPWA about a grants program. She resolves to send a fax to NAPWA right away. Then she decides to plant an additional vegetable garden.

October 2001, Singisi

Nozuko is fine. The children are fine. The vegetable garden is fine. Nozuko’s attempts to find an additional source of income have not materialized.

Like anyone with a true calling, she chooses a course that is less practical but has a greater impact on the world. She attends a weeklong training course to become a Mother To Child Transmission (MTCT) counselor. Every Thursday she and another volunteer, Nonjambulo, travel to clinics. On other days Nozuko meets with people in a nearby office for AIDS education and counseling. "The government counselors elected by the community gave the office to me because they recognize that my work is very important," Nozuko says.

Personal experience continues to be her most effective tool. In one of her disclosures she speaks of choosing a life of abstinence, "I’m not going to be involved in those things anymore because God didn’t create me to destroy his world. But he created me to bring good life."

February 2002, Singisi

Nozuko has been involved in pre- and post-test counseling at the hospital. "Sometimes the counseling becomes very difficult," she says. "I tell myself I’m going to do it. I’m telling myself I’m going to succeed. It’s giving and receiving. It has made me feel well, like something hard has been removed from my shoulders.

"The more you talk to people the more you find yourself free," she adds. "It’s because of the sharing of views. Sometimes a person comes with a problem. Then to try to talk about her problem helps me because it teaches me something I did not know."

Nozuko continues: "Hope—that’s if you have hope, like ‘I am going to be well’: that is going to help you. Acceptance—that’s if you have a problem and accept it as it is, you feel relieved. Because many people don’t survive, because they lose hope, they deny the situation. When their mind has been disturbed, there is stress. It’s important to talk about something; don’t let it be a secret. That makes you feel much better."

In addition to the counseling and presentations, Nozuko also gives interviews on the radio. On one particular morning, her words make a deep impression on two individuals in Pretoria named Giles and Catherine. Giles, a 45-year-old attorney, is aware of the problems caused by HIV/AIDS, but has no direct contact with those affected. He says, "I have been removed from the circumstances of people like Nozuko." When he hears the interview on the way to work, something beyond Nozuko’s voice reached deep inside of him. He holds on to that energy until he arrives at his office and immediately seeks the website mentioned on the broadcast.

Catherine, 48, an information technology specialist and company owner, responds to Nozuko’s interview immediately. "She really touched my heart. That she and her family try to live on 100 Rand (about $14.70 U.S.) per month, I said, this cannot be true. Even if I give only R100 per month I would be doubling her income. So I took some trouble to contact her," she says.

Their separate searches lead them to Dr. Clare Hoffman. Dr. Hoffman puts them in touch with each other. In Catherine’s first conversation with Giles, "We decided to do something, to help this woman. She is so undeserving of what has come her way. She was so uncomplaining about her story."

Nozuko is at a meeting of the Treatment Action Campaign in Khayelitsha Township near Cape Town when she receives a call from Catherine to offer support for antiretroviral medications. In what must be her first speechless moment, Nozuko can only say, "Thank you." Nozuko’s family has been very grateful for Giles’ and Catherine’s support. The additional donations of food and clothes for the children have made a big difference.

On February 11, Nozuko receives her first month’s supply of three antiretroviral drugs. ARV drugs help those with low CD4 counts. A CD4 count is the most important number in an HIV-positive person’s life because it reflects the body’s total of T-helper cells, essential to a healthy immune system. A healthy body has a CD4 count of about 1,000. If someone with HIV has a CD4 count of 200 or less, ARVs are essential. Nozuko receives Zerit, Stocrin, and Videx. Because the drugs have not yet been approved by the Department of Health, Nozuko receives them in Dr. Hoffman’s home instead of the hospital. The cost is between R700 and R800 per month (about $100-$120 U.S.). Dr. Hoffman advises that Nozuko may experience fatigue, nausea, or rashes.

At the same time, Dr. Hoffman herself starts a course of the antiretroviral AZT for one month—while suturing a stabbing victim at the hospital, she received a needle prick. That patient’s blood tested HIV-positive.

Healthcare workers in clinics and hospitals are vulnerable to HIV every day. Because of the potential for accidental transmission, many hospitals keep a supply of the antiretroviral medication AZT available to the staff. The course of medication must be started within 72 hours of exposure and maintained for one month.

Dr. Hoffman, a mother of four, braces herself for the predicted side effects of AZT. While she expects to take the medications for one month, Nozuko expects to have to take them for the rest of her life.

<h3>December 2002, Rietvlei Village</h3>

Nozuko’s liver decides to act up, like one more kid jumping into a schoolyard fray. It takes a month in King Edward Hospital in Durban to diagnose the ailment. It is difficult to separate Nozuko’s symptoms from the side effects of the ARV therapy. Dr. Hoffman reluctantly stops all medications, including the ARV, giving Nozuko’s liver an opportunity to recover. The doctor wants to resume the ARVs within a few months, hoping Nozuko’s system will not develop resistance to both medications in the meantime.

Nozuko finds a small house to rent close to the Hoffmans’ and the hospital so her health can be closely monitored. This enables her to keep her children with her. Two of Nozuko’s sisters are with her as well. Her daughter, Nqobile, will soon join her and attend the local school.

Nozuko likes living in Rietvlei. She’s near her sidekick, Nonjambulo, and has made friends in the community. "I didn’t have any friends in my village," Nozuko says, smiling. "I only had sisters."

In addition to working as a counseling team for the hospital, Nozuko and Nonjambulo also conduct weekly support group sessions on Wednesdays. The first attendance was disastrous, but the numbers have been increasing since by three or four new members every week.

"We spend our time talking about problems we have and concentrate on making the other people feel at home. Some don’t know what to do, and they are relieved when they see us talking. They see it’s not only they who have problems."

March 2004, Rietvlei Village

Nozuko shoots from one end of the hospital room to the other holding the metal bedpan in gloved hands, thrusting it toward the retching patient like an outfield ball player desperately reaching for a fly ball. She had fetched the pan for her friend Tenjiwe who is in the hospital and nauseous with AIDS-related TB, but instead answered the more desperate call of the woman on the other side of the room. Fortunately, Tenjiwe ended up not needing the bedpan after all.

Nozuko’s round figure is out of place on this ward, in this room of five women who endure the days mostly in weary silence. Her T-shirt conveys silent irony with the telltale red ribbon on the front and the words glaring across the back, "I care enough to help—do you?"

Tenjiwe may not recover from TB, and she reminds Nozuko of this at the close of her daily visit. She cries and asks Nozuko, "What if this is the last time we ever see each other?" Nozuko can’t answer that question with words, so she replies with a shrug. She doesn’t jerk Tenjiwe around with promises of certain recovery. "We will see the morning when it comes, because it might not come." Nozuko has seen AIDS win too many times to deny the bitter taste of it.

She does try to cheer Tenjiwe with chatter about this and that, inducing an occasional smile. Then she jokes about how, despite the T-shirt’s display of her HIV status, rumors once circulated that Nozuko was a prostitute. Tenjiwe grimly reports the latest rumor that Nozuko has been cured of HIV by a pill from overseas and now does nothing for the others. Nozuko shrugs these things off. More good than bad responses have come from her public disclosure. She offsets the negativity with small gestures, like flying across a hospital room with a bedpan for a vomiting stranger.

Nozuko struggles just to keep her own head above water. Recently she has been doing translating for the dentists at the hospital, which produces some income. Supporters of her efforts chip in for the children’s schooling and the roof over their heads.

Meanwhile, Nozuko has taken a break from volunteer counseling. She had hoped to present her concern for the need for more counselors to the health minister, but the latter did not make it for a scheduled visit. "I was very, very disappointed," Nozuko grumbles. "Everywhere there are patients who are not getting the counseling they need because there is no one to do it. . . . Many of the women who come into maternity can’t even get tested because there is no one to counsel them." Women who have not been counseled and tested do not have the opportunity to use nevirapine at the time of birth. The need for the counseling process will be compounded during the distribution of antiretroviral medications, which the government has promised.

Azola is now seven, and has excess energy that has been difficult to contain, sometimes leading to collisions with classroom structure and other embarrassments for his mother. In contrast, Nqobile, now ten, is a quiet, diligent pupil.

The HIV virus saps Nqobile’s physical energy with a chronic cough and occasional bouts of diarrhea. When others run in play, she stays behind and watches, but recently has been brighter and eager to attend school even when she is not feeling well. Her teacher, Mrs. Ncokazi Sylba-rose, has been supportive and has learned to recognize the symptoms that indicate when Nqobile should be with her mother.

The grass around the Rietvlei Primary School is tall enough to swallow some of its students. Like anything neglected, the school suffers; walls are cracked and peeling, windows are broken or missing altogether. Litter strewn from the rutted village road lurks in the grass.

Mrs. Sylba-rose has taught at the school since 1978. The 40-plus children sit three to a desk in her classroom. Nqobile sits in the second-row-center, nestled between a girl and a boy. Mrs. Sylba-rose commands attention from the noisy youngsters, directing them to write the lesson on the chalkboard in front of them.

One cannot tell just from looking that Nqobile has HIV. Although older, she is smaller than many; but her uniform is neat and clean, and she is just as mischievous. Mrs. Sylba-rose has made sure the little girl with the round face and bright eyes is treated like the others. Though the teacher has not disclosed Nqobile’s status to the class, many parents of the children have read about Nozuko and Nqobile in regional publications. Still, Nqobile has no problem with the other children, who treat her like any other classmate.

It is uncommon for a child with HIV to live as long as Nqobile, but it does happen for reasons not fully understood by experts. It could be that she is well cared for and has a good diet in a stable, loving environment. It could be that Nqobile’s physical constitution is more resilient to the virus, as her mother’s appears to be. Or it could be that elusive factor that has bewildered humankind for thousands of years: the spirit. Spiritual believers acknowledge that the gods work in mysterious ways sometimes, often through the most unlikely of messengers. That the information necessary to protect lives from a deadly disease comes from those afflicted may be one of those mysteries.

Nozuko and Nonjambulo, along with the staff at Rietvlei Hospital, relentless in their pursuit to provide HIV education, have targeted teachers at Rietvlei schools. Mrs. Sylba-rose has understood and absorbed the information, and now she not only passes it on to her own students, but, in the case of Nqobile, she puts those rules into practice.

"I teach the children that HIV/AIDS is an infectious disease and how someone gets affected, but I also teach them how to escape it, because in the beginning the children are afraid," she recites. "I also tell them that one who is HIV-positive must be accepted, even at home."

Nozuko and Nonjambulo also participate in the Good Start Program, based at University of Western Cape. They receive a stipend to follow up, monthly, on babies of village mothers for the first nine months of the baby’s life. On a sunny autumn day, Nozuko travels to a remote village near the Singisi Road to follow up on one of her five clients. It takes an hour to get there. Returning home from the journey, Nozuko breaks the silence with her trademark refrain, "I am sooooooo hungry!"

A clear sign that, for now, all is well.

November 2005, Umzimkulu

For Nozuko, her own little miracle is second only to that of her 11-year-old daughter. Nqobile started on ARVs in July 2004. The sickly child, who battled and hacked her way through each day for the past six years, now sashays through her granny’s house in slip-on plastic pink high heels and a flouncey skirt.

She has exchanged her economy of motion for a little bit of rhythm in every step, even some spontaneous jumping. She’s hot stuff and she knows it. Her last CD4 count of nearly a year ago was 338, up from 80.

Nozuko continues to counsel, now receiving a salary supplied by a foundation in Colombia, visiting the HIV-positive and their families. For World AIDS Day she will participate in an educational event at her home village, Singisi, and publicly disclose herself to the community for the fourth time. There’s still a lot of work to do, but Nozuko’s personal transformation has been remarkable.

Currently, Nozuko describes herself as happy. "Everything is good this way. I have my children and family to love and I feel that there is nothing to stop me from doing what I like." What has she not been able to achieve? Don’t ask her about her driver’s test results or romantic relationships. Do ask her about her CD4 count—it has risen to 739 in six months.

Susan Winters Cook

Susan Winters Cook is a former member of Mullica Hill (N.J.) Meeting. From 1981 to 1997 she was a staff photographer for the Philadelphia Daily News. She traveled to South Africa several times between 1988 and 1994 on her own, partially funded by Philadelphia Yearly Meeting, to document Quaker development and empowerment activities as a response to apartheid and then during the intense time of transition from apartheid to democracy. She began documenting the HIV/AIDS situation in 1995, then returned to South Africa in 1997 permanently. She started a provincial-based AIDS education periodical Ubomi (Xhosa for "Life") in 1997 out of a realization that "the people who needed the information the most were those most at risk—and that was the rural poor." She writes: "The real tragedy of AIDS in South Africa for me was, having seen what the parents endured and sacrificed to ensure a better future for their children, to discover that many of those young people would not live to accept that gift of freedom."