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African experience of AIDS






Some years after AIDS was first diagnosed in the United States, the first cases were recognised in Africa. We know today that for years thousands had been dying, but their deaths were blamed on tuberculosis and other diseases.

In many towns and cities across Central Africa, up to a third of all young adults are infected. A third of the truck drivers running the main north/south routes and half the prostitutes in many towns are carrying HIV. One relief agency in the early 1990s talked unofficially about pulling out of Central Africa. `What's the point in drilling more wells when most of the people will be dead in a few years?  

Over 45 million Africans were infected by 2002 of which more than 30 million were still alive.  A further 12 million children had already lost one or both of their parents.  The effects over the last 15 years have been a catastrophe. Seven countries, all in southern Africa, now have prevalence rates higher than 20%: Botswana (38.8%), Lesotho (31%), Namibia (22.5%), South Africa (20.1%), Swaziland (33.4%), Zambia (21.5%) and Zimbabwe (33.7%).

Uganda remains the only country to have subdued a major HIV/AIDS epidemic, with the adult HIV prevalence rate continuing to drop-from 8.3% at the end of 1999 to 5% at the end of 2001. Huge challenges persist, however, such as taking care of the 880 000 Ugandan children who have been orphaned by AIDS.  60% of all adults infected are women.

I have visited villages where grandmothers are looking after their grandchildren because so many young men and women, the parents, have been wiped out by AIDS. Armies of troops in Central Africa are being depleted---not by rockets and machine guns, but by AIDS. Breadwinners for families and providers of the countries' wealth are missing. The educated elite living in the main towns and cities have often been worst hit.

In the country, fields are uncultivated and cattle wander aimlessly. One journalist visiting an African country described areas where whole families had been wiped out, plantations gone back to bush. I have met someone who claims to have satellite photographs of a country in Central Africa taken two years apart, showing not deforestation, but reforestation as the amount of farming falls. It is an effect attributed to AIDS---the country is not at war.

As early as 1991 I found it hard in a city like Kampala to find a family that was not attending an AIDS funeral on average once a month. Deaths continued to soar over the next decade among young adults. In Africa they called it the `slim' disease. Some Africans believe if you sleep with only fat women you are safe. `To be fat is to be healthy.'  Uganda has seen a dramatic response to prevention campaigns but for those already infected it is all too late.

In the early days of the pandemic, officials stood at the doors of some hospitals selecting the fit ones for treatment. Anyone who looked thin and weak was sent back into the bush---`Probably got AIDS; nothing we can do for him.' Many were sent away with perfectly treatable diseases such as tuberculosis. You cannot tell the difference at the door.

Years and years of careful preventive medicine has been undermined. How do you start educating about a disease which produces no illness for years, when nurses are still battling against ingrained habits just to get mothers to give their children a healthy diet?

The children's wards are full of dying children. Many are babies under one or two years old. Many are not dying of famine, but of AIDS. A terrible tragedy is that a significant number in the 1980s and early 1990s caught the virus not while in their mothers' wombs, or from their mother's milk, but from the use of unsterilised needles.

AIDS is not a gay plague; there are millions more women and children infected with HIV throughout the world than there are gay men. It gained this reputation in the United States because gay men were first to be diagnosed, yet 98% of all new infections worldwide are heterosexually acquired - and in the poorest nations.