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AIDS puts extra burden on poor

Colin Powell today visits South Africa, where he will view scale of epidemic that has a nation in mourning.

By Nicole Itano Special to the Christian Science Monitor / May 25, 2001



JOHANNESBURG, SOUTH AFRICA

Standing in the immaculate living room of her suburban Johannesburg home, Marion Kotzee points to two empty coffins.

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One, dark brown with golden plastic handles, is the new, patented cardboard coffin she began marketing in local townships in March. The other, unpainted and crudely wrought out of wood, is a traditional pauper's coffin. The cardboard one, surprisingly, looks the sturdier of the two.

"I know that people want to bury their loved ones in the best way possible, but if I can provide a nice-looking coffin for cheaper, then I'm providing a service," says Ms. Kotzee, explaining that once mass production begins, her coffins will retail for around $12, less than half the price of the wooden one.

Even at somewhat initial high prices, her coffins are selling well.

With AIDS deaths placing an enormous financial burden on families, South Africans are increasingly embracing burial practices like cremation and Kotzee's cardboard coffin that violate deeply held cultural beliefs. The trends indicate the ways in which AIDS and poverty are subtly changing the fabric of social life.

Visiting here today as part of a four-nation African tour, US Secretary of State Colin Powell will tour a South African AIDS clinic to observe first-hand the scale of the epidemic. What Mr. Powell is unlikely to see during his brief visit is the financial and emotional toll AIDS deaths are taking on families.

Kotzee and her five associates, all white Afrikaans-speaking business owners from Johannesburg suburbs, know they must overcome a number of cultural barriers to their product. No matter how good the coffins look, there's a certain stigma attached to burying a relative in a cardboard box, especially in black South African communities, which place an enormous importance on the quality of the funeral provided by family members.

Still, in less than two months of operation, Affordable Coffins of South Africa has sold more than 2,000 coffins, mostly in Johannesburg townships where even the most basic funeral costs more than most people make in two months. A Mozambican company is negotiating a contract to import 6,000 of the coffins a month, and buyers in Malawi have expressed interest as well.

Those sales are driven by demand. Mortality rates in South Africa more than doubled between 1994 and 1999. Although the contribution of AIDS to the increase in deaths is difficult to determine - South African death certificates don't list AIDS as a cause of death - UNAIDS and World Health Organization estimate that in 1999 the disease claimed about 250,000 lives, and was responsible for nearly half the total death rate.

Even that statistic fails to show the severity of the crises in certain areas of the country. Philip De Jager, president of the National Association of Funeral Undertakers, says while the death rate in white communities has held fairly steady at about 6 per 1,000, in some rural black communities, it has risen as high as 25 or 30 per 1,000.

It's not hard to find other anecdotal evidence of the skyrocketing morality rate in communities hit hardest by the AIDS epidemic.

Four years ago, there were no funeral parlors in Matubatuba, reported to have among the highest AIDS rates in the country. Today there are six. Twenty-five miles away, in the community of Empangeni, there are now 13 funeral parlors. Five years ago, there were two.

Many old-time funeral-parlor owners worry that newcomers to the business overestimate the potential profit and underestimate the importance of community service. "In this business, if you are coming in to make profit, it's not going to be easy," says Lunga Mvelase, who has run Scotties' Funeral Parlor in Vosloorus Township for almost 32 years.

"Ninety-five percent of our clients are poor."

The cost of Mr. Mvelase's most basic funeral package is $225, a large sum of money in a country where most people make less than $100 a month. Mvelase says many of his customers pay on a six-month credit plan and, often, he simply accepts that he will never be paid.

The surge in deaths has also created a severe burial-space shortage, which will soon reach critical levels.

Royal Ntombela, director of the cemeteries and crematoria in the coastal city of Durban, says the cemeteries in the city's two largest townships are already full and that within five years, there will be no more space in the city to bury the dead. Between 1999 and 2000, there was a 20 percent increase in the number of burials in city cemeteries, he says.

In an attempt to forestall the coming crisis, Mr. Ntombela says Durban has launched a massive education campaign in area townships to gain acceptance for cremation and grave recycling. Both ideas are hard to sell to South Africa's black community.

"Most of the Africa community still perceives cremation as taboo,". Ntombela says. "Generally, the African community has had a very sentimental cultural attachment to their loved ones who have passed away. They also refer to them as ancestors, and they do special rituals to remember them."

The educational campaign, which is focusing both on eliminating the stigma of cremation and on pointing out the cost-saving benefit of the practice, has made some headway in Durban townships.

Five years ago, there were almost no cremations in Durban's black community. Today, that figure has risen to 3 percent and many in the industry predict financial realities will make cremation - and innovations like cardboard coffins - an increasingly attractive option for many families.

"The economics of this whole thing will change the attitudes of the people," says Musi Myeni, the owner of a small chain of funeral parlors and a funeral insurance network in the AIDS-stricken province of KwaZulu Natal. "It's ridiculous to spend a huge sum of money on a box that people see for only two hours."

(c) Copyright 2001. The Christian Science Monitor