Allies of AIDS / Among warring factions in Congo, disease is mutating

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Allies of AIDS / Among warring factions in Congo, disease is mutating

Newsday - July 9, 2000
Laurie Garrett, Staff Correspondent


Kampala, Uganda-It was born out of war, spread in war and may now be
mutating into an explosive nightmare amid war. HIV, soldiers, rape
and prostitutes: These are the elements that spawned and spread
Africa's horrendous AIDS epidemic.
For at least thirty years military forces have served as mobile
vectors for the deadly virus. Today, HIV has found unwitting allies
in the war raging in the Democratic Republic of Congo.

Surprisingly, the war in Congo has indirectly affected computer
information at Los Alamos Laboratory in faraway New Mexico. In the
enormous computers there are stored the genetic details of every
analyzed strain of HIV viruses, with the earliest sample dating from
1959. Dr. Bette Korber and her colleagues have noticed
that, "something strange is going on in Congo. It's as if all the
African HIV clades [subtypes] are mixing there, forming strange
recombinants. We're seeing variants never seen before."

At least seven different countries are fighting against one another
in battles meant to decide the fate of Congo, formerly known as
Zaire, and its valuable oil, mineral and gem resources.

The Congo War, which began as a civil war in 1996 overthrowing former
dictator Mobutu Sese Seko, originally placed rebel leader Laurent
Kabila in power. Guerrillas, representing various Congolese ethnic
groups, are fighting Kabila and one faction or another is backed by
military forces from Uganda, Rwanda, Zambia, Namibia, Zimbabwe and
Angola. Congolese rebels also have been moving freely in Tanzania,
Burundi, Sudan and the Central African Republic. South Africa has
attempted to broker a peace, but all sides are tugging at the
influential nation, hoping to drag it, too, into the fray.

This spring, hostilities took turns for the worse as Rwandan and
Ugandan troops-supposedly fighting as allies-opened fire on one
another. In May, Kenyan President Daniel arap Moi and Tanzanian
President Benjamin Mbaka brokered a peace deal but fighting has
continued. In northern Tanzania, government officials said they fear
the war will soon spill over into their Kagera District.

Until recently, one of the "remarkable features about HIV" was the
geographic restrictions seen of various subtypes, or clades, of the
virus. In the Lake Victoria region (Uganda, Kenya, Tanzania and
Rwanda), nearly all HIV was of either the D or A clades. In southern
Africa, where the epidemic is comparatively newer, C clade has
dominated. The C clade has also been the major form of HIV in
Ethiopia and the Horn of Africa. West Africa, in contrast, has been
dealing mostly with A, G and D clade viruses.

But now, Korber said, "recombination is happening so fast that we see
the clade distinctions beginning to blur," and viruses are emerging
that have genetic bits of, for example, Ugandan D clade HIV, C clade
pieces that look Zambian and A clade material that appears Congolese.

It is not possible to predict whether this Congo HIV mlange will lead
to greater dangers.

Maj. Ruranga Rubaramira of the Uganda Defense Forces acknowledges
that AIDS is taking a serious toll. In a May speech at an AIDS event
in Kampala, Uganda's vice president, Dr. Speciosa Wandira Kazibwe,
declared the epidemic "a security issue," implying that her country's
advances in rolling back HIV incidence could be threatened by viruses
brought home by returning soldiers.

It wouldn't be the first time soldiers brought HIV home to their
Ugandan wives and girlfriends.

In 1962, Uganda gained its independence from the British Empire,
bringing Milton Obote and his military right-hand man, Maj. Gen. Idi
Amin, into power. Amin then overthrew Obote in a coup in 1971,
commencing what is commonly called "the Ugandan Reign of Terror." He
bled the national economy dry, expelled the nation's Asian population
and ordered the torture and execution of an estimated 500,000
Ugandans, about 3 percent of the population, during his eight- year
reign.

Amin directed much of his brutality against the Baganda people of
Uganda's Rakai District. For three years Amin's soldiers, many of
them mere boys, occupied the district, exacting "tributes" in the
form of sex with village women.

On Oct. 30, 1978, Amin's army, bolstered by arms supplied by Libya,
launched an invasion of neighboring Tanzania. The troops massed in
Rakai District and rolled unopposed across the border, seizing the
Kagera District of Tanzania. Six months later, the Tanzanian Army
reclaimed Kagera with a force of 45,000 and, upon seeing the
destruction, rape and brutality Amin's soldiers had exacted upon
their fellow countrymen, descended upon hapless Rakai with a
vengeance.

"They stayed here a very long time," Serapio Semanda, age 75, recalls
in Kibumba village in Rakai. "They were just brutal, taking the
women, roaming like vagabonds."

Amin retreated to Kampala, recalls attorney Sophia Mukasa-Monico, who
was then a student at Makarere University. Even then, according to
Mukasa-Monico, Amin said, "There is a very, very bad disease that is
passed by sex and it is from Tanzania. It is venereal and it is
incurable."

"And that was 1978," said Mukasa-Monico, who heads Uganda's private
group, The AIDS Support Organization. "Even at the University we were
saying some of the boys had this new disease-be careful. And during
Idi Amin's time something fell in the morals. And sex was the
release."

But the disease wasn't from Tanzania-though by then infected
Tanzanian soldiers were spreading it. Thanks to the Amin brutality
and the movement of soldiers in the area, AIDS soon exploded in the
Kagera District of Tanzania.

Since the global AIDS pandemic first exploded out of warfare between
Uganda and Tanzania, military activities-both conventional and
guerrilla-have played a key role in spreading HIV around the
continent. In April, when President Bill Clinton declared the AIDS
epidemic a U.S. national security threat, the rising infection rates
among African militaries were crucial to his move.

In Uganda, military affairs were also what originally awoke President
Yoweri Museveni to his country's AIDS crisis shortly after he
overthrew the government in a military action in 1986.

"Because in 1986, after the president came to power, they had a
guerrilla force," recalled Dr. David Kihumuro Apuuli, head of the
Uganda AIDS Commission. "They wanted to transform it to a
conventional army. So they sent 50 generals to Cuba for training. And
18 turned out to be HIV-positive, and Castro called Museveni and
said, 'You have a problem.' And Museveni felt so sorry, so upset,
because these were comrades who had fought with him in the bush."

Maj. Rubaramira, who fought alongside Museveni and became infected
with HIV in 1985, said that Museveni "talked about HIV even when we
were in the jungle. He wrote a message to all officers to be careful
of the new disease."

Following Castro's startling phone call, Museveni decided to tell the
whole nation, starting Uganda's large-scale and candid AIDS education
campaign.

A similar chain of events befell the Zimbabwe Armed Forces, as
related by Brigadier General David Chiweza-but with a markedly
different outcome. Chiweza fought alongside Robert Mugabe in the
Rhodesian Civil War of the 1970s, and once Mugabe became president of
the renamed nation, Chiweza rose through the ranks of Zimbabwe's
professional military.

"This is where I come in," Chiweza explained. "I got a vision 10
years ago. I was in China as Zimbabwe's defense attach."

China had a mandatory HIV testing law for all foreigners. The men
under Chiweza's command were screened, "and the Chinese called me in
and said, 'Look, we can't accept them in the country.' And I saw a
lot of my guys were HIV-positive. It was 1990 and 13 out of 60 were
HIV-positive, and 30 out of 60 had" sexually transmitted
diseases. "So that was a shocker for me. As a military man I never
thought about HIV. For at least a week I was not myself. I went mad
because I couldn't believe I would be well when so many of my
countrymen were not."

Chiweza retired from the military in 1995. Today, he notes, HIV rates
are soaring among Zimbabwe's military personnel. And unlike Museveni,
Mugabe has remained nearly silent on the subject of AIDS throughout
his 20-year rule of Zimbabwe.

HIV rates in African militaries all over the continent have reached
frightening proportions, with the highest seen in South Africa. This
spring a malaria survey was conducted of the South African National
Defense Forces stationed in the state of KwaZulu- Natal. It was
decided as an afterthought to screen the blood samples for HIV-90
percent turned up positive for infection. Soldiers in a base near the
Mozambican border tested 70 percent positive, prompting newspapers
across South Africa to declare that three-quarters of the nation's
soldiers were infected.

Seventy-five percent is the current infection rate of the Malawi
Army. And Zimbabwe's Army, in a recently disclosed survey that had
been meant to remain secret, turned up 80 percent positive.

Earlier this year the U.S. Central Intelligence Agency released its
estimates of African military infection rates, indicating that up to
60 percent of Congo's and Angola's armed forces, 20 percent of the
Nigerian military, and 30 percent of Tanzania's army are now
infected.

"Amazing, no?" asks Apuuli. "So definitely war is going to perpetuate
HIV/AIDS on this continent."

Marked features of contemporary African warfare are famines, massive
refugee movements, widespread rape of village women and elevated
levels of prostitution in urban areas by women desperate to find
means to feed their children. All of these outcomes may promote
sexual behaviors that spread HIV.

"So, soldiers die of HIV in Congo-is anybody surprised by that,"
indignantly asks Dr. John Rwomushana of Uganda's AIDS
Commission. "They shouldn't be. This whole region is a refugee
setting. These issues must be addressed. A success story of Uganda
[AIDS control] is nothing in a sea of HIV/AIDS. The war is
demonstrating this. For HIV there are no boundaries. Leaders have to
put down their arms and fight a different war-against HIV."

Zimbabwe, where one of four adults is HIV-positive, is taking an
opposite course, however, spending roughly twice as much Zimbabwean
money on the war in Congo-a nation with which it shares no borders-
as on health.

"I have to defend Defense," Minister of Health Dr. Tim Stamps
insisted. "It's a very unstable continent...We are reluctantly in the
DRC [Congo]. None of us want our people to be killed on foreign
land."

Chiweza, the retired general, was stunned.

"I think it's always better to serve the highest, rather than the
immediate goal. In the end you will be confronting graves."

In Uganda, Major Rubaramira was more adamant, and angry. "This is
war," he shouted, pounding his fist on the table. "If there is any
strategy to fight AIDS it should be used. And if someone prevents
that, that person is an enemy for humanity...the spread of HIV is the
fault of the leaders.

"And I think if they are not going to listen we should find a
mechanism of infecting them."