Cover Stories: In the Grip Of the Scourge

By Michael S. Serrill

"Oh, what will happen in this world if we have to die when we make love? AIDS is the century's evil." That lament, from a pop ballad that is sweeping west Africa, probably seems overdrawn to most Americans. Not so for Josephine Najingo, a 28-year-old mother of five who lives in the dusty Ugandan trading center of Kyotera, near the Tanzanian border. For her, the lyrics describe a bitter reality. Josephine is dying because she had sexual intercourse with her late husband. A prosperous trader, he had contracted "slim disease," a painful wasting away of body tissues by uncontrolled weight loss, chronic diarrhea and prolonged fever. The affliction is the most common way that AIDS manifests itself in Africa.

By now, Josephine's own symptoms are well along. She knows she will die, just as thousands of people in her town and the surrounding countryside have already died after being infected with the AIDS virus. Townspeople first attributed the mysterious disease to witchcraft. Now they know that their lovemaking is to blame. They have seen the pattern of infection as it travels from husband to wife to lover. Fifty of Kyotera's leading businessmen are dead. The streets are filling with homeless orphans, the offspring of AIDS victims in outlying areas. Josephine, racked by fevers, chronic diarrhea, throat lesions and a painful itching rash that covers her chest and arms, now passes her days sitting listlessly on a straw mat outside her house, waiting to die.

Josephine's tragedy is the tragedy of central Africa. AIDS has swept across the midsection of the continent like an ancient curse, and will soon have extended its reach through most of western and southern Africa. In Uganda the number of AIDS victims is doubling every four to six months. Says Dr. Samuel Okware, the Ministry of Health official in charge of Uganda's AIDS prevention program: "In the year 2000, one in every two sexually active adults will be infected." The Geneva-based World Health Organization estimates that 2 million to 5 million Africans are now carriers of the AIDS virus. Leading researchers believe at least 50,000 people have already died of AIDS in Africa, and unless a treatment and vaccine are found, a million and a half more may succumb over the next decade.

What is most frightening about the AIDS epidemic in Africa is that it primarily affects heterosexuals, striking down men and women in equal numbers. "Many of us are very alarmed by what we are seeing in Africa," says Dr. Thomas Quinn, an infectious-disease expert at the National Institutes of Health in Bethesda, Md. In the West, modern medical facilities, blood- screening equipment and speedy communications may keep AIDS under control. But Africa is on the front line of what some researchers are already calling an AIDS pandemic. The African experience suggests the dangers and tenacity of AIDS: how thoroughly it can infect a heterosexual population, how difficult it can be to convince people to change their sexual behavior, even in the face of death.

The first cases of AIDS arose among African prostitutes in the late 1970s, at about the same time it first appeared among Americans and Haitians. The disease has now spread to some 30 African countries, mostly in the so-called AIDS belt -- the string of central and east African countries that include Uganda, Rwanda, Burundi, Tanzania, Zaire and Zambia. Medical researchers caution that most AIDS studies done so far in Africa are spotty and preliminary. But none doubt that AIDS is both widespread and running out of control.

Once the disease gained a foothold, it spread rapidly among Africans in the same way it has among homosexuals in the U.S.: through sex with multiple partners. Surveys of African AIDS patients in Rwanda and Belgium found they had had an average of 32 sex partners. Huge reservoirs of infection exist along trade routes connecting the hard-hit countries of the AIDS belt. "In the epicenter," says Belgian Microbiologist Peter Piot, "15% to 25% of the adult population is affected. That's really mind blowing."

In Lusaka, the capital of Zambia, 16% of the adult population, including up to 30% of the men, have been exposed to the AIDS virus. Now babies and young children are also being infected, some at birth via their mothers, who are AIDS carriers, and others through blood transfusions, which are frequently administered to children suffering from malarial anemia. In tiny Rwanda (pop. 6 million), researchers estimate that as many as 22% of AIDS victims are children.

Researchers believe promiscuity combined with a higher incidence of venereal disease among Africans has accelerated the spread of the AIDS virus. Last November the nonprofit London-based Panos Institute reported that the rate of gonorrhea per 100,000 people was 10,000 in Kampala, Uganda, and 7,000 in Nairobi, Kenya, compared with about 975 in New York City and 310 in London. A study of 800 Nairobi prostitutes showed that 88% carried the AIDS virus and more than half had some sort of venereal disease. The women reportedly had an average of 1,000 clients a year.

The geometric explosion of AIDS has been aggravated in part by the slowness of most African governments to launch vigorous anti-AIDS information campaigns. Such programs as there are have been complicated by extraordinary problems with funding, manpower, transportation to remote areas and, significantly, language. In Uganda, for example, 22 different tongues are spoken among the 14 million people. The message of the government's anti-AIDS campaign to "Love Carefully" has been translated into only ten of them.

Another key factor in the transmission of the disease is the unwillingness of many heterosexual men to change their sexual practices. "We tell people this disease is caused by sexual intercourse and they laugh," says Louis Ochero, who heads Uganda's AIDS education program. "They say, 'But we've been having that for years and never got such a thing.' " Nor has the American boom in the use of condoms yet taken hold among most Africans. "Condoms here are regarded as something dirty," says Ochero, "something you use on harlots." The resistance extends into elite circles. A frank lecture last year to a group of medical students at the University of Zambia on the dangers of taking too many sexual partners was greeted with jeers and derision.

The first line of defense against AIDS in most countries is the state-run health-care system. Many poorly equipped facilities are already badly strained by a flood of AIDS patients. One study noted that the cost of treating ten AIDS patients in the U.S. -- about $450,000 -- is more than the entire budget of one large Zairian hospital. Clinics and hospitals are now routinely discharging AIDS patients after emergency treatment to make room for those who can be effectively treated. Doctors often have to make painful decisions. A case of bacterial pneumonia can be cured with $5 or $6 worth of drugs, for example, while cryptococcal meningitis, a frequent manifestation of AIDS infection in east Africa, costs $l,000 to treat -- and the patient is certain to die.

While African nations so far have not been destabilized by AIDS, there are signs of trouble ahead. Most of the victims are young people between the ages of 19 and 40. African governments are therefore bracing for the loss of many of their best and brightest. "I believe that AIDS will have a major impact on the development of Africa," says Microbiologist Piot. "The ones who are dying are the young adults in whom governments have invested the most in terms of education."

For now, African officials seem more concerned with the short-term economic impact. While most governments have stopped denying that the AIDS threat exists, officials fearful that publicity about the AIDS epidemic will hurt tourism and foreign investment have continued to play it down. In Zambia, the Lusaka government banned all press statements on AIDS last March. Government officials are "putting their heads in the sand and hoping the disease cures itself," charges one Zambian doctor, who expects to see "scores of thousands of deaths from AIDS" in the next two years.

In Kenya, the press has relentlessly attacked Western news reports on the AIDS epidemic. The latest flap came after London's Daily Mail reported that Prince Charles would carry his own supply of blood with him on an upcoming trip to the continent. PRINCE CHARLES SCARED OF AIDS! screamed the headline in the Kenya Times.

In the West, AIDS experts are watching the infection race across Africa with mounting apprehension. Says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases: "The potential is devastating. Even the reality is a very serious situation." Still, few experts expect that AIDS will penetrate the heterosexual population in the West as rapidly or as pervasively as it has in Africa. The reason: factors such as unscreened blood transfusions, rampant venereal disease and unsterilized hospital needles are not common in Europe and the U.S., as they are in Africa. In addition, vigorous AIDS education campaigns appear to have the potential to slow down the rate of new infections.

Should AIDS somehow deeply invade heterosexual populations elsewhere, Africa has a stark lesson to teach about how suddenly and inexorably the disease can erode and destroy the comfortable assumptions and familiar habits of a more advanced culture that believes itself immune to the most primitive -- and frightening -- forces of nature.

With reporting by Jim Fish/Lusaka and Maryanne Vollers/Kyotera