Resource Title

Three Letter Plague


This book is about the cultural obstacles, misunderstandings and stigma that, especially in rural the areas that challenge the efforts to tackle the very high HIV rate in South Africa. Although the country has rapidly increased activities to achieve universal access to HIV prevention and treatment, which has lowered the infection rate in some age groups, there remain 5.6 million people living with the virus.

Resource Details


This is the story of 30-year-old Siwze (not his real name) who lives in the small village of Ithanga in the Eastern Cape, South Africa. Most of the few hundred villagers are unemployed, but Siwze runs his own busy convenience shop. He is due to be married soon and is expecting a baby. All seems to be going his way but darkness hangs over him. Although obviously an intelligent man who has made the best of his life, he refuses to be tested for HIV, despite his risky past and the existence of a well-run testing and anti-retroviral programme in his area.

So why won’t Siwze and millions like him get tested? This is the crux of Steinberg’s book and by hanging out with Siwze he slowly teases out the answers. One of the reasons is that Siwze is still influenced by old traditions and beliefs. He is aware that HIV is a viral infection that can be tested for and treated, but deep down he also believes he may get sick and die because he has failed his ancestors or angered a neighbour. Siwze reveals that if you go to get tested people are watching you to see if you emerge right away or an hour later. There is a fear of the disease, and the unspoken belief of sickness as some kind of bewitchment. At the same time he urges a sick relative to get tested and start treatment and is pragmatic in the help he offers her.

Dr Hermann Reuter and his army of Treatment Action Campaign activists are running the testing and treatment centre in Ithanga. Although, they are doing a great job there remains suspicion about this white doctor. Is he actually infecting people when he tests them? This may all sound odd, but when you consider that ten years ago the then President Thabo Mbeki denied that HIV even existed. Mbeki became a champion for a small but vocal minority of medical opinion which believes that HIV does not cause AIDS. Despite international outcry from 2000 to 2005, South Africa declined to roll out adequate antiretroviral therapy and it is estimated that because of this 350,000 people died unnecessarily.

Among other reasons not to test is a simple one – Siwze does not want to rock the boat, his life is going well, he does not want to know his status because if he is positive he knows he will lose the will to go on. He knows he can get treatment but he can’t get his head around the fact that he will feel like his life is over. At first Steinberg is frustrated and even angry with him. But in the end once he is honest and looks at his own past he begins to understand this basic need to stick your head in the sand. When a problem seems so big it is easier to not deal with it. At least this is how I understand why Sizwe would not go for testing. It shows us how you cannot use logic to predict people’s behaviour.

There is hope in South Africa as anyone who goes there will tell you. Slowly, testing and treatment are becoming normal. Every day roughly 800 South Africans die of AIDS, but this should change. This book has highlighted why current attempts to get people tested need to be changed to take into account people’s natural fear.

About the Author

Jonny Steinberg is one of the most important non-fiction writers in South Africa today having carved out a niche for himself writing about policing and crime, and in his latest book one of his country’s biggest issues -HIV and AIDS.

Born in Johannesburg in 1970 he studied at the University of the Witwatersrand before obtaining a scholarship to Oxford. In the late nineties he returned to South Africa to work as a journalist. He wrote his first book ‘Midlands’ in 2001, which was about the murder of a white farmer in 1999 and explored tensions in post-apartheid South Africa. His second book, ‘The Number’, followed in 2004 and told the true story of the life of a prisoner in the notorious Pollsmor Prison in Cape Town. Both books were awarded The Sunday Times/Alan Patent Award for Non-fiction.

In ‘Three Letter Plague’ Jonny Steinberg undertakes to clarify why the problem is particularly bad in his country. Explaining why he wrote it he said: ‘When people die en masse within walking distance of treatment, my inclination is to believe that there must be a mistake somewhere, a mismatch between institutions and people. This book is a quest to discover whether I am right’

Review by Mary McCarthy who is currently living in South Africa. Previously, she worked as a journalist in Dublin for five years. Her most recent post in Ireland was with RTE reporting business news and writing reviews for the broadcaster’s entertainment website.