|Happiness Home Page||
Separate Search Page
|Purpose||Write To Karl Loren||Table Of Contents|
|Role Model||You Can Help!|
Karl Note: AIDS is a problem in morals, not a problem in medical drugs. The problem of AIDS will never be solved as long as the issue of morals is ignored. Morals CANNOT be forced onto a people -- but, immoral people should NOT be rewarded. In fact the entire "technical" approach to AIDS is so flawed (click here for that expose) that it almost appears that a large number of those who claim to want to help the Africans are, in fact, conspiring to allow Africans to die, without any effort to point out that not only is the morality problem senior, but that the drugs and medical help being suggested are, themselves frauds. It is time some black leaders began to see what is happening! If Black leaders continue to avoid preaching morals to these people, they will continue to die!
Third of four parts
AIDS AND THE AFRICAN
A CONTINENT'S CRISIS
'Unless there is a fundamental change in behavior, there will be no drastic change in the evolution of the epidemic.'
First of four parts
JOHANNESBURG - Two million Africans south of the Sahara died of AIDS last year, five times the number of AIDS-related deaths in the United States since the disease was discovered nearly two decades ago.
But that is just the beginning of the devastation to come.
More than 22.5 million people in the region carry the AIDS-causing human immunodeficiency virus. Of the 11 people worldwide infected every minute with HIV, 10 of them live in sub-Saharan Africa.
Five countries bundled together in southern Africa now form the global epicenter of the epidemic. South Africa counts 1,600 new infections a day, the highest rate in the world, while in Namibia, Botswana, Zimbabwe, and Swaziland, one in four adults carries HIV. It is estimated that 90 percent of those infected do not know it, and therefore aren't aware when they might transmit the virus to their partners.
Within five years, 61 of every 1,000 children born in the five countries won't reach their first birthday, the United Nations estimates, and by 2001, it is projected that there will be 13 million AIDS orphans in sub-Saharan Africa. Companies are overhiring to keep pace with AIDS deaths in the labor force.
The statistics indicate what few officials are willing to admit: that this region faces a crisis of shattered mores, where sexuality is no longer guided by traditional norms. In an environment where old rules have clashed with, or been eclipsed by, rapid social change, African men are killing themselves - and their women and children - with sex.
Hiding behind a historical reluctance to speak openly about sex, African political and religious leaders have failed to acknowledge this deeper cultural crisis at the root of the AIDS epidemic. And international experts, averse to sounding judgmental or racist, tread lightly on the epidemic's behavioral undercurrents. Behavior, consequently, has been narrowly defined as simply having safe sex. But as effective as condoms are in stopping the transmission of HIV, they do not stop epidemics.
"Without addressing behavior, the response to prevention strategies will always be limited,'' said Elhadj As Sy, head of the United Nations AIDS program for Eastern and Southern Africa, based in Pretoria. "We'll create some results here and there, but unless there is a fundamental change in behavior, there will be no drastic change in the evolution of the epidemic.''
Return to Top
HIV is transmitted primarily through heterosexual contact in sub-Saharan Africa. The alarming spread of the disease has been fueled by larger factors: rapid political and economic change, Westernization, migrant labor, poverty, and gender inequality. Promiscuity, however, is quickly dismissed in Africa as a racist term: code, in fact, for the myth of the black man's unbridled libido.
But AIDS experts throughout the region agree that far too little is understood about sexual dynamics in modern African societies. Important questions thus arise: Why, for example, are teachers the third highest HIV-infected job group in Namibia, after truckers and the military? Is a man who lives at home but takes many partners abiding by traditional sexual norms? Why does HIV spread fastest among youths, the age group most informed about AIDS and condoms?
"People don't want to do this research, so there are patterns of black behavior no one wants to acknowledge,'' said Mary Crewe, director of the Center for the Study of AIDS at the University of Pretoria. "They'd rather lay blame on the apartheid past, which I'm not sure is right.''
Contrary to what infection rates in sub-Saharan Africa suggest, HIV is not easy to contract. In a stable and healthy environment, the probability that an infected man will transmit the virus to an unprotected woman is less than 2 in 1,000, according to World Bank figures. But it is easy for that risk to rise. A person afflicted by other sexually transmitted diseases, which are rampant across the region, is two to nine times more likely to contract HIV if exposed to it. And if a man has 10 partners, and the partners have each had 10 partners, he's potentially been exposed to 100 people.
In addition, several socio-economic factors lead to high levels of casual sex in sub-Saharan Africa, experts say. The region has seen serious upheaval for decades, the past 10 years being among the most turbulent. Genocide in Rwanda and the end of apartheid in South Africa caused the movement of masses of people; porous borders, regional development corridors, and political change have reshaped and extended sexual networks. Poor health care facilities, meanwhile, leave many without access to quality treatment and prevention, while high unemployment leaves youths idle.
"When you see such an epidemic as we have, it points to a very stressed society,'' said Clive Evian, a South African doctor who helps industries cope with AIDS-related labor costs. "HIV epidemics go with a package: an emerging economy, transitions from traditional cultures into industrial economies, high levels of other sexually transmitted diseases, and economic stress on families.'' Among the factors fanning the AIDS epidemic, migrant labor and gender inequities have perhaps been the most damaging. Throughout the century, men from around the region were drawn or conscripted to work in distant gold, mineral, and diamond mines. They left their families behind in rural villages, lived in squalid all-male labor camps, and returned home maybe once a year. Lacking education and recreation, the men relied on little else but home-brewed alcohol and sex for leisure.
A man who makes his living deep inside a South African gold mine has a 1 in 40 chance of being crushed by falling rock, so the delayed risks of HIV seem comparatively remote. Mining companies pay out $18 million a year in wages to 88,000 workers in the pits of Carletonville, the center of South Africa's gold industry. The wages buy, among other things, sex. Some 22 percent of adults in Carletonville were HIV-positive in 1998, according to UNAIDS, a rate two-thirds higher than the national average.
"High alcohol and sexuality are symptoms of things going wrong on a big scale,'' Evian said. "They reflect a kind of aggression, the sad social state of the man. They have been thrown into horrible lives and become frustrated. It would happen to any man anywhere.''
Most African women, meanwhile, live in poverty. They have little or no economic control, and therefore virtually no say in sexual relationships. "Women know they are in danger, but there is nothing they can do about it,'' said Lahja Shiimi, HIV/AIDS health program officer in northern Namibia. "Men decide when to have sex, with whom to have it, and how.''
Physiologically four times more susceptible to HIV infection, women in the region are contracting the virus at a faster rate than men, and at a younger age. Most of the women who tested positive for HIV in Namibia in 1998, government figures show, were in their early 20s, while most men were in their mid-30s. According to the latest UNAIDS statistics, 46.7 percent of Namibian women at rural prenatal clinics tested positive in 1996.
If mobility, migrant labor, and gender imbalance are conducive to the swift spread of HIV, they also underscore the breakdown of social cohesion. When truckers and miners go home, they take the virus with them. Sometimes they infect their wives, sometimes women become infected through sexual contact with other men while their husbands are away. Rural infection rates are catching up to urban figures. The role men traditionally played as head of the family has broken down. Boys grow up without fathers. Wives are left impoverished and unprotected. A South African woman is raped every 26 seconds, the highest rate in the world.
But socio-economic arguments about AIDS do not fully explain how sexual relationships are changing as African societies evolve. Notions about masculinity and fertility vary widely among Africa's diverse ethnic groups. Health workers across southern Africa agree, however, that traditional cultures had strict rules governing sexual relationships. Those codes have broken down and nothing has replaced them.
"In our culture, having a lot of women is a kind of status,'' said Milka Mukoroli, the HIV/AIDS coordinator at Rundu Hospital in Rundu, Namibia. Under the old rules, "a man might marry two or three women, but he would never stray from home, and the first wife had to be consulted about each new wife.''
Now, Mukoroli said, wives never know about their husbands' other women. Men take lovers furtively. Many traditional cultures frowned on premarital sex. Today, older men look for young girls to take care of, seeking sex in exchange for providing school fees and nice clothes, often in the mistaken belief that sex with virgins can cure AIDS. Health workers say many male secondary-school teachers sleep with their female students. A new study of Carletonville conducted by the Pretoria-based Council for Scientific and Industrial Research found that 60 percent of women are HIV-positive by the time they are 25. Throughout sub-Saharan Africa, infection rates among teenage girls are significantly higher than for teenage boys. Infected by older men, the girls then infect boys their own age.
"Social pressure should be put on older men to avoid forcing or coercing young girls into sex, or enticing them with sugar daddy gifts,'' a UNAIDS study on behavior released last month concluded.
Changing behavioral patterns are not restricted to men, AIDS workers say. Traditionally, women were not supposed to enjoy sex. Increasingly, however, they are asserting their own sexual needs and priorities.
"Promiscuity is prevalent predominantly because heterosexual relationships are changing,'' said Peter Schmidt, a German doctor serving as chief medical officer in the AIDS-afflicted Ohanguena region of Namibia. "This is a very sensitive subject and very difficult to tackle. So many dependencies in African societies relate to sexual relations.''
The heterosexual nature of the epidemic does not rule out the probability that HIV is also transmitted between men, but homosexuality is deeply closeted in African societies and there are comparatively far fewer same-sex infections, according to AIDS experts. Youths provide a compelling reason to think differently about behavior. Across the region, young people have been exposed to more education about HIV and condoms than their elders, yet they have the highest infection rates. Knowledge about risk and condoms hasn't slowed the epidemic.
A new study of sexual behavior among youths between the ages of 11 and 24 in KwaZulu-Natal, South Africa's hardest hit province, indicates why: Young people are on their own in an aggressive and evolving sexual environment without the communication skills necessary to negotiate the function or frequency of sex in relationships.
Consequently, the social ills governing gender relations among adults reappear among youths. Both men and women in the study said that condoms threatened trust within the relationship. Most women said they were powerless against male sexual coercion. Many from both sexes said they would prefer abstinence or monogamy, but said peer pressure is a strong influence.
"For young people, sex is a must to be taken seriously by their peers,'' said Christine Varga, research fellow at the Australian National University in Canberra, currently based at the Reproductive Health Research Unit in Durban.
Significantly, said Varga, who conducted the KwaZulu-Natal study, young people feel increasingly isolated from the adults in their lives. Traditionally, cultures included some mechanism for passing on the rules of sexuality and intimate relationships to adolescents. Parents, however, never spoke to their children about sex. Unmarried aunts or older sisters informed younger nieces or sisters coming of age. Uncles and older brothers did the same for boys.
Now confusion prevails. Rural youths in particular "are much more likely to evince attitudes that are a combination of old conservatism and new sexuality,'' Varga said. They combine new attitudes like "sex is a must'' with traditional mores such as "condoms are for prostitutes.'' The result is high-risk sex.
From 1997 to 1998, infections rose 65 percent among South Africans between the ages of 15 and 19. All too quickly, HIV is claiming another generation.
"The way to fight the epidemic is not just with condoms. We have to change mores,'' said Patricio Rojas, the World Health Organization representative in Namibia. "Openness happened fast in Africa, and it happened wrongly. There is no grooming of boys and girls as partners in a relationship, so sex has no aspects beyond the instinctively physical. We have to create an environment of normality again.''
This story ran on page A01 of the
Boston Globe on 10/10/99.
© Copyright 1999 Globe Newspaper Company.
AIDS AND THE AFRICAN
AIDS AND THE AFRICAN
Second of four parts
NEW TAFARA, Zimbabwe - She had to get the babies, her nieces and nephews. They were sleeping in the jungle, and she thought the darkness might get them, if not something worse. Their mothers - her sisters - were dead, or dying. Their fathers had abandoned them. She couldn't sleep. The thought of the babies kept waking her.
''They were living like animals,'' says Esther Daiton.
She didn't have any money. She had a precious TV; she hawked the thing without a second thought. But it wasn't enough. She started begging, got enough cash together, then she hit the road. First by bus, then foot.
Esther crossed north into Malawi, through Zambia, covering a distance of several hundred miles. On the days she slept outside, her body would crumple beneath trees from exhaustion. Her sleep would be deep. But when awake, she traveled like a woman who didn't need sleep.
She traveled as fast as her thin legs would take her. And, after two months of searching, picking up clues, using some of the first children she found as her guides to the others, her journey was complete. She had found Tsi Tsi and Paul. She found Fungai. She found Manyara, Elbe, Allan, and John. Seven in all.
They'd been living as orphans - orphaned to the jungle. Four were her two sisters' kids. One sister had died of AIDS, while the other lay terminally ill with the disease in a hospice. Of the seven children, three she had never laid eyes on.
Across this drained continent, beset by wars, famine, and misfortune, the AIDS epidemic has left something else in its wake: millions of AIDS orphans. By 2001, according to figures presented last month in Zambia at an international conference on the disease, the number of AIDS orphans in Africa will reach 13 million.
Zimbabwe has the largest number of AIDS orphans on the continent - an estimated 670,000 - and the number is growing at a rate of 60,000 a year, according to the government-funded National AIDS Coordinating Program.
''The social welfare system is not working,'' says Colletta Peta, a social worker who works at an AIDS hospice in Harare.
Traditionally, extended families here and elsewhere across Africa would be expected to take care of their relatives' homeless children and even some orphans, leaving the social welfare system as a last resort. But deaths from AIDS have severely blunted the effectiveness of the extended family. Now, the orphans seem to be everywhere, and they are at risk. ``It is a tragedy,'' Peta adds. ``We really can't protect the orphans.''
To keep and protect her babies, Esther Daiton sells popcorn on the roads of this village, 10 miles outside Harare. She saves her pennies. ``I pray to God,'' she says.
There are nine children lying at her feet in her hut here, the seven she retrieved from Malawi, plus her natural-born son and daughter, Peter and Desilyn. Every one of them has lost one - or both - parents to AIDS. The sun is slicing through the cracks of the hut. The children scamper about like pups. They are hungry, but there's not a scrap of food in sight.
``This is all so impossible,'' Esther says.
Esther herself is all bone and skin.
Esther Daiton was born Nov. 11, 1973, in Masvingo, about 180 miles from Harare. Her mother, Neliya, and father, Malinga, lived and worked on a tobacco plantation. There were six children born to Neliya.
Esther enjoyed growing up in Zimbabwe. School was fun. In the 9th grade she met Andrew Lyadutu. Actually, he was her teacher. He asked Esther to marry him. She said yes. She was 14 years old. "He lost his job because of the marriage,'' says Esther.
She was young and immature, she admits, about her first marriage, which ended in divorce. Three years later, still young, she met Thomas Kabalika. He made all kinds of promises. It was the marriage vow of fidelity he couldn't keep. "He was not used to sleeping inside,'' Esther says. "He wanted to sleep outside - with the prostitutes.''
Esther left him.
Two marriages down, she still had faith. Love was not a word that frightened Esther Daiton. She met Loton Mafuta. A smooth talker, he was the kind of man who showed Esther his hard-earned money at the end of each pay period.
On May 11, 1997, Esther married Mafuta. She was 23 years old. Her years had been hard, but Africa was Africa, a place where the clouds were always heavy.
Mafuta had a good job. He managed a construction site. Esther became a clerk there. She was still living near her home. Her father had become ill. Esther, like her mother, wiped the sweat from his brow, brought his medicines to him.
"My father used to drink beer at the pubs,'' recalls Esther. "He would collect other women in the pub and go into the bush.''
Sores broke out all over her father's body; diarrhea weakened him. The old man - who really wasn't old at all, he just looked it - sat in silence.
"It was a hard time,'' says Esther. Her father had AIDS.
Not long after his diagnosis, Esther's mother returned to the hospital with him. Then she, too, was diagnosed with the virus. "We were at the hospital and the nurses were doing counseling to my mother,'' says Esther. "My father apologized to her and said, `I am the one who did this to you.'''
Her mother and father were soon admitted to Bonda Hospital, three miles outside Harare. Esther prepared food for them at home and took it to the hospital. "It was difficult,'' she says. "I talked to God: `Help me.'''
The hospital sent Esther's father home. They gave him a a discharge card. It was stamped "DH'': Died at Home.
On April 5, 1997, Esther's father died. That's when the dying began.
Four months later, on Aug. 11, Esther - who had given birth a year earlier to little Emmaculate and was suddenly worried because Emmaculate was sickly - went to the hospital. Esther had taken an HIV test weeks earlier.
Her test came back positive.
"I went to my house with my child,'' she recalls. "I started crying for two hours. I told my sister, Martha, that I went to the doctor and he told me I was HIV-positive. My sister started shouting, and said, `I don't want to talk to someone who is HIV-positive. So leave!' My sister - my blood sister - said to some of my friends, `Esther is already dead.'''
Esther was alive. But the clouds were rolling in fast.
Nine months after her father died, Esther's mother breathed her last breath. It was Jan. 4, 1998. Esther pulls a copy of her mother's death certificate from a sack. "Vomiting,'' it says, was the cause of death. In Africa, because of the stigma of the disease, it is rare for a death certificate to list the cause as AIDS.
Then trouble began brewing in Esther's own marriage. Her husband was vanishing at night. Away on construction jobs, his time was his own. "He would go out in Maputo,'' she says. "He was paid in US money. He started using drugs, drinking.'' Esther discovered that her husband had been sleeping with a friend of hers.
But then Mafuta grew too weak to vanish into the night. He too broke out in sores. He had chest pains. She wanted to talk about her HIV status; she hoped for some answers. But he didn't want to talk to Esther.
On May 20, 1998, men started lifting shovels again. This time, the length of the plot was quite short: The hole was for Emmaculate, Esther's 19-month-old daughter. Her little baby. Dead of AIDS.
Esther needed money for the coffin, and money to rent the flatbed truck to haul the coffin to Mabvuku cemetery, 10 miles from her home. "I asked friends for money. I sold Popsicles.''
They laid Emmaculate in the ground on a cool, quiet day. Esther couldn't afford a stone. She laid a little blue dish atop her daughter's gravesite so she could find it.
She turned her attention to her husband, and again, the shovels were swinging. Exactly one month after the death of their daughter, Loton Mafuta died of AIDS.
Loton had surely passed the disease on to Esther. "He didn't apologize either,'' she says.
All of her loved ones seemed to be dropping into the ground. Esther still had her two own children, Peter and Desilyn. But now, she had lost both her mother and father. She had lost her baby. She had lost her husband.
She felt lonely. She was also hurting. She walked to the hospital. She got medicine for stomach ailments. She got medicine for the flu. She needed money for AIDS drugs, but like almost all Africans, there was no way she could afford the high cost of such medication. So she's had to do without it.
Then word flew in like a poisoned dart that her sister, Naipiri, who had two children - Tsi Tsi and Paul - had died in Malawi of AIDS. Another sister in Malawi, Maria, who had two children named Manyara and Fungai, was bedridden in a hospice with AIDS.
Naipiri's and Maria's children - Esther's nieces and nephews - were living as orphans in Malawi. Weeks and months passed. She slept fitfully when she slept at all. She had to find those babies. Sick as she was, she had to find them. "I said to myself, `My mother and father kept us well. But now my mother and father are dead. My husband and daughter are dead. My sister is dead. And if I don't find these children, they will be street children.'''
A doctor, a nurse, her friends, all told Esther to stay put, told her the children would have to fend for themselves.
Alone, Esther went to the bus depot in August of 1998 and set out to find them. She was carrying her passport in a little plastic bag. She had a little money from the sale of her television set. It took her two days over bumpy roads to reach Malawi, a tiny country set in the Great Rift Valley of southeastern Africa. Compared to other African states, marred by wars and strife, Esther couldn't have picked a better place in which to travel alone. Malawi is peaceful.
She made her way to the central part of the country, where her sisters had resided, and started asking questions. She got enough answers to keep moving. She slept in guest houses for $2 a night, and when the guest houses were full, she slept outside, in the bush. Some kind souls at the Zimbabwean embassy in the capital, Lilongwe, gave her some food. Days later, still roaming, she came upon some women working in a stall of markets alongside a road, and they gave her more food. She kept going. "I was just walking around,'' she says. "I spent two months sleeping in the bushes. I would tell people I'm from Zimbabwe and I'm looking for these children.''
There were leads that fell into other leads, only to completely collapse. And then she spotted the first ones. "I found Paul and Allan sleeping outside, in front of a shop.''
Paul was Naipiri's child. She didn't know who Allan's parents were; he was an orphan who had befriended Paul. Esther scooped him up. Allan pointed into the bush, in the direction where he and Paul had laid Fungai, Maria's boy, while they went to look for food. After a brief search, they found Fungai, alone and screaming.
She was given another tip: A market lady had seen some kids roaming down a road about a mile away. Esther raced there and spotted Manyara and Elbe, another orphan the children had befriended, on the side of a road. Less than an hour later she found Tsi Tsi near a riverbed.
"The children didn't know me,'' she says. "They had forgotten me. The children were not eating. They were living like animals.''
But now she had all four of her two sisters' children: Fungai and Manyara, Tsi Tsi, and Paul. There were three other AIDS orphans she had found with the others that she decided to bring home, too: John, Allan, and Elbe. "If you would have seen me with these children, you would have thought they were getting ready to die the very next day,'' Esther says. "But it was not God's will.''
The clouds were suddenly lighter. She had the babies. Everyone headed home.
Only when she returned to Zimbabwe, Esther didn't have a home any longer. She had been staying with her grandfather, but now, because she had so many children with her, he no longer wanted her there.
She showed up at a side door of the Faith Ministeries Church in Harare. She needed some food and she needed some help.
"People don't want them on their property,'' Colletta Peta, the social worker, says of Esther and the children she cares for. Peta happened to belong to the church whose door Esther knocked on. "We've managed to get a shack for them,'' Peta says.
The shack, made mostly of cardboard, is off a dirt road, squeezed in by other shacks. It is 12 feet long and six feet wide. It looks something like a cage one might see in a zoo. Esther says it's better than living in the bush.
There is no running water. Even in Africa, the nights can get chilly, but Esther and the children have no heat. She's got two blankets. They're thin, and both have holes in them.
She is crazy about the children.
"I must love them like they are all with their mothers,'' Esther says. She's sitting on the edge of her tiny bed in the hut. " It's hard,'' she confesses minutes later, her eyes having suddenly teared up.
Two of the children, Manyara and Peter, are always sniffling. Manyara has open sores on her legs. Esther fears the worst, but she hasn't any money to take them to the clinic to get HIV tests.
One day, not long ago, Esther got her hands on some cash. That day Fungai was sniffling badly. She rushed him off to the hospital. "But he was negative,'' she says about Fungai's HIV test.
This is how Esther scrapes money together: She buys Popsicles wholesale. Then she borrows a cart and pushes it out to the road. Peter, Desilyn, and Tsi Tsi help her when she's sick. Along with the Popsicles, she totes sacks of popcorn. And sometimes Allan, gifted artistically, scrapes up metal pieces he finds and molds them together, little model figurines. He sells them.
"How those children struggle day to day,'' says Peta, the social worker.
There are many mornings, however, when Esther can't lift a Popsicle, much less push a cart out to the side of the road. It's her AIDS; it can keep her in bed for days.
She hates going to the hospital. "At the clinic,'' she says, "the nurses shun me. When they know you've got AIDS, they don't do too much.''
She was bedridden just recently. She felt like boulders were rolling around in her stomach. The children huddled around her in the hut, their world suddenly reduced to the skin-and-bones woman lying on the bed. "They were praying for me,'' she says. "I said, `Go play.'''
Not a child moved.
She's been brutally honest with the kids, but it just tore her heart that she had to confess to the children that she, too, has AIDS. "I tell them I may wake up sick tomorrow,'' Esther says. "Or I may not wake up at all.''
Each child has a distinct personality, says Esther.
When there is food, says Esther, "Fungai likes to eat too much.'' Fungai's smile is wide and sweet. He's four years old and AIDS stole his mother, Maria, who died in May. Fungai prays a lot.
"John is mischievous in a quiet way,'' Esther says, shooting a glance at John, who smiles back at her.
"Tsi Tsi likes selling things,'' says Esther. "Popcorn, freezies.'' One moment Esther shows off her medicine, strewn around the little hut. And the next moment, as if by magic, she reaches under a pile of things and pulls the prettiest school uniform out that Tsi Tsi wears to school. All ironed.
The children are hers now. "I must give them all equal love,'' Esther says. "I cannot favor mine. If I go buy something, I must give each one the same thing. I must give them equal shares. Manyara is my child. Fungai is my child.''
A man can't move Esther Daiton's heart anymore. "If a man says he loves me again, I will cry. I don't want it. I'm sick.''
Later in the week, Esther has gotten some food. She has borrowed a hot plate. She fixes margarine sandwiches for the children. Fungai loves margarine sandwiches. She prepares some tea. Tsi Tsi cups her tea like an English queen. There is chicken and rice. A pot falls off the hot plate and a piece of chicken falls onto the dirt. Fungai scrambles for it in a motion so swift it seems almost electric. He picks it up and tosses it back in the pot, and takes his seat again on the dirt.
Not a child touches the food until it all has been placed on every plate. Until a prayer has been said. The children have lovely - since there is no table - dirt floor manners.
Esther eats her margarine sandwich. She looks exhausted. But all the children have allowed smiles to flower across their faces.
A day later, the children, after school, after their tea, are outside playing. Sunshine is everywhere. Everything seems normal. With the exception of so much death. Six members of her immediate family, all gone to AIDS.
But Esther lives. She's not exactly happy. The school fees are due and she hasn't got a dime. The landlord across the road wants his rent for the shack. She hasn't paid anything in two months. The man's kindness might run out.
Still, she is happy just to be alive. She was at the hospital not long ago, having problems breathing. She ached all over. Plans were made to admit her. "They wanted to give me a bed,'' she says. "I said no to the nurses. I had to get back home. The nurses said, `Why?' I said, `I've got these children.'''
Esther walked back home, and the children - her babies, as she calls them - loved the sight of her.
AIDS AND THE AFRICAN
Third of four parts
RUNDU, Namibia - On a continent where the common official response to the AIDS plague is denial, Bishop Joseph Sikongo speaks with rare candor.
''Nobody has been outspoken,'' the Roman Catholic elder said in an interview here, referring to government leaders as well as his ecclesiastical brethren. ''Just now, when we see people dying, we are beginning to pay attention. But we have not been focused, and we have failed to meet our responsibility.''
Every year, AIDS kills 10 times more Africans than die in wars annually, and poses the single biggest threat to development on the continent, yet very few leaders - in parliament or the pulpit - have anything to say about it. Sub-Saharan countries spend about $160 million fighting 4 million new AIDS cases per year, and most of that is foreign aid, according to US government figures. By contrast, the United States spends $880 million on just 44,000 new cases annually.
''By any measure, the HIV-AIDS epidemic is the most terrible undeclared war in the world, with the whole of sub-Saharan Africa a killing field,'' said UNICEF executive director Carol Bellamy last month in Lusaka, Zambia, in a speech at the annual conference on AIDS in Africa.
Strikingly, no African heads of state attended the meeting, the most important periodic conference on the African AIDS epidemic. Not even Zambian President Frederick Chiluba, whose office is just minutes away.
''There is a need for political commitment at the highest level, and little explanation for why that commitment is not there,'' said John Caldwell, who attended the conference as an expert on Africa from the Australian National University in Canberra. ''AIDS must be the central issue on the African political agenda.''
A few African leaders, such as South Africa's Thabo Mbeki and Ethiopia's Negasso Gidada, have begun to move the AIDS epidemic higher on their priority lists. But most remain silent or pay the problem only lip service, leaving the international community and underfunded private organizations to confront the epidemic.
This reticence has had dire consequences. Existing AIDS-related laws are not enforced, allowing discrimination to go unchecked. Stigmas endure. Treatments remain costly and inaccessible. Rape and other sexual violence flourish. Insurance companies refuse to cover people infected by the human immunodeficiency virus, which causes AIDS, and withhold benefits to families of policyholders who have died of the disease. Half-hearted education efforts make little impact on risky behavior.
These factors ``drive the epidemic underground,'' where it continues its sweep through the population, said Mark Heywood, director of the AIDS Law Project at the University of the Witswatersrand in Johannesburg.
More than 15 years into the now-raging AIDS epidemic, as African countries strive to cope with the burden of rising death rates, official denial is hard to fathom. AIDS, it is widely suspected, has taken a personal toll at the highest levels of government. Corridors buzz in every country with stories of ranking politicians who have died or lost family members to untimely deaths. Namibian President Sam Nujoma lost two sons and a daughter-in-law. Bennie Mwiinga, Zambia's minister of local government and housing, died on the eve of the AIDS conference last month, leaving delegates to speculate about the end of a young and prominent political figure.
In each case, the official cause of death was listed as something else, though Western diplomats and some African health experts all said privately that AIDS was the culprit.
Former Zambian President Kenneth Kaunda admitted that he lost a son to the disease, and the preeminent South African judge Edwin Cameron has disclosed his positive HIV status. But Africa, sadly, still awaits its Magic Johnson, someone of mass popular appeal stepping forward with personal testimony to break the myth and stigmas of the epidemic, to say unequivocally that AIDS affects everyone.
``These leaders don't understand that they just leave people laboring to explain why they are silent,'' said Beatrice Were of Uganda's International Community of Women Living with HIV/AIDS, an advocacy group. ``They deepen the stigmas attached to AIDS.''
The silence may be rooted in fear of failure. African leaders do nothing, Caldwell argues, because they think they cannot influence the sexual behavior of their most important constituency: young and middle-aged men. They may also be bound by traditional African taboos about sex. Such issues are seldom brought into the open, let alone discussed between partners. Few couples, experts on African sexuality say, communicate about the role of sex within their own relationships.
As former South African President Nelson Mandela said last March in one of his last official comments about AIDS, ``HIV/AIDS is one of those critical issues which demand visible leadership.... Why understand why there is this silence? It is because transmission occurs primarily through sex, which is not openly discussed.''
Martin Foreman, director of the AIDS project at the Panos Institute, a London-based research center, raises another possible reason for official reticence: traditional notions about African masculinity. Men, he argues, are supposed to be emotionally and physically strong. Many cultures expect men to have multiple sexual partners. Powerful leaders see the AIDS epidemic as threatening their status, both as men and as officeholders, Foreman said.
Whatever the reason, the lack of political will has had measureable consequences. In study after study across sub-Saharan Africa, most people indicate that they have a basic knowledge of how HIV spreads, how to block transmission, and that the virus is lethal. But they also do not perceive themselves to be in danger. While an increase in knowledge about HIV and AIDS has resulted in marked changes in sexual behavior in countries like the Netherlands, Australia, and Thailand, awareness has not resulted in a decrease in high-risk behavior in the majority of sub-Saharan African countries.
``The knowledge of HIV is high, but disassociated with risk,'' said Karen Tate of the information and education department of the Ministry of Health in Rundu, one of the most affected areas in Namibia. ``So even if people say they know about HIV, there is a gap between that knowledge and behavior. Behavior is based on immediate needs,'' rather than prevention of something that poses delayed risks.
Infection rates remain stubbornly high as a result, especially among the youngest age groups of sexually active adults, those ironically, those most aware of the dangers of the virus and how to protect themselves.
Ten African countries, most represented by their health ministers, declared AIDS a national disaster during the Zambia conference last month. They committed themselves to providing more political leadership, increasing resources devoted to a national response to the epidemic, and making HIV/AIDS a priority in all developmental programs. They also vowed to introduce initiatives to address behavior and encourage discussion to create a more supportive environment for those infected and dying.
``What's coming through is that there is starting to be accountability at the highest level,'' said UNAIDS director Peter Piot in an interview. ``But denial is still a fundamental aspect of the epidemic. Some African leaders are speaking out, in some places the machinery is in motion, but that doesn't mean we have action.''
The new resolve spelled out in the declaration also begs questions about how African countries apply AIDS-related laws and policies already on their books, as well as about the budgetary decisions they make. In 1997, the countries of the Southern African Development Community, a trade bloc, adopted a code for HIV/AIDS and employment, agreeing to incorporate its provisions in national legislation.
Requiring important education programs and protection of workers' rights, ``the code will aim the code aims ``to ensure non-discrimination between individuals with HIV infection and those without, and between HIV/AIDS and other comparable health/medical conditions.''
But national priorities have not reflected adherence to the best intentions of the code. South Africa has one of the world's most liberal constitutions, but its military is one of the leading discriminators against people with HIV/AIDS. People must submit to mandatory HIV screening and test negative prior to being allowed into the service.
AIDS activists believe one of the best ways to lessen the stigma attached to HIV is to assure confidentiality. Yet several countries have engaged in new debate this year on whether disclosure promotes the common good. Politicians argue that notification meets a society's need to monitor the epidemic. Speaking after a regional meeting of health ministers in April, Namibian Health Minister Libertina Amathila said ``the situation as it is now protects only the sufferers but not the community. The special confidentiality accorded afflicted people encourages them to infect others at random without being detected.''
Many AIDS experts denounce such arguments, saying that confidentiality is essential to encouraging people to learn their status and inform their partners. Notification to interested parties such as employers, they say, is a fundamental violation of the right to privacy and only promotes discrimination. In South Africa, a government proposal would require any health care worker who diagnoses a person as HIV-positive to file a report containing the patient's age, sex, race, medical condition, and ``probable source and place of infection.'' It also would force the health officer to inform family members and others giving care to the patient. The initiative is pending.
``Eliminating stigma must be central in the response to AIDS,'' Piot said at the Zambia conference. ``We know that three things contribute most to people learning and acting responsibly on their status, and thus protecting their community. First, access to confidential counseling and testing. Second, understanding of the incentives to do so. And third, the level of support in the environment in which they live.''
Another area of discrimination involves insurance. Underwriting companies, bracing against the rising costs of AIDS, often refuse to cover HIV - positive people or pay benefits to policyholders who die of AIDS. Across sub-Saharan Africa, doctors often omit AIDS as a cause of death, indicating on death certificates some other related illness to help families recover insurance benefits.
For countries that have begun to implement more serious national responses to the epidemic, Uganda is the model. One of the first to face a full-blown crisis, the east - African state has been hailed as a success story. President Yoweri Museveni was outspoken about HIV long before any of his counterparts, and mobilized his government to treat AIDS as a concern for all ministries and sectors. The country encourages people to have confidential HIV tests prior to marriage and promotes community-based care for those ailing from advancing AIDS.
After reaching a peak in the early 1990s, when as many as 36.6 percent of urban pregnant women tested positive for HIV, Uganda has apparently reversed infection rates. By the end of 1997, only 14.8 percent of women attending urban clinics had HIV.
Few argue with the importance of making AIDS a priority in every government department, as well as teaming up with the private and volunteer sectors. Namibia and South Africa have begun to adopt that approach.
In March, Namibian President Nujoma launched a national campaign against HIV/AIDS that called for a coordinated strategy at the national, regional, and local levels. The plan spells out goals for improved health care, education, and anti-discrimination measures. But the government has allocated only $3.5 million to implement it over five years, and interviews around the country with officials people responsible for putting the plan to work reveal an ignorance about what specifically the various programs are supposed to accomplish once they have been established.
Of all the countries in sub-Saharan Africa, South Africa faces the fastest-growing AIDS crisis: 1,600 people contract HIV every day, and within five years more than six million South Africans will have the virus out of a population of 40 million.
But the country is also the best equipped to respond to the disease. South Africa has the strongest economy in Africa and the most sophisticated infrastructure. Still, its response has been slow. Warnings of an impending catastrophy early in the decade, when there was still time to avert the worst, went unheeded amid intense negotiations to end apartheid and the opening years of majority rule. It wasn't until the closing months of Mandela's presidency when, last October, then-Deputy President Mbeki outlined a national response.
Even then, South Africa allocated only about $13 million to AIDS-related education and care programs over five years. By contrast, the government is spending roughly $6.5 billion on new military hardware, including three German submarines for a navy that faces no threat.
Mbeki, now president, shows signs of understanding the threat AIDS poses to his goals of improving the lives of the impoverished black majority. But government is still more focused on the medical aspects of HIV/AIDS, rather than on behavior and care and assistance for people with HIV and their families. South Africa, for example, will spend more than $10 million over the next three years on vaccine research for the subtype of the HIV virus most prevalent in the region.
Government officials, critics say, also show a surprising lack of knowledge about the epidemic. The new health minister, Manto Tshabalala-Msimang, won accolades for traveling to Uganda shortly after assuming office in June to learn from that country's experience. But her major initiative so far has been to rally religious leaders to help build awareness from the pulpit, despite the numerous studies indicating that ignorance is no longer a critical problem. Tshabalala-Msimang did not respond to requests for an interview.
In August the education ministry published new rules pertaining to HIV in schools. The policy outlines in detail how to administer first aid to superficial wounds, despite acknowledging that HIV is rarely transmitted through casual contact with open cuts. Conspicuously absent are specific guidelines for sex education in the classroom and punitive measures for teachers caught having sex with students.
Asked to explain these omissions last week, Education Minister Kader Asmal said ``these are matters for further discussion.'' He added: ``Teachers are embarrassed to give the facts, but the taboos must give way.'' The country is only just now beginning to deal seriously with violence against women, one of the most menacing causes for the spread of HIV. Despite new legislation broadening the definition of rape - a woman is raped every 26 seconds in South Africa - and imposing new minimum sentencing requirements, courts still show surprisingly callous attitudes.
In August, a high court judge in Bloemfontein sentenced a 23-year-old man previously convicted of a sex-offense to just 10 years in prison for abducting and repeatedly raping two 15-year-old girls. In his ruling, Judge Dirk Kotze argued that the attacks were simply the result of the man's virility, and that the victims were not virgins at the time they were raped.
For their part, religious leaders throughout sub-Saharan Africa have been mostly silent about the epidemic, despite the obvious role they could play in addressing behavior, counseling, and caring for orphans. Bishop Sikongo in Rundu says part of the reason is condoms. The Roman Catholic Church, for example, won't advocate condoms because they interfere with conception, and because such a stance might appear to be condoning types of sexual behavior that do not conform with church doctrine. Not knowing how else to respond, Sikongo said, his brethren have done nothing.
``Condoms are the easy way out,'' he said. ``They don't require sexual responsibility. We would like to see the human take charge of himself. But we have not promoted our view vigorously.''
The Rev. Barry Hughes-Gibbs, an Anglican priest near Pretoria, has been providing care for HIV-infected adults, children, and their families since 1994. The people he helps live in abject poverty, and the premise of his project is to help them move from dependence to a degree of self-sufficiency. In addition to feeding and treating patients, he also employs them in the program.
Hughes-Gibbs' program relies on foreign donors and receives no help from the government. Earlier this year, without explanation, Gauteng Province stopped sending subsidies - about $50 per adult and $150 per child. Nor does his own organization support him. Hughes-Gibbs half-jokingly says the project, which currently cares for 2,500 children and more than 4,000 adults, is successful because it isn't tied to the church.
In the absence of commitment from political and religious leaders, nongovernmental organizations are left to do the heavy work of testing, counseling, and caring for those with HIV and AIDS. And communities have begun finding innovative ways to address the epidemic at ther their level.
Some Zulu villages hold ceremonies to test boys and girls for virginity. If they pass they are given certificates and special status. Others act out the dangers and consequences of AIDS through traditional dances.
``People are not putting enough pressure on African governments,'' Caldwell said at last month's conference in Zambia. ``African governments are not putting enough pressure on Western governments and international systems. The conspiracy of silence must be broken.''
Tomorrow: US black leaders react
Globe online This series is
available on the Globe online at http://www.boston.com.
Use the keyword: AIDS.
This story ran on page A01 of the
Boston Globe on 10/12/99.
© Copyright 1999 Globe Newspaper Company.
AIDS AND THE AFRICAN
Last of four parts
View a gallery of photos from Globe Staff Photographer Dominic Chavez. -Click here
Stunned by the soaring number of AIDS deaths in Africa, where more than 12 million lives have already been lost, American black leaders are scrambling to call attention to the crisis, and concluding that they themselves must exercise more vigor and ingenuity in confronting the epidemic.
''People have been slow to recognize the changing face of AIDS, and therefore the changing politics of AIDS,'' says Ron Dellums, the former California congressman who was a leader in forcing economic sanctions against the old apartheid regime in South Africa. Dellums now heads the Washington, D.C.-based Constituency for Africa, an advocacy group whose mission for the next year, he says, will be to try to focus American attention on the AIDS crisis in Africa.
After returning from a recent trip to Africa, Dellums rolled from pulpit to pulpit across black America, confronting church leaders. ''I said, `Look folks, 12 million Africans have already died. You should stand up with moral outrage.' The reaction of people was, `My God, I had no idea,''' Dellums says. ''What this issue has lacked is people prepared to talk loud enough to take it to a political level.''
In addition to those who have already died of AIDS, it is estimated that upwards of 22 million people are infected with HIV in sub-Saharan Africa. The crisis has gotten so grave that in Zimbabwe, one of the most besieged countries, many funeral homes now keep their doors open 24 hours a day.
''With ferocious speed, AIDS has wiped out many of the development gains Africa has achieved over the last two decades,'' said Calisto Madavo, a Zimbabwean who is the World Bank's vice president for Africa. Speaking at an international conference on the epidemic held in Zambia last month, Madavo said AIDS was ''killing adults in the prime of their working and parenting lives, decimating the workforce, fracturing and impoverishing families, orphaning millions, and shredding the fabric of communities .... It has reduced life expectancy in the most-affected areas and now threatens businesses and economies.''
The National Association for the Advancement of Colored People, America's oldest civil rights organization, recently passed a resolution vowing to pay more attention to the AIDS scourge in Africa.
``For many years the NAACP didn't do enough about AIDS,'' concedes Julian Bond, chairman of the organization's board of directors. ``I don't think anyone in the US, the NAACP included, is doing enough about AIDS in America, let alone Africa.''
That admitted shortcoming, and other we-must-catch-up sentiments echoed by black leaders, is being seized upon by Eugene Rivers, the peripatetic Boston minister who has long felt comfortable bumping heads with old-guard civil rights leaders and their practiced orthodoxy. Rivers is leading his upstart 21st Century Group into the heart of the Africa AIDS debate by trying to place the issue at the top of black America's post-civil rights agenda, and by assailing many American black leaders as ``exhausted'' or suffering from a ``crisis of vision.''
Rivers calls 21st Century the ``intellectual arm'' of his 10-Point Coalition, which has long battled crime in Boston's urban areas. Rivers sees sexual promiscuity in Africa as a form of violence against women that is mainly to blame for the astonishing rate of AIDS deaths on the continent. He is planning a series of nationwide forums to increase public awareness, political advocacy, and humanitarian assistance, both in America and Africa.
``We want to give the issue of AIDS and sexual behavior the same level of visibility that a previous generation gave apartheid in South Africa,'' he says.
Rivers has also been recruiting some prominent national figures to his cause, among them Bishop Charles E. Blake of the 18,000-member West Angeles Church of God In Christ.
``The Africans, based on my observations there, are very religious people,'' Blake says. ``Many are very responsive to Christianity. They would be influenced by a message that had Christian morality attached to it. If Gene saves only 10 people with his message, that would be great. But I'm sure it will be greater numbers.
``It is time for us to link up city to city,'' Blake says of those congregations wishing to focus attention on AIDS in Africa.
Rivers recognizes that his inflammatory charge that many African men are promiscuous, and his call for abstinence, may win him unlikely allies among some white conservatives, moralists, and other so-called Eurocentrics - thereby alienating his liberal, civil rights base.
``Where the argument has merit, it will be addressed,'' he says of possible criticism. ``When they are obviously partisan, they will be ignored.''
But seminars, conferences, and resolutions about AIDS are meaningless, according to Rivers, if the issue of promiscuity isn't broached.
``The behavior dimension of this is the third rail,'' Rivers says. ``That's the one no one wants to touch.''
Bond denies that promiscuity is taboo. ``I've heard people talk about this,'' he says. ``In a speech I am currently giving, I quote (W.E.B.) Du Bois talking about `a loss of ancient African chastity.' I heard Jesse Jackson talk about this. Maybe it's not talked about enough.''
Eva Thorne, a member of Rivers' 21st Century Group, contends blacks have long been shy in airing their troubles from within. ``People don't want to talk about when black is ugly,'' Thorne says. ``They only want to hear about `black is beautiful.'''
Bond, who has been praised for chairing the NAACP board following a period of turmoil within the organization, says there is only so much the NAACP can do when it comes to AIDS and the issue of promiscuity.
``Is our role to speak of abstinence?'' asks Bond. ``We're not a birth control organization. That's not our mission.''
Rivers, a minister in the Church of God In Christ, is being courted by the presidential campaigns of both George W. Bush, the Texas governor, and Vice President Al Gore. He plans to circumvent traditional black leaders and appeal to the major political parties, as well as the Roman Catholic Church, to help him and his organization address the plight of AIDS sufferers in Africa.
``You cannot advocate for black people in the United States without understanding the interdependence of black problems throughout the world,'' Rivers says. ``We're going to be moving beyond the bifurcation between domestic and foreign.''
For decades, black Americans have had a spiritual connection to Africa. During the 1960s, stories of Africa's struggles for independence from the French and British were chronicled endlessly in the black press. Blacks were proud when their representatives in Congress - principally Adam Clayton Powell and Charles Diggs in those halcyon days of African freedom battles - presented themselves at African independence ceremonies. Diggs was known to drop tears on such occasions.
The 1970s saw an even more impassioned identification with Africa following the dramatization of Alex Haley's ``Roots'' from book to television screen, a telling of an African's journey from his homeland to slavery in America. The 1980s were a rallying cry to cripple apartheid in South Africa. But it didn't take long, following the 1990 freeing of Nelson Mandela and his 1994 ascent to the presidency, for some American blacks to dream of putting a foothold on the continent.
``Black Americans felt that economic opportunities were limited to them in America, Asia, and Europe,'' says Marsha Coleman-Adebayo, a former senior foreign policy researcher for the Congressional Black Caucus Foundation, who now heads Ncediwe/Brits, a Washington D.C.-based group that works with Africans grappling with the AIDS crisis. ``So they focused their attention on a continent that might be more open to them and provide more economic opportunities.''
Meanwhile, underlying the romance of going back to Africa, of making money there, a monumental health crisis was looming: AIDS. But black business interests still continued to push the Clinton administration for a trade bill with Africa.
``I would argue that that is extremely shortsighted and detrimental,'' Coleman-Adebayo says. ``Is that the most important thing you can do in Africa - support a trade bill - when we have millions dying of AIDS?''
Coleman-Adebayo sees further catastrophe looming. ``We're looking at the depopulation of Africa as we know it,'' she says. ``It's going to become a continent of orphans, the elderly, war victims, and the sick. I believe we should look at AIDS in Africa as a war. And we need a war chest. We need at least $1 billion.''
The Clinton administration recently announced a $100 million aid package to help Africa deal with its AIDS crisis.
``That's an important step - but a small step,'' says Dellums, who plans to encourage other foreign governments to contribute. ``Africa is our heritage, America is our citizenship. As part of our citizenship, it is our duty to challenge this country to realize that millions are dying in Africa.''
US Representative Barbara Lee, Democrat of California, has presented what she is calling a ``Marshall Plan'' to Congress to help deal with the African AIDS epidemic. The bill, which would establish an independent agency to help fund research and programs to combat the crisis, is languishing in the House. Lee has corralled nearly four dozen sponsors, but realizes there is no hope the bill will be passed this session. ``But the support is building,'' Lee says. ``Next year we'll have a jump start.''
Lee doesn't think Rivers' criticism of other black leaders will help. ``We've got to unify,'' she says. ``This is a whole new state of emergency. You can't get cynical and you can't bash organizations that are doing a good job.''
One challenge, black officials acknowledge, will be how to focus on the AIDS crisis in Africa when black Americans have a major AIDS problem themselves. Blacks contract 45 percent of new AIDS cases in the United States, according to the Centers for Disease Control. In the mid-1980s, that number was only 25 percent.
``Many blacks who have not done anything in the black community are now going to help the Africans,'' says Pernessa Seele, founder of Balm In Gilead, a New York -based group working to develop AIDS awareness in black churches. ``I am saddened by some of the very movers and shakers who have jumped on AIDS in Africa and not done anything about AIDS in our own communities.''
Dellums agrees. ``This AIDS issue is not an `over there' issue alone,'' he says. ``It's also right here in the 'hood.''
Seele's is one voice not shying from the issue of promiscuity. She wants blacks to talk more openly about sexual practices in their own communities. The issue of promiscuity, she says, is not endemic to Africans only. ``We have some of the same practices here and we don't talk about them. We don't talk about the brothers who sleep with four and five women.''
Seele says that the traditional role of missionaries alighting from American churches for the shores of Africa now must change. ``As our black churches continue to do their missionary work in Africa, they have to do something other than just spread the word of God,'' she says. ``They must begin to address the issue of AIDS.''
Rivers believes that black Americans can position themselves to save a continent that continues to grip them emotionally and spiritually.
``Africa may yet be delivered by those to whom Africa sold into slavery,'' he says. ``That's the great irony.''
End of series
Globe online This series is
available on the Globe online at
Use the keyword: AIDS.
This story ran on page A01 of the
Boston Globe on 10/12/99.
© Copyright 1999 Globe Newspaper Company.