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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

 

'UNLESS THERE IS A FUNDAMENTAL CHANGE IN BEHAVIOR, THERE WILL BE NO DRASTIC CHANGE IN THE EVOLUTION OF THE EPIDEMIC.';
AIDS AND THE AFRICAN;

 

http://www.faculty.fairfield.edu/faculty/hodgson/Courses/so191/AIDS_IN_Africa/BGonAIDSinAFRICA.html

BYLINE: By Kurt Shillinger, Globe Correspondent

BODY:

   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. Half of all babies born there are infected with HIV.

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."

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."
 

 

Copyright 1999 Globe Newspaper Company
The Boston Globe

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October 10, 1999, Sunday ,City Edition


SECTION: NATIONAL/FOREIGN; Pg. A1

LENGTH: 416 words

HEADLINE: THE DYING;
'We grew up telling ourselves, 'If you have one girlfriend, you're not man enough." ';
AIDS AND THE AFRICAN;
First of four parts

BYLINE: By Wil Haygood, Globe Staff

BODY:

   JOHANNESBURG - Hector was a nobody with few girls. And so he got them. For the price of a warm beer he had a bedtime partner every night. He'd boast of his conquests like so many boys in this country boast of their moves on green soccer fields.

Hector's dying now.

Colin found his women in the bars of Hillbrow, the section of Johannesburg where white liberals used to congregate during the mean days of apartheid. These days a lot of flesh gets peddled in Hillbrow. Colin found girl after girl after girl.

Colin's dying now.

Pete and Sonny Boy couldn't stop themselves from bedding women. Their fathers bedded many women. Sex and more sex was due them, they felt. A rite of passage.

Pete's dying now, and his girlfriend, Queen, is already dead. She lies in a township graveyard, right alongside their son, Manietjies, who was 6. They called him little Pete. Little Pete died four months ago of AIDS. Just like his mother.

The deaths made Sonny Boy blue. But he swears he'll save big Pete. Big Pete is skinny as wheat. One hundred and five pounds, and dropping. Sonny Boy needs some fresh fruit and vegetables for Pete, but doesn't have a dime in his pocket. Still, he believes in miracles. "I will care for Pete," Sonny Boy swears. "You will see."

Sonny Boy could use a miracle himself. He's dying too.

This is now the land of the dying and the dead. They're all victims of AIDS.

As the AIDS scourge sweeps a wicked path across the continent, health experts predict that 50 percent of all new infections in Africa will take place right here, in battle-torn South Africa.

"Most women in this country know their husbands or boyfriends have multiple partners," says Morna Cornell of the Johannesburg-based AIDS Consortium, a clearinghouse for organizations fighting the epidemic. Cornell estimates that in the next five to 10 years, 3.5 million people will die of AIDS in South Africa. "It's on a scale unimaginable to anybody else," she says.

Bart Cox, an AIDS activist here, says that "it's interesting to talk about promiscuity, but very risky, even dangerous. So many of these young black males feel a sense of entitlement. Meaning, if they see a woman as dressing sexy, they think they are entitled to her."

All tuckered out and dying, Pete hates that his sexual vigor is not what it used to be. Not that his new girlfriend knows he's infected. "I met her one day and had sex the following day," Pete says, letting a guilt-free smile flower across his face.

 


PART 2
 

Copyright 1999 Globe Newspaper Company
The Boston Globe

 View Related Topics

October 11, 1999, Monday ,City Edition


SECTION: NATIONAL/FOREIGN; Pg. A25

LENGTH: 853 words

HEADLINE: Prostitution plays key role in fueling Africa's AIDS crisis;
AIDS AND THE AFRICAN

BYLINE: By Wil Haygood, Globe Staff

BODY:

   CARLETONVILLE, South Africa - Ten women are striding up a dirt road in this old mining town. Emily Ntsekawla is giggling, kicking at weeds. Gladys Nicholas, all lipsticked up, is scanning the distance. It's midafternoon. The air is clear and the ladies are going to work.

They reach an opening in the middle of the adjacent bush and take seats on tin cans. A few have condoms in the palms of their hands. There's a tall and lean miner coming just now. Nicholas chats with the miner. Then she vanishes with him into the bush, twisting like a schoolgirl.

The women are prostitutes. And out here, in a stretch of rural landscape about 45 miles west of Johannesburg, it is mean work. Malaria-causing mosquitoes are one thing; the real possibility of robbery another. But the most lethal revelation is this: Carletonville has one of the highest rates of AIDS in the world.

"In young women 25 years old and under, two out of three of them are already infected with AIDS" in Carletonville, says Brian Williams, a researcher at the University of Pretoria who has been studying the area for the past year. "So, two out of three girls will die before the age of 30."

Health officials say prostitution is playing a key role in fueling the AIDS crisis in sub-Saharan Africa.

But Emily Ntsekawla, a prostitute who is 22, doesn't pay much attention to statistics, or mortality rates. She's more concerned with everyday survival out here in the bush.

"Sometimes you get somebody who takes your money and runs," she says.

Thugs shot Ntsekawla six times earlier this year. "I was praying that God would take me," she says. "I was in such pain."

Ntsekawla wears a crude surgically-implanted metal device in her left arm that helps heal the bones that were shattered from the shooting.

"This is like a no man's land, so you have gangsters who put themselves into a position of governing," says Zodwa Mzaidume, a counselor with the Mothusimpilo Outreach Project, an AIDS educational program funded by the American and British governments.

Mzaidume has been teaching the women about safe-sex practices. Mzaidume confesses she can't watch every woman going into the bush, and knows that not all of them will insist that the men use condoms.

"Nobody protects the women," she says. "They are open to any type of harassment - police or criminal. Some guys even rape them."

The women - who prefer the title "sex worker" - all live three miles down the road, in Leeupoort, a squatter camp that one can only enter by traversing wicked dirt roads. There is no electricity or running water in Leeupoort. Someone has scrawled "Tigers Don't Cry" on the side of one of the dwellings, as if to underscore that this is no place for the faint of heart. There are 150 sex workers who live in the squatter camp. Many have their children with them, kids who can be seen scooting around in the dust during the day.

"The hot stuff is 20 rand," says Emily Ntsekawla. "The cold stuff is 6 rand."

The hot stuff is sex. The cold stuff is beer. Twenty rand is the equivalent of about three American dollars.

"There's no time for intimacy," says Mzaidume, the outreach counselor. "It's pay and go."

Mzaidume is still grieving over Tstelele Phuteho. Phuteho drove the van for her program, delivering condoms to the ladies in the bush. Hoodlums robbed the condom deliverer and shot him dead in April. "I come in here knowing very well that something could happen to me," Mzaidume says, after hiking into the bush one recent afternoon to check on the women.

They are never short of customers. There are three shifts of miners at nearby Goldfields Mines, which employs more than 7,000 people. Most of the miners are migrants who live in hostels on the mine company's property.

"You've got men living in single-sex hostels without their wives," says Williams, the University of Pretoria researcher. "What do you think they're going to do, play backgammon?"

Mzaidume has been dispensing more than 80,000 condoms a month, trying to stem the staggering rate of AIDS infection in this area.

"When I first met these sex workers," she says, "they knew nothing about AIDS or STD's (sexually transmitted diseases). It took me three months to get them to accept me."

Xoliswa Jaho, who is 36, has worked here for three years, after arriving from Cape Town. "I was working in the kitchen of a house," she says, adding that by working as a prostitute, she easily quadruples the salary she would have made continuing to work as a domestic.

Khanyisiele Hlongwene, 23, says the work is not that grueling. "Some men look at me and discharge before they even touch me," she says, laughing.

Gladys Nicholas, whose family thinks she is scouring the country, job hunting, has dreams. "My dream is always to get a better job than a sex worker," she says. "I would like to have a clerical job."

In recent months, Nicholas, Hlongwene, Jaho, and the other women here have had to dig into their savings for coffins and train fare. Three of their colleagues fell dead from AIDS. The bodies had to be shipped back to their families.

 


 

Copyright 1999 Globe Newspaper Company
The Boston Globe

 View Related Topics

October 11, 1999, Monday ,City Edition

 


SECTION: NATIONAL/FOREIGN; Pg. A25

LENGTH: 744 words

HEADLINE: Rape victim: 'I felt myself drowning';
AIDS AND THE AFRICAN

BYLINE: By Wil Haygood, Globe Staff

BODY:

   SOWETO, South Africa - Her day started beautifully.

Portia Moalusi was out for a stroll with her boyfriend. They were holding hands, chatting, smiling, just strolling around this old epic-sized township on the outskirts of Johannesburg. It was a Sunday this past June.

"I saw two people walking," she says. "I thought they were lovers. When I started to turn a corner, they approached me with guns."

She's sitting in a clinic here, meeting with her doctor.

She goes on:

"I said, 'What do you want? I can give you my necklace.' "

The gun-wielding couple - immediately joined by another male - didn't want her necklace. Moalusi's boyfriend was told, at gunpoint, to flee. He did.

She was hustled into a car. She was blindfolded. Her heart pounded. The car came to a halt. It was at the edge of a river.

Moalusi knew what the men wanted. The woman helped hold her down.

"Before they started raping me, they pushed my head into the water," she says. "I felt myself drowning."

Her doctor, Mary Jane Kumasamba - who has heard some evil tales of crime and rape while working as a doctor here - grimaces. There were deep genital bruises on Moalusi when the doctor first examined her.

"We were shocked by the story," the doctor says. "This is like Sodom and Gomorrah."

Portia Moalusi is 29 years old. She's single and unemployed. She has close-cropped hair and small hands, which she keeps folding and unfolding in her lap.

"I told myself I would cooperate because they told me they would kill me," Moalusi says about her abductors.

She said she was repeatedly raped by the men, and recalls quite vividly the words of the last man who attacked her. "After he raped me, he said to me, 'I've got something to tell you. I'm HIV-positive.' I was in shock."

A rape occurs every 26 seconds in South Africa, the highest rate of rape in the world, and the country's rate of 1,600 HIV infections per day is also the highest in the world, more than 14 times greater than in the United States. While there are no numbers relating the astonishing AIDS figures in South Africa directly to rape, no one denies that sexual assaults are adding to the problem significantly.

On this afternoon, Portia Moalusi is waiting for HIV test results at a clinic on the grounds of the Chris Hani Baragwanath Hospital. The clinic deals with rape and child abuse cases. Moalusi and her doctor have agreed to let a reporter sit in while they wait.

When Moalusi came to the clinic, Dr. Kumasamba did something she was not supposed to do: She opened the anti retro-viral "starter kit" she keeps in the clinic - in case any staff member is exposed to blood - and gave it to Moalusi. The starter kit consists of two potent drugs that if given immediately can often halt the virus in its tracks. In giving the medicine to Moalusi, Kumasamba left herself and the clinic without any of the drug. "I knew I was going to be in trouble," she says, "but there was a life to save."

Kumasamba has two large spiral notebooks. They detail the date of all reported rapes and the names of the victims. They also report the results of the AIDS tests for those who were raped. More than half are given the dreadful news that they are HIV-positive.

There is a police officer on duty 24 hours a day at the clinic. Kumasamba's job is dangerous. When the police arrest someone, she often testifies on behalf of rape victims, going eye to eye with the accused in the courtroom. But the police have so far made no arrests in Portia's rape.

After an hour-long wait, the sounds of clicking heels can be heard coming down the hallway. The door opens.

"The results are negative," says Sally Mbulaheni, a nurse, who is allowing herself a smile as she reports the news.

The doctor hugs Moalusi. "You made it," the doctor says. Moalusi covers her face in her hands, overcome with emotion. "I'm so happy," she says.

"It's a victory for us," Kumasamba says.

The doctor couldn't bear - at least in Moalusi's presence - to talk about reality. The reality is that Moalusi's first test results, while gratifying, could take a bitter turn. It can take up to six months after an infection for the virus to be detected. "She might still be positive," the doctor would say.

Later in the afternoon of the day she received her test results, Moalusi, standing in front of her home, twirled like a little child. Then she vanished with something approaching happiness on her face.

 

PART 3
 

Copyright 1999 Globe Newspaper Company
The Boston Globe

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October 12, 1999, Tuesday ,City Edition


SECTION: NATIONAL/FOREIGN; Pg. A1

LENGTH: 3105 words

HEADLINE: Most leaders won't confront the epidemic ;
AIDS AND THE AFRICAN ;
Third of four parts

BYLINE: By Kurt Shillinger, Globe Correspondent

BODY:

   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 Zambia in a speech at the annual conference on AIDS in Africa.

Strikingly, no African heads of state attended the Lusaka 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 lip service, leaving the international community and underfunded private organizations to confront it.

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.

"The fact that no heads of state went to the Lusaka meeting is a negative sign. It is not coincidential that they are all men," Foreman added. "Political, community, and religious leaders in Africa are men. The male self-identity is dependent on the sexual identity. For many men, any attempt to discuss and restrict sex belittles their masculinity. That's part of what's going on."

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, 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 aims "to ensure nondiscrimination 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 antidiscrimination measures. But the government has allocated only $3.5 million to implement it over five years, and interviews around the country with officials 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-suffficiency. 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.

"The church, and by that I don't just mean my own, is doing nothing," he said. "There are a few in the clergy who are fighting rifles-against-tanks battles. But most give AIDS lip service at best, and many deny that it is in their own congregations."

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 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 silenc§anc0000e must be broken."

Tomorrow: US black leaders react

 


 

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October 12, 1999, Tuesday ,City Edition


SECTION: NATIONAL/FOREIGN; Pg. A21

LENGTH: 1175 words

HEADLINE: Couple fights AIDS virus, taboos;
AIDS AND THE AFRICAN ;
Third of four parts

BYLINE: By Kurt Shillinger, Globe Correspondent

BODY:

   LUSAKA, Zambia - Though physically small, Kabanda Syamalevwe was once the kind of man who embodied his Tonga tribe's ideals of masculinity. He ruled his wife and children as lord and master. He took other women. His peers, he recalls now with laughter, called him a bull.

But one afternoon in 1993 his world collapsed. A friend walked into a bar where Syamalevwe was having a few drinks and showed him a story in the local newspaper revaling that a school teacher had tested positive for HIV. The woman in the accompanying photo was his wife.

"Imagine the feeling of helplessness and uselessness," he said during a recent interview.

For most African women, having the AIDS virus is a multiple curse. It can lead to rejection and violence. Most women contract HIV from their husbands or boyfriends, but few men willingly accept responsibility. At the time Brigitte Syamalevwe learned she carried the AIDS virus, she and Kabanda had been married for 21 years. She had never strayed. Both knew he was the source of her infection.

Instead of destroying their marriage, however, the personal crisis of HIV started the Syamalevwes on the kind of long and fundamental reassessment of their attitudes about sexuality and marriage that experts increasingly believe is the only true solution to Africa's AIDS epidemic. It is a process that involves breaking old molds, elevating the status of women at home and in society, and redefining what it means to be a man.

"Men must be confronted with change," said Kabanda, a former health clinic officer. "Our cultural upbringing has a bearing on our sexual patterns. So we need to focus on how social expectations shape our behavior as men and women."

In the six years since they learned they were infected, Brigitte and Kabanda, who live in the northern Zambian town of Kitwe, have tried to understand why men behave the way they do, how women contribute to that behavior, and how to change. Both are now involved in community-based HIV/AIDS education. In their spare time, and with their own resources, they run workshops for men and women on sexuality and marriage.

They are now in the process of creating Africa's first Society of Men Against AIDS, a male version of programs in countries like Senegal that encourage open discussion about behavior and AIDS among women.

As their story spreads, the Syamalevwes are quickly becoming a model for how to change sexual dynamics in sub-Saharan Africa. Responses to the AIDS crisis in the region have tended to focus on women because they are more vulnerable and also more likely to attend clinics and obtain information. But that has not slowed the epidemic, and a consensus is beginning to grow that more emphasis needs to be placed on male behavior. A study released last month at an international AIDS conference in Zambia, for example, indicated that 80 percent of men in that country have multiple sexual partners.

"Men are the cutting edge," said Salif Sow, an expert on infectious diseases at Dakar University in Senegal. "The problem is that we're always talking about women, but they don't have the power to protect themselves. Men are the key to HIV transmission."

At the conference last month in Lusaka, Zambian Health Minister Nkandu Luo actually suggested that the time had come for African women to riot against men. But the Syamalevwes have a different approach: they work with each other to overcome the kind of gender inequities that have helped AIDS to flourish.

It hasn't always been easy. The paternalistic influences of Kabanda's Tonga tribe left deep marks on their marriage. His father had three wives. Men were taught to be physically strong and emotionally remote. Women were to be weak.

"If I called him on an issue, he would punish me by coming back home later than usual," Brigitte said. "It threatened him."

HIV changed the scenario. Brigitte had herself tested against Kabanda's wishes, and then did not tell him. She had seen some of her students struggle with losing their parents to AIDS, and worried about how her own children would cope in the same situation. After Kabanda read the story in the newspaper, it took several months for him to muster the courage to find out his own status.

Faced with the sudden prospect of shortened lives, the couple began breaking free from prescribed molds. Kabanda paid less heed to peer pressure, stopped sleeping around, and took a more active role in raising the couple's 11 children. He became more supportive of Brigitte's career and flouted a traditional taboo by having a vasectomy.

Brigitte also changed. She became more assertive. Whatever Kabanda expected of her, she held him accountable as well. "Women are collaborators in their own servitude," she said. "Pregnant women are emotionally weakened in the relationship, so I was Kabanda's slave for a long time. This experience has given me a chance to get liberated from men, to become an equal partner."

The Syamalevwes are a rare case. Kabanda was willing to make changes. Most Africans find it hard to discuss sex openly, and many women risk violence, blame, and rejection for having HIV. The couple say they talk about sex and AIDS with their family, but so far have not insisted that their children be tested for HIV.

In one of their first workshops, in 1994, Brigitte and Kabanda asked the women to go home that night and ask their men for sex, knowing that their culture frowns on women who do so. The next day, 23 of the 24 women reported being harassed over the request.

"It should be appreciated that in our culture, promiscuity is associated with women," Kabanda said. "It was never in our vocabulary to say that men were promiscuous. They reject it because of what the word attaches to their masculinity and superiority."

A groundbreaking program in Botswana underscores how difficult it is to change deeply-rooted attitudes. Over the past 18 months, the Norwegian-funded Men, Sex, and AIDS has run workshops to encourage men to talk openly about sexuality. Pilot programs modeled after the project are scheduled to start next month in Zambia, Zimbabwe, and Swaziland.

By the end of each three-day workshop, most of the men overcome their initial shyness. But it is too early to tell if the work will lead to changes in behavior.

"Men are difficult to reach. They don't go to clinics and can't be bothered to get information," said MacDonald Maswabi, the program's director, in a phone interview from Botswana's capital, Gabarone. "So our main concern for now is creating a place where men can go without being labeled. Many of the men at our workshops admit they need to change their lifestyle, but it will take a very long time, assuming we do have an impact."

The Syamalevwes, however, say that it is often the men who reject or ridicule their message publicly who come back privately for help. Many men are afraid to show weakness, they say, and conform to peer pressure. But what Brigitte tells them is simple: "You don't lose your manhood through good actions."

 

PART 4
 

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October 13, 1999, Wednesday ,City Edition


SECTION: NATIONAL/FOREIGN; Pg. A1

LENGTH: 1918 words

HEADLINE: AFRICANS AND AMERICANS;
'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';
AIDS AND THE AFRICA;
Last of four parts

BYLINE: By Wil Haygood, Globe Staff

BODY:

   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."

 

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October 13, 1999, Wednesday ,City Edition


SECTION: NATIONAL/FOREIGN; Pg. A17

LENGTH: 890 words

HEADLINE: THE OUTSIDER;
Minister tries to shame officials into action;
AIDS AND THE AFRICAN;
Last of four parts

BYLINE: By Kurt Shillinger, Globe Correspondent

BODY:

   JOHANNESBURG - The prospect of a straight-talking minister from Dorchester prodding African leaders with a new gospel that casual sex is tantamount to violence meets skepticism from Cape Town to Kampala.

It is the aim of the Rev. Eugene Rivers to stir the waters rather than still them. Angered by the ravaging of Africa by AIDS, he is launching a campaign to shame African governments for doing and spending too little, and prominent black Americans for watching in silence as millions of Africans die each year.

"It is time to embarrass the ambassadorial representation of African countries in Washington," Rivers says. "If they could mobilize around the issue of apartheid, why don't they do the same for AIDS?"

The blitzkrieg approach might work on American politicians in Washington, where confrontation is the norm in politics and the Clinton administration sympathizes with issues such as the need to ease Africa's debt burden and break the corporate grip on anti-AIDS drugs.

But Africans may be harder to influence. As leaders like South African President Thabo Mbeki promote their vision of an African renaissance, they are increasingly impatient playing the junior partner in North-South relations. They reject implicit assumptions that the West has all the answers for Africa.

Against this backdrop, Rivers raises thorny issues. He argues that the AIDS epidemic is a symptom of a cultural collapse in Africa, and wants to make abstinence a human rights issue. But Africans are traditionally reticent talking about sex. Most find it difficult to discuss the subject even with their own partners, studies have shown, let alone outsiders. At a church conference in Zimbabwe last December, when Rivers first floated the idea that in the age of AIDS male promiscuity is a form of violence against women and children, his pleas for open discussion were met with shocked silence.

"It is dangerous to bring in outsiders to talk about sexuality," says Patricio Rojas, representative of the World Health Organization in Namibia. "The field is so complex. If you talk about changing mores, mores in Boston are very different from mores in Namibia. We try to promote a strong interchange of experiences within Africa. That is more useful. Closeness is fundamental to the success of the message."

But John Caldwell, an expert on Africa at the Australian National University in Canberra, has grown impatient with the light-handed approach. In his latest book on the AIDS epidemic, he argues that "government silence is partly explained by the surprising fact that overseas donor governments have not put sufficient pressure on political leaders to speak out and do so continuously, and to organize against the disease.

"There have been no inducements, such as massive help to the health system and to programs to curb AIDS given on condition of sustained and high-profile leadership."

If donor governments have the clout to attach conditions, however, smaller players probably don't. Mark Ottenweller, an American doctor who runs 12 AIDS support groups in Soweto in a partnership between local officials and the US organization Hope Worldwide,says that engaging African leaders often is a matter of tact and tone.

"Frequently it's out of guilt that they get involved, as long as you're not too critical," he says.

The same rule applies at the street level. Ottenweller, who still carries the Bayou accent of his Louisiana upbringing, holds informal workshops on marriage in his free time. The way to break through silence, he says, is to establish a sense of common experience.

A health official in the northern Namibian town of Rundu, where AIDS is taking a particularly grim toll, agrees. "If you just walk in and start talking about sex, you will make people resistant," the official says, requesting anonymity. "People must feel you're not an outsider. You must use 'we' and not 'you,' and have an entry point into the community like a school or a church."

Adds Bart Cox, director of the AIDS Committee at the Anglican Diocese in Johannesburg: "It is the interdependence of people that matters. Stories of, 'Oh, you too?' " he says. "We have to create bonds of compassion through human experience."

Still, as the epidemic swells, it is creating an increasing "compassion burden." More people are falling sick and dying, more families are losing breadwinners, more children are left parentless. Governments must be held more accountable, AIDS experts say, but it is also critically important to get new players - notably churches - involved in building community-based care networks.

"One of the main objectives over the next couple of years is to bring churches on board," says Peter Piot, executive director of UNAIDS, a joint program of several agencies in the United Nations. "To be blunt, orphanages will mean tremendous business for churches."

The outsider question doesn't deter Rivers, who models his initiative after the Biblical story of Joseph. Sold into slavery by his brothers, he later saved them from famine and ruin.

"Until Africans in Africa confront their complicity in the slave trade, they have no moral standing to challenge blacks in the US who challenge them regarding the same indifference that they now express toward the holocaust in Africa today," Rivers says.