by Ashley Judd
At the time of our visit, between only 1 and 2 percent of the population of nineteen million was HIV-positive. That was the good news. The frightening news was that what little the Malagasy people knew about HIV was mostly rumor and misinformation. It reminded me of the United States in the early 1980s, when there was so much fear and such a terrible stigma attached to the virus that HIV carriers were afraid to be tested. But with the Malagasy government’s support, PSI was unleashing a massive social marketing campaign to educate the people about HIV/AIDS and how to prevent it.
Part of my job here was to use my high profile to crack open the social taboos surrounding HIV/AIDS and to find at least one HIV-positive Malagasy to go on television with me to put a human face on the epidemic for the first time. It took Tim Hobgood, PSI’s young country director, most of the week to track down a willing subject. The woman who had agreed to meet me wanted to back down, because she was afraid that if her relatives found out about her disease, they would reject her bones upon her death and she wouldn’t be buried with her ancestors. In the culture here, that is the same as being sent to hell for eternity. We had to keep trying to overcome the stigma: If people couldn’t even talk about the virus, how could they be educated about how to prevent it?
While we waited for Tim to work his magic, I had the distinct pleasure of visiting the clinic run by one of the many unsung heroes in the fight against HIV/AIDS, Dr. Rene Randrianga. Dr. Rene is a large man with skin the color of milk chocolate, wide cheekbones, and almond-shaped eyes that reflect the mélange of African and Asian ethnicities that make up the Malagasy people. Toss in the French language inherited from the island’s former colonizers, and the mix is complete. For ten years, Dr. Rene has provided health care and counseling to the capital’s prostituted women in an effort to keep them from contracting and spreading HIV. Two factors complicate the danger here: Many Malagasy consider it perfectly normal to have multiple sex partners, in or out of marriage. And this country has one of the world’s highest rates of sexually transmitted infections such as syphilis, and the open sores from these infections facilitate HIV transmission. The best solution available was education and condoms—and PSI was providing both. Dr. Rene would be our guide into the streets of Antananarivo, where—to make a terrible joke—the rubber literally meets the road.
That night, the skies opened up like spigots as we drove down dark, sloppy clay roads lined with tiny, ramshackle shacks until we arrived at our destination. As far as I could see, sidewalks were lined with pathetic tarps made from plastic rice sacks—they called them “rice tents”—where the poorest and most desperate women would lie down on the pavement with johns for as little as 15 cents a trick. That thing I was saying that I couldn’t be shocked anymore? Ha! This scene was unimaginable. I saw a man holding an infant in the rain as he supervised his wife, a prostitute, with a client in a nearby rice tent.
I got out of the car and from beneath a leaky umbrella called out, “Bonsoir!” as cheerfully as I could.
Dr. Rene’s smiling round face emerged from the waiting crowd. “Bonsoir!” he said. “And here are the girls!”
We had arranged a dry place to meet and talk. The women were so poor that no individual could afford to rent a room or even the dollar it cost to buy the sheets of plastic to cover the sidewalks where they worked. So two, three, or more went in together. That type of clustering was apparent as they swirled around me in pairs and threes to be introduced. I needed my local translator, Nouci, because none of these prostitutes spoke French, only Malagasy. The lovely Nouci was such a sweet, compassionate sister to have in these situations. She would always show such sensitivity in incredibly raw, delicate circumstances, and her abilities facilitated remarkably vulnerable conversations.
Everyone was smelly. Many of the people I meet on my trips had little opportunity to bathe. Sometimes the stench was overwhelming to the staff that came with me, but for some reason, I rarely had a problem with it. I like close contact with people, to touch and hug, and tangy, sour smells came with the territory. But this group tested even my gag reflexes—it was a different kind of odor, a homeless smell. The worst smelling was Nini, and she was also the most destroyed person I had met so far in my life. She—just barely—lived on the streets with her children. She told me she was about to have her fifth child any day now, and she’d already buried two of them. Her problems were an acute distillation of poverty, lack of education, gender inequality, preventable disease, unplanned pregnancy, and no way out. She never looked up, always holding her eyes in a dead, downward gaze. Even the abducted women of Cambodia and Thailand had something in their reserves that life in this country had drained out of Nini’s spirit. I would caress her, and something like the ghost of a smile, the memory of what a smile might have been in another life, would pass over part of her face, but never all of it, never completely.
We gave her some food, but Papa Jack saw an older woman take it from her, and we fretted for days over whether or not she might have gotten it back.
I asked the women if I could peek inside one of the makeshift rice tents, which were loosely attached to a piece of fencing for height, with a rock or piece of garbage holding the edge down to prevent the plastic from blowing away. I squatted and then crawled through the small opening, feeling how close, how stifling, the tiny space was. I knelt on the muddy plastic for a few moments, taking it in, observing, feeling. It was one of the darkest moments of my life. The ground was littered with torn foil packets and damp condoms—which in its own way was good news. The bad news was that I could not make conscious contact with God in that hellhole. I literally felt a rebuff, like a “not here” answer, that startled me badly.
There was a transcendent moment with this group of new friends, however, and that, coupled with the fact that I spent time with them over a number of days, has imprinted them into my soul. They had their babies with them, even though they were working, and one especially young prostitute let me hold her son, Patrick. Oh, boy. He did that thing babies do when they rest on your chest, then lift their heads a bit to consider the world but decide it’s not worth it, why bother with all that, when you can simply sigh and burrow into that safe place of shelter within the bosom. I nearly died on the spot. I began to sing to him a French Christmas carol—incongruous for January, but the words just came to me:
“Il est n’e le divin enfant, chantons tous son avènement.” He is born, the divine baby, and is that not what all babies are? A spark of the divine is in us all, immutable, incorruptible. My sisters on the street began to sing with me, and when we finished, the air was different, charged, sacred. We were outside of ourselves, outside of these lives, inside something wonderful and good, the love and promise a baby can make you feel.
We stood quietly for a long moment, then Dr. Rene began a lullaby. This great man had continuously declined other jobs, options, administrative work, raises, whatever, so he could stay with the least, the lost, the last. He deserves to be enshrined. Given the geometric movement of the HIV virus, it is impossible to estimate the number of lives he has saved by teaching high-risk groups and their clients about condoms and risk reduction. Even more immeasurable is the humanity, so delicate in these circumstances, he has kept alive with lullabies such as the one he sang for us that night.
Not far from the rice tents, on a larger, boulevard-style corner, a group of older, more seasoned prostituted women welcomed me. Among them was our peer educator and shining star of the streets, Sahouly. Plump and ebullient, with bright eyes and a toothy smile, Sahouly had trained herself to offer reproductive health and HIV prevention education, and Dr. Rene had worked hard to give her a sense of self-assurance and authority. PSI paid Sahouly a small salary, as we do all peer educators, but it was unfortunately not enough to allow her to reduce the required number of seven clients per night to feed her family and make ends—barely—meet. The price of a trick on the streets here, I was told, was the equivalent of a dollar with a condom, two without. It was Sahouly’s job to ke
ep herself safe and to explain to the others why the extra money wasn’t worth the risk.
The hotel where we were staying in Tana was under construction, with work on the floor below and the roof above my room, which for some odd reason had seventeen chairs in it. I woke up the next morning to a voice message from Dario, who called as he watched a nearly full moon rise that made him think of me. The sound of his voice made me emotional and weepy, as I’d been so lonely for him on this trip. And there were still nearly two weeks to go. I also wept as I remembered the man I had seen holding an infant as he supervised his prostituted wife while she serviced a client in a nearby rice tent. I wondered: What separates Dario and me, another married couple, from the grave misfortune of Malagasy I see all around me?
However, I also felt serene, having created a protected, peaceful space in the room, with an altar on which I put my incense for both harmony and love, powerful spiritual iconography such as a cross, some special stones, Nelson Mandela’s autobiography, and other resonating items. Moyra, Kate, and I blessed the space (and ourselves) with a deep yoga practice, concluding with a long prayer, which I dedicated to our teachers: the easy stuff, the hard stuff, the eternal stuff. But it was possible I was confusing serenity and low-grade depression.
Later that week, Sahouly invited me to her home. I was having a “bad” day, crying uncontrollably during our short lunch break back at the hotel. I had gone full fetal thinking about baby Patrick’s likely life, and it was only the sweetness of Sahouly’s offer that motivated me to peel myself by the ponytail off the mattress. I tried to dress, hardly able to see myself in the mirror for the tears, and played the outfit game, trying to choose something I thought she’d like. But the bow on my shirt hadn’t been ironed right and looked like a shoelace instead of a lovely ribbon, so I finally just put on Mamaw’s pearls. They’re the equivalent of my heavy artillery, and I bring them out when I am at my lowest and need her strength and guidance the most. It’s never failed.
Sahouly and her family lived in two very small rooms, dirty through no fault of her own, as the courtyard she shared with forty others was unpaved red, raw dirt that tracked unrelentingly. Her water source was a spigot not too far away, and she used our Sur’Eau water purification solution, to prevent diarrheal disease in her family. She had a suite of wooden furniture with no cushions and we sat directly on the slats, all except Dr. Rene, who rightly assumed the rickety pieces would not hold his weight. Her two girls sang a few songs for us, and we chatted about this and that. They both loved school, particularly math and science. They had no idea what their mother did to provide for them.
Sahouly had told us she’d turned to prostitution ten years ago to pay for the medical bills after one of the girls was gravely ill. Although her husband knew she turned tricks, her children thought she was just a counselor for PSI. After the visit, she took us into her crowded neighborhood to show us the stop where she caught the bus to the red-light district every night. Sometimes she met her quota of seven clients in time to catch the nine p.m. bus home, but more often she was stranded in town until service resumed at four a.m. Once home, she slept for a few hours, then did her day job: mother of three, wife of eighteen years.
Moyra and I had an extraordinary opportunity with Sahouly, and we seized it. We rode the bus with her to work, and I chuckled when she pointed out her in-laws’ shack, and we had a conversation so typical as to be ubiquitous: How do you get along with your mother-in-law? In town, she showed us her corner and walked us through what her night would be like, but as it was still daylight, after she traced for us what her typical nights were like, we found ourselves idle. Men would not be trolling for sex until after dark, and that was when Moyra and I hatched a plan. We invited Sahouly to our hotel room, where we could offer her a hot meal and a bath.
She’d never taken a bath before, and as we ran the water for her, we explained the concept, feeling so pleased when she stepped into the water, only to be surprised when she popped back out into the living room. We clearly hadn’t explained well enough. Relax, we said. Submerge your head underwater and let it all go. Fall asleep if you like. We ran the bath again after I cleaned the tub (her first dip, however brief, testified to her lack of running water at home) and gave her a bottle of beer. We didn’t see her for a long time, and while I took the second of my three showers, I thought of her down the hall, doing the same thing, united by this simple act and separated by so much.
Afterward, we ordered off the room service menu, and she left not a trace on her three plates of food, all of which was typical local fare. I had thought she might choose meat or other rarely accessed delicacies, but she went for the usual rice and pap gravy. When I scooted the bread and butter toward her, she ate that, too. Her hair was wet and fell in ringlets past her shoulders, and as she sat there, gorgeous, clean, in her bathrobe, I saw the change in her demeanor, the understanding in her eyes. She was here among her sisters, who honored her for who she was, the shining star Sahouly, a woman of stunning potential.
When we returned to the red-light district, Sahouly took us to a peer education session in a small room in a brothel. All the women sat on the floor, chatting animatedly, legs draped over one another’s, interrupting, talking over one another, answering one another’s questions before Sahouly or Dr. Rene had a chance to chime in. They had already learned a lot in the program but still had lot of questions, including HIV risks to pregnant women. This topic allowed me to delicately introduce an idea I had longed to bring up: being tested. But I knew I had to handle it with exquisite care or I’d blow it.
Veronica, a prostituted woman who was six months pregnant, was my entrée. Moyra, a mother of two, had picked up on how anxious she was about the health of her baby. Dr. Rene and I talked to her about mother-to-child transmission and how critical it is to know your status, and also about syphilis, which causes birth defects. Then I pounced: “Why don’t you and I go to the public health clinic tomorrow to be tested?” She said yes. On a roll, I asked others. Five of them said they would. I couldn’t believe it. As I sat there trying so hard not to roar with joy, they bickered among themselves about the time and finally settled on three p.m., plenty of time to grab a little sleep after a night’s work and tend to the kids. Our group dispersed into the night, and my satisfaction melted into worry about attrition and who, out of fear, would blow it off and not show up.
To our delight, not five but seven from Sahouly’s group showed up to be tested for HIV, some with their children in tow. While we ate pizza, I asked if the women would prefer to wait to discuss our tests at the center, out of earshot of the café staff, because the taboo was so extreme. Again this remarkable group of strong women surprised me: They didn’t mind discussing it one bit. We talked about Nini, the pregnant homeless woman from the rice tents, whom I was hoping to get tested with us. Even though Dr. Rene had scoured the streets to bring her here today, he had not been able to find her. I was afraid she might have vanished forever.
After eating, we gathered in the waiting room of Dr. Rene’s clinic to have our blood drawn. It was a little awkward when the time came, so I shot my hand in the air like an eager schoolgirl and volunteered to go first. By this time I’d had so much blood drawn at clinics and voluntary testing centers that I should have had a tap attached to my inner elbow. Moyra, who is afraid of needles, declined the invitation, but she dug deep to sit by Veronica’s side and held her hand through the test.
When it was over, I was more than disappointed to learn we could not get the rapid results we expected. There was equipment available that could get results in minutes, but it was not at the clinic that day. The quick test is so important, because 35 percent of all people who are tested do not return to find out the results. But we were forced to wait in suspense for another twenty-four hours. We hugged and kissed and bade farewell again. I wondered if they would all have the courage to come back to face their status.
Meanwhile, a woman named Annie who had AIDS and might be willing to talk abo
ut her condition on television—as long as her identity was disguised—had been located in town. She was terrified that her neighbors would kill her if they found out she had the disease, so we agreed to meet in a café far away from her home.
To get there we walked a narrow red dusty street lined with little shops selling small goods. The businesses here were tinier than the stands in American parks where you can buy a pop or snow cone, barely big enough for a person to work behind the rough wood counter. We found Annie sitting in a café patio. She was a tiny, lovely-looking woman, terribly frail and missing some teeth but quick to smile and giggle. She ordered a glass of milk and, speaking through Nouci, told me her husband was also infected, and they didn’t know who had given it to whom. Their kids were eleven and fourteen and didn’t know the family secret. Only Annie’s husband and mother knew her condition.
She explained that she had a message for her people: be wise. AIDS is here, and it is not something the Americans made up as a reason to spend money—which was one of the rumors going around. AIDS will infect and kill you if you don’t prevent it in yourself and your family, she said. Unfortunately, she had decided she would not repeat this message on television. It was too dangerous for herself, her family, and her place with her ancestors. Annie was afraid she wouldn’t live to see the day when people could talk openly about the virus. She was sure she would be dead in a year. I tried to rebuke that fear and reached out and rubbed her neck as she bit back her tears. Then she looked at Nouci and asked, “Isn’t she afraid to catch my disease?”