Alistair Martin is a Sydney native who also has strong ties with Cape Town. HIV-positive for 17 years, he has watched the epidemic unfold on both continents. Health24 journalist Olivia Rose-Innes spoke to Alistair about his experiences.
Olivia: The Australian response in the early years of the epidemic seems to have been exemplary in contrast with South Africa's dismally slow and ineffective start. In fact, Australia's been held up as a model other countries should consider following. Do you agree, or does Australia's response just seem commendable relative to places like South Africa?
Alistair: Australia's wasn't one united response. Firstly, in the early years the general tone of the media was fearful and sensationalist, and the church's judgmental and uncaring - so much so that some gay men demonstrated by throwing red paint over the front doors of Sydney's catholic cathedral. Of course there were more enlightened people working in both institutions, but it was unquestionably a battle against some institutions and powerful groups who weren't the least concerned that poofters were dying young.
Secondly, each Australian state is responsible for its own health care expenditure and policy. For Sydney, that was New South Wales, which had a centre-left government that was working in the dark. All we knew in those days was that gay men in certain parts of America had suddenly begun to die. As I remember it, the government didn't really know how to respond to AIDS, so it gave resources to a group of volunteers (mostly gay men) who had already begun to organise a response. They were supporting the sick, distributing information, informing people of their legal rights, pushing for political change.
The government funded this group, telling them to develop policy for the New South Wales health service. The vast majority of positive people were gay men, but the organisation was open to all who needed it. (Years later right-wing Christians - unaware of the history, I guess - complained that the homosexuals had taken over the organisation!)
So what can South Africa learn from how Sydney handled the crisis?
Grass roots empowerment. HIV/AIDS spreads best when there is ignorance, fear and segregation.
What was the social climate like growing up gay in Sydney in the 70s and 80s?
A mixture... School was tough: daily verbal abuse, regular physical violence. I estimate that that distraction in my education set me back the best part of ten years. And I grew up in the narrow, religious world of the Salvation Army, so coming out of the gay closet was liberating, not only regarding sexuality, but in terms of how I saw life and related to individuals. Overall it was very exciting; I was amazed and delighted by the possibilities.
That innocence only lasted a few years, then AIDS wiped the gloss off things and life became uncertain and confusing.
Do you remember the first time you heard about the virus?
Yes, I was on holiday in America; I met a man from Chicago who spoke about 'gay cancer' and warned me not to have sex with anyone from New York or San Francisco. Men were apparently falling sick. They didn't know why, but there were all kinds of rumours. When I got back to Australia I made a point of watching the media for information, but there was almost nothing. And I remember that in Sydney, people often didn't want to have sex with Americans, and the right wing was calling for bans on gay Americans visiting the country.
During those days in Australia, AIDS was all about gay America, not Africans and Africa.
What was it like finding out you were HIV-positive?
Shocking. Completely bewildering. Completely disempowering. The doctor who told me my test results said I had a maximum six years to live. He suggested I give up university and go off and do what I wanted. I didn't understand him. After all those years struggling to get an education, university was just what I wanted to do. He took more blood for a test to confirm the results. When I returned for the results he apologised, saying there had been a mix-up and I wasn't positive after all… He took more blood for yet another test to confirm the new result, and I skipped all the way home!
Two weeks later there was a note in my letter-box asking me to call in at the surgery.
"No, I'm sorry, you are positive. You do have HIV," he told me.
I dragged myself home, feeling the weight of living-death pressing all around me. I changed doctors.
During all this I was what was then called the 'sexuality officer' at university. My position was to enlighten the student body of 20,000 about human sexuality, and to inform them of the issues surrounding HIV and what constituted safe sex. I felt a little foolish...
I found it difficult to tell anyone I was positive – and not telling became a habit. I waited eight years to tell my siblings in Australia, and, a few weeks later, friends in South Africa. The next year I went to Australia to tell my parents. There was a lot of conservative religious fear to confront – real and imagined. And over the years, to protect myself, I'd built high walls of silence around my emotions and my HIV status.
But I had to break out in order to live: I was choking on the words I couldn't say, and suffocating in a closet which confined and stifled life. This second closet was much more difficult – for me – to leave than the gay one.
Over those years my parents too had shifted ground, and were ready to hear the news and offer unconditional love, which was a very important part in the emotional healing surrounding the disease.
With those efforts, years of living with underlying stress and fear finally dropped away. And slowly I began to realise that HIV had brought more than just trauma, fear and an increased sense of victimisation.
What brought you to Cape Town, and how did it compare with Sydney?
I was drawn there because the most friendly, warm and embracing people in my teenage years in Australia had been South African immigrants from Cape Town. I arrived six weeks before the '94 election for a holiday. Then returned a year later, remaining on-and-off for three years. Since then I've returned every year to see friends and feel Africa between my toes.
Australia's society is economically rich and socially poor. People work hard and the material standard of living is generally high outside the Aboriginal population. Socially it's a clumsy place. People knock each other about, as if they were all living on a busy, crowded street.
And it's a conservative place. Not so much out of deeply held fears, as in America, rather more from a lack of imagination and carelessness. The country's situation was referred to by one writer as a "crippling slumber".
South Africa felt like a home-coming. The many similarities between the two countries, but mostly the warm welcome and social ease of South Africans - compared to narky Australian cynicism - was delightful.
Ah! And Evita Bezuidenhout! I was fascinated by her! The way she sought to educate. Amazing! In Sydney gay men had the condom-distributing Safe-Sex-Sluts, and the hetros had the Hookers for Christ…well… you can imagine there was little chance of broad social influence! The different approaches of Evita and the condom-distributing Sluts and Hookers in Sydney also highlight the differences between the two countries' HIV/AIDS experience. AIDS in South Africa is a national disaster - Australia's concern is mainly with HIV, which is still contained, to a greater or lesser extent, among gay men.
The Australian government and the country's wealthier institutions were in a good position to respond to HIV and human need. Things were more fragile for everyone in South Africa.
While gay blokes in Australia had largely accepted concepts of safe sex and were busy playing hide-the-sausage with each other, my impression of gay South African men when I first arrived was that they seemed less well informed, and much more sexually withdrawn.
Yet several South Africans played important roles during those first years in Cape Town, in helping me come to terms with HIV. I had a relationship with one South African who, on our second date, did something which, during years of dating in Australia, had never ever happened - he disclosed his HIV status to me. And he did it with such ease and caring-truth that I began to fall in love with him. He inspired me to grow, to mature with HIV, and stop pretending it wasn't there.
How has living with HIV changed for you over the years since you became aware of your status?
Physically I've learnt to listen to my body. To be conscious when it's struggling, and respond with what it needs, not just in serious matters of HIV, but general health.
Another South African friend was very important in this process. He was studying Ayurveda and helped me see the benefits in reclaiming my body from years of doctors, blood tests and drug trials. I stopped taking western medication for over a year, and took up some Ayurvedic practices, which I wouldn't have heard about in Australia. Almost two years later I was ready to gently move back to western medicine - but on my own terms!
On the day I was to begin taking the drugs again I invited friends over for dinner and asked them to bring their favourite pill - given that it was a week night most brought vitamins. After dinner I brought in a tray carrying the bottles of new medication and several burning candles. I was nervous about taking such toxic drugs again, and so with the candles I was focused on the 'healing light' they would bring to my body. I described the different pills and then invited everyone to join me in a toast to life - we raised our glasses and swallowed. But the greatest changes have been psychological and emotional.
Having HIV has pushed me to consider and change almost every relationship in my life. Most importantly for me, I found a way - with the help of many people – to use the presence of HIV to live more truly.
I now find myself living a comfortable, secure life in which I do not feel currently threatened by HIV. I know this is not the experience of most. When I'm in South Africa I can't help but be faced by another reality. It's a surreal experience sometimes - apparently living peacefully with HIV when others are shattered and struggling not to die.
My experience with HIV – and South Africa's too - shows that it's not just about having condoms in critical moments. HIV thrives where there's a lack of self worth and love, where people feel like victims and/or commodities. These formed some of the foundations which ensured I was fertile ground for HIV 17 years ago. The process of healing these emotional lacks became the basis on which - with the help of many people - I've built a happy and healthy life.
It's the same for South Africa. Years ago, as a young gay man in Sydney, I would never have thought it possible that HIV could be a force for positive change. But I know that now. When these changes come – and they will – they'll come through the hearts and minds of a majority of individual South Africans.
- Health24, updated May 2009
Gay, lesbian and bisexual expert