Sizwe's Test: A Young Man's Journey Through Africa's AIDS Epidemic

by Jonny Steinberg

The award-winning author of The Number explores the perspectives of HIV-positive villagers in rural South Africa, revealing the cultural misunderstandings, superstitions, and stigmas that compel people to refuse free treatment and challenge efforts to stop the spread of AIDS. 35,000 first printing.

Genres: Nonfiction, Africa, South Africa, History, Science, School, Travel

349 pages, Hardcover

First published February 12, 2008

Reviews

[Kitty G Books · Rating 4 out of 5]

I'd give this a solid 4*s overall as I found the writing in this book to be pretty approachable and intriguing. This is a non-fiction story about Jonny Steinberg's travels to South Africa and his time meeting a local resident and shadowing some health professionals such as Dr. Herman Reuter who worked for Medecins Sans Frontieres (Doctor's Without Borders).

The story takes place mostly during the early 2000s, and Steinberg (a young gay man himself) was interested in learning about the shadow and hopes AIDs and HIV brought to the country. It focuses mostly on South Africa's Eastern Cape and a village called Ithanga, a very isolated area far from most of the MSF clinics set up to help treat AIDs and HIV, so many of the people within the village either resent, are afraid of, or are bemused by the idea of white doctors coming over with drugs to treat illnesses that they have only seen killing people.

The book is largely told from Jonny's perspective, but we do get a few interviews and moments with Sizwe, a young black man who is a shop owner and who is pretty skeptical of HIV testing and treatment in general. He's a fairly standard example of most locals, and Steinberg finds his views on life, death and everything in between to be fascinating.

One of the interesting things I enjoyed about this book were the moments of facts vs the moments of anecdote and story. This certainly felt to me like it was telling you a story of a village and the slowly (but noticeably) shifting viewpoints, but it also felt very readable when the factual moments popped in too. Sometimes I feel like non-fiction leans too heavily on fact, but I think this does have a good balance of fact and anecdote, to really tell you the viewpoints of the people living through what is - essentially - an AIDs epidemic.

Overall, a very solid read and one I am happy I picked up becuase of this prize. I would definitely recommend it if you're interested in the topic of HIV and AIDs yourself. 4*s

[Sipho Lukhele · Rating 4 out of 5]

I picked up the book as I thought I do not know enough about HIV/Aids. I am glad I did so as I have learned a great deal and among other thing's, I learned what the CD4 count is all about. Nothing this important aspect regarding the virus opened a whole new world.

I was one of those who defended the former president Mbeki's stance on HIV/Aids. This I did as I thought he was looking out for a whole country. I thought he was fully informed and better place to make an important call on the virus. Well, having read what Jonny penned, through an eye of a young native based in the remote area in the Eastern Cape, South Africa; I thought the former leader could have done better.

There are many faces to this epidemic. This book is very well written and I am looking forward to reading Steinberg's work. What a brilliant writer.

[J.L. · Rating 5 out of 5]

Johnny Steinberg traveled around a small 40-mile radius with a black South African in the Eastern Cape, exploring the concept of male shame and trying to explain why black men aren't getting tested for HIV in South Africa. His explaination is, ultimately, deep and brilliant--but definitely hidden in the pages, so you do have to read the entire book to get it. But it's an easy read and a fun read. If you're interested in South Africa, especially South Africa in a post-apartheid age, this is a book you must read.

[Annie Holmes]

I think it's called Sizwe's Test in the U.S. 100% recommended. As remarkable for the writing and thinking as for the subject - or, rather, the subjects: HIV/AIDS, culture and tradition, South Africa, race, gender, heath systems, how to write creative non-fiction. I couldn't stop reading, finished it on two consecutive flights.

[Dillon · Rating 5 out of 5]

Steinberg goes to a rural South African village, where electricity is a luxury and TVs and Cars are nearly non-existent, to try to determine what creates the stigma around HIV/AIDS, and why someone would refuse to take anti-retroviral drugs that could potentially save them when they are so readily available. The story follows Hermann Reuter, a white doctor who is determined that everyone will take ARVs so long as the drugs are consistently available in close proximity to the people in need, and Sizwe Magadla, a local spaza store owner, who is currently settled down to marry the mother of his yet born son, but has had many sexual partners, and is afraid to get tested for the disease.

The book follows mostly Steinberg and Sizwe, as Steinberg attempts to understand the fear, anxiety and shame Sizwe and other residents feel towards the disease, the medicines and the cause of the illness. Sizwe becomes Steinberg’s interpreter as Steinberg interviews local clinic works and home health aides. Through these meetings, Sizwe begins to see the myths from the realities, while not completely believing the westerner nor his traditional beliefs. It is truly a great book for anyone who is interested in HIV/AIDS in South Africa or Africa in general. NOTE: It is not a history of the HIV/AIDS epidemic in Africa, it doesn’t discuss the causes of the spread, nor the international struggle with funding, drugs distribution, etc. People looking for a macro level discussion will be disappointed even though it wasn’t the books intention.

[AJ Payne · Rating 4 out of 5]

This review is actually for the non-US version of this book "Three Letter Plague." I don't think there are any differences between the two versions though, other than the title and probably the spelling of some words that differ from American English!

This one is a fascinating look, on a micro level, the politics and social implications of HIV testing in rural South Africa, and the realities of rural health care.

I really liked getting to know the people of the story, and how they live and how they see the world, including how they marry the traditional with the modern. This one is not an overall look at HIV and stigma and the epidemic in South Africa - it only looks at one small corner of one corner of South Africa - so you can't expect it to give you that, but it does give you a very personal view of how one young adult approaches HIV (and the ultimate question of whether or not to test), and the health system that exists that could support him.

This is a great addition to HIV/AIDS literature that often doesn't give you a detailed psychological picture of one person and the world in which that person lives - often you see macrolevel analysis, or superficial case studies. This is neither of those, and goes very deep into the life of the subject. Definitely recommended reading for people interested in the African (and specifically South African) HIV epidemic.

[Laura · Rating 4 out of 5]

Wow! This book, so far, is very good. It is a non-fiction story following a 29 year old South African trying to make the decision whether or not to get tested for HIV. To an American, it may seem absurd that one would not get tested, although in some ways the social stigma is still there. But in Africa, making this sort of decision is woven with many other fibers, ones most Americans will never experience. Fibers of witchcraft, revenge, financial ruin, myths and false truths.

Very eye opening, and I am only 50 pages into the book!

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As stated previously, I thoroughly enjoyed this book. There were parts that dragged a little...descriptions of Doctors Without Borders and the history and background of this and other medical organizations...but I believe they were necessary. What really struck me came at the end of the book, though; page 293 in my edition. A great book about race relations and apartheid, education, a broken health system, & social stigmas.

[Alicen · Rating 3 out of 5]

An interesting take on the HIV/AIDS epidemic in South Africa from the perspective of one man and, through him, his community told by a journalist. Is a good reads as it humanizes many aspects of the epidemic, but falls short of being great due to what feels like the author's confusion as to why he decided to tell this young man's story in the first place.

[Jean Grant · Rating 5 out of 5]

A stunning accomplishment, so subtle. I woke up early to read it. Stayed up late. It's the kind of book which makes me wish I didn't give 5-stars so readily, as so many of them, compared to this book, are only 4s.

Love Steinberg's imaginative use of language, sometimes old-fashioned but the rhythm moves one along.

[Monica · Rating 5 out of 5]

Very compelling, approachable (nonfiction) account about AIDS in South Africa written by a South African journalist. This book tells the story of a young man who, despite knowing about HIV and learning about the benefits of antiretroviral treatment, remains afraid to get tested so that he can learn his own status. Steinberg does a great job of unpacking the personal, familial, cultural, and historical factors that, for rural black South Africans, contributes to the AIDS stigma that continues to drive people away from testing and treatment for what is now a highly treatable disease. Very well written and very moving.

Note: I bought this book in the late 2000s in South Africa, where it is known by the original title, “Three Letter Plague”. It has sat on my shelf since that time until now, when I finally picked it up to read it. Why did I wait so long?! Will definitely be looking for more books by this author.

[Grace · Rating 3 out of 5]

3.5…I think it could have been better if it was a bit shorter. I think this is likely because I read it for a class and just wanted to get through it. But it was pretty good. The writing for the most part was easy to follow and entertaining. It mention male genitalia much more than I would have guessed (I don’t know what I was thinking it’s literally about HIV). But I feel enlightened about the issue of HIV/AIDS in Africa, particularly in South Africa where this book focuses. I do like how the author is able to connect the health care system and stigma issues to the influence of Apartheid.

[Rachel Iwaniw · Rating 3 out of 5]

I really like the messages pushed in this story and it provides an important context to the conversation of aids in south africa. I do think that the author tends to get a little psychoanalytical even about things that don’t add to the story, and the organization is not great - each chapter jumps back and forth between very different ideas. While I really enjoyed certain parts of this book I wasn’t left loving it overall.

[Bat · Rating 5 out of 5]

That rare kind of non-fiction that you can't put down. I was really there in Ithanga with Jonny. The emotional intelligence of the writing and the way it takes time to note and explore the interpersonal minutiae of both the narrator and other characters is really what makes this book. And the reader certainly learns an immense amount.

[Mrs. Danvers · Rating 4 out of 5]

I've been reading so much history, written about groups of people in the past, written with a goal to tie up the narrative neatly by the end, that this book kind of took me by surprise. Steinberg does try to find the universal in the personal, but for me, letting Sizwe be Sizwe and not an emblem of a generation or of men in Sub-Saharan Africa is more helpful and interesting.

[Izabella Britten · Rating 4 out of 5]

I feel as though I was left on a cliffhanger. However I really did enjoy this book, it was very informative! It showed a glimpse into the rural lives in South Africa which was very informative and interesting to read about. Certainly not a topic that is written about a lot and had a lot of really good insights.

[Jennie · Rating 3 out of 5]

Having hiked many of the hills in Pondoland, this book resonated with my experiences of the geography and villagers, but the author steps into the kraals and rondawels to reveal the thoughts and fears of the Mpondo people. His writing is eloquent.

[Nancy Mcdaniel · Rating 2 out of 5]

I quit at age 167
Just couldn't get into it altho I loved Steinberg's other book Man of Good Hope

[Mareaa · Rating 5 out of 5]

One of the best books I have ever read.

[Rae]

AIDS/HIV. South Africa. Tribal traditions. Western medicine. Sobering.

[Colleen · Rating 5 out of 5]

Like others of Steinberg's books, this provides an insight into the thinking not just of the young man of the title, but others in his family and community. While the story is predominantly based on interview Steinberg did with him, in English rather than the language of the community, the journey of those navigating the AIDS/HIV epidemic is compassionately told.

[David J. Kleinhans · Rating 4 out of 5]

This was quite the insightful read. Steinberg is such an amazing author, he covers every angle and communicates it in such a beautiful litterary style. Steinberg tells the story of HIV in South Africa by following one person, situating it within the complex web of South Africa's social history. On the one hand this book is about HIV, but on the other, it is much more than that, it gives you a glimpse into the life of South Africa.

[Sandra · Rating 5 out of 5]

Jonny Steinberg clearly and humanely presents the dilemma facing Siswe, one of thousands of South Africans who face what Westerners regard as the essential HIV test.

Partly in response to the South African government's inaction and dismissal of the pandemic of HIV and AIDS, Medecins Sans Frontiers establishes a program to educate villagers about HIV and to disseminate ARVs. Testing seems an obvious choice to Jonny and Dr. Hermann Reuter (of MSF): If Sizwe takes the test and has positive results, he will be prescribed ARVs that will keep him healthy and able to support his family.

But Sizwe fears his village's reaction. A positive HIV result brings disdain: he's witnessed it himself when others have tested. Everyone knows that those who don't emerge quickly after receiving their results are being counseled so they can deal with their illness.

If Sizwe tests positive, it's likely that he'll lose the clientele he's built up for his shop. He also knows that if he dies, his family will seize his hard-won earnings instead of taking care of his young son.

There are also fears that westerners have discovered a cure for AIDS and are deliberately holding it back from Africans. If this seems far-fetched, think of how many conspiracy theories are churning around the internet, from Princess Diana's death to speculations about 9/11.

Having worked in Kenya, I can attest to the deep divide between accepting western medicine and traditional reliance on the herb doctors. Chinua Achebe captures a similar this division (over religion) in The River Between.

Jonny Steinberg discusses this Sizwe's vacillation (he wants to test but he daren't) with great sensitivity, compassion, and intelligence. He even includes a discussion with Sizwe: by telling Jonny "black secrets", has Sizwe betrayed his people?

I couldn't put this book down. It's an enlightening journey, at least for this reader. Jonny also includes a booklist for further reading.

Can't wait to read the next Steinberg!

[Lindsay · Rating 3 out of 5]

The book I was most reminded of while reading this book is "Witches, Westerners, and HIV" by Alexander Rodlach. Both are really informative and well-written, and get at the heart of stigma and shame experienced by many people who are either HIV positive or are unwilling to be tested. "Sizwe's Test" deals more with the latter, and differs from Rodlach's book in that instead of detailing the experiences of a whole village or region, Steinberg chooses to present what is, for all intents and purposes, a case study. This is a very compelling way of dealing with the subject, as it relates Sizwe's very personal and specific experiences, which adds a new dimension to the topic.

This book does a very good job of covering a lot of ground in a fairly concise way. At only 326 pages, it does manage to touch on a lot of elements of why someone would essentially choose to die when life-saving medication and testing facilities are right around the corner. However, despite the fact that this is a short, clearly written book, I felt like it took me forever to get through it. I didn't really get pulled into the narrative, and I think that one of the advantages to doing a case study is that readers can feel that they really get to know the person being written about. I didn't really feel like I got that from this book, though, and I didn't feel as compelled to read it as I expected.

A very eye-opening read, and one that I enjoyed, but didn't quite live up to my high expectations. 3.5 stars.

[AJ Payne · Rating 4 out of 5]

This one is a fascinating look, on a micro level, the politics and social implications of HIV testing in rural South Africa, and the realities of rural health care.

I really liked getting to know the people of the story, and how they live and how they see the world, including how they marry the traditional with the modern. This one is not an overall look at HIV and stigma and the epidemic in South Africa - it only looks at one small corner of one corner of South Africa - so you can't expect it to give you that, but it does give you a very personal view of how one young adult approaches HIV (and the ultimate question of whether or not to test), and the health system that exists that could support him.

This is a great addition to HIV/AIDS literature that often doesn't give you a detailed psychological picture of one person and the world in which that person lives - often you see macrolevel analysis, or superficial case studies. This is neither of those, and goes very deep into the life of the subject. Definitely recommended reading for people interested in the African (and specifically South African) HIV epidemic.

[Hamad · Rating 2 out of 5]

Although this is a quick and easy read, I still found myself nodding off to sleep every time I opened it. Apart from its sleep-inducing qualities, it is quite interesting from a health-behavior seeking perspective. In South Africa, the book is known as 'The Three-Letter Plague', which I like better as a title.

According to Alena, the summary:

Whine, whine, whine...I'm not getting an HIV test...whine, whine, whine...Should I get tested...whine, whine, whine...what would people say?...whine, whine, whine...I'm gay...ooops...whine, whine, whine...no one actually ends up getting tested...the end.

All jokes aside, it does seem to stretch a bit with its HIV exceptionalism, and I understand the whole stigma deal, but it is a disease and we should move on. What I did like about the book were its anthropological aspects. It showed the evolution of Zulu culture and inter-relationships between the generations.

So, in all it was an interesting read, but skimping is encouraged.

[Sunflower · Rating 4 out of 5]

This is a book about HIV and Africa. It is a book about "black people's secrets" and why people don't get tested or get treatment when they can. When I bought this book, the white South African that sold it to me almost threw it across the counter and said "Enjoy your holiday", but the tone implied that he thought it was inappropriate for me to be reading this. I wanted to say that I wasn't on holiday, I was working, but thought perhaps there are "white people's secrets" around this too.
Interesting for the individual stories of those involved, a wider perspective on the management of an epidemic in a third world setting, and for the author's analysis of the reasons behind his subject's actions.

[Garrett · Rating 4 out of 5]

This was a well researched story examining the reasons people do or do not decide to test for HIV and/or start HIV treatment through the eyes of Sizwe and a pioneering doctor from MSF (Doctors Without Borders). For me, it was a good reminder of what we're up against in trying to combat the spread of HIV, and a reminder that we need to be singularly focused on addressing the barriers to testing and treatment. Some barriers are are systematic, others are deeply personal and cultural. Finding ways to address those personal and cultural barriers, to me, seems to remain the biggest challenge of all.

A good read for anyone trying to understand the challenges of treating HIV in Sub-Saharan Africa. Sizwe could definitely be a Swazi citizen, for sure.

[Julia Hill · Rating 4 out of 5]

For those unfamiliar with the complexities of providing AIDS treatment, even when medicines are freely available, Steinberg's book uses the story of a young man named Sizwe to illustrate the challenges that stigma, personality, ignorance and location play in limiting access to HIV testing and treatment. Doctors Without Borders' Lusikisiki program features prominently, as do the personal efforts of a community health care worker. The picture seems a bit grim from where it is told, focusing on why a man who could access an HIV test refuses to do so. By focusing on a single personal choice, it fails to consider very deeply a wider problem: how in many places, people don't even have the choice to treat or not.

[Olwethu Nqevu · Rating 5 out of 5]

This books ticks all the boxes for me. I have read it for way more than anybody ever reads a book, way more than I should have. I was avoiding having to restart it. In one go, I have bushed it.

I was thrilled by Steinberg's research and honesty throughout the book. With my paternal family in Lusikisiki I found myself relating completely to the book contents.

Having spent some time in the area around the time he was there (although I did not know him nor have met him) I can't help shake the feeling I know some of the people he is trying to convey through his work. But that could just be my mind overpowering me :-)

I love this book and since it relates to me in so many ways, it will be mine for a very long time coming, I will need it it for referencing :-)

[Jrohde · Rating 5 out of 5]

An insightful and incredible study of the HIV epidemic and the difficulty of applying traditional medical models to both diagnosis and treatment. Spell binding and an absolute must for all persons working with HIV in Africa

Merged review:

this is the most insightful and illuminating book I have read about the cultural antecedents of HIV in So Africa. A MUST read for anyone trying to understand the extent of this epidemic and why it is so bad in southern africa compared to anywhere else. It had the added interest of describing an area where I have worked in Eastern Cape and with people (Dr Hermann Reuter of MSF) who I know and respect. a really fine book full of insight