AIDS ‘Stalks’ Africa, Time Cover Story Reports

HIV "sweeps mercilessly" through sub-Saharan Africa, constituting "the fiercest trial that Africa has yet endured," yet considerable ignorance and denial of AIDS "herald victory for the disease," the cover story of Time magazine reports. "As AIDS migrated to man in Africa, it mutated into a complex plague with confounding social, economic and political mechanics that locked together to accelerate the virus' progress," the article says, adding, "The region's social dynamics colluded to spread the disease and help block intervention." Focusing on Botswana, South Africa and Zimbabwe, "the heart of the heart of the epidemic," Time interviews several local people infected with HIV, describing their quality of life and future as "bleak." AIDS in Africa, Time says, "bears little resemblance to the American epidemic," where AIDS is seemingly limited to "specific, high-risk groups" and controlled by "intensive education, vigorous action and expensive drug therapy." In Africa "everyone who is sexually active is at risk," there is no wide-scale HIV testing, AIDS is not listed as the cause of death on mortuary certificates, and HIV infection rates are typically only reported from infected pregnant women. The lack of knowledge of the disease, or the unwillingness to know about the virus, is even worse. "Ignorance is the crucial reason the epidemic has run out of control," Time says, noting that some Africans say that the disease is the "familiar" consequence of poverty, others say it is witchcraft, and still others believe HIV was introduced by whites to control black Africans after the end of apartheid.

Silence and Promiscuity Fuel Epidemic
Mary Crewe of Pretoria University explained, "It is presumed if you get AIDS, you have done something wrong. We have no language to talk candidly about sex, so we have no civil language to talk about AIDS." As a result, the consequences of the silence "march on: infection soars, stigma hardens, denial hastens death, and the chasm between knowledge and behavior widens." Because "the nature of AIDS feasts on promiscuity," migrant truck drivers and prostitutes commonly spread the virus. In Francistown, Botswana, where international highways and trade routes converge, at least 43% of adults are HIV-positive. Prostitutes often trade sex for the transport of fruit, toilet paper and toys to families, and everywhere "there's premarital sex, sex as recreation. Obligatory sex and its abusive counterpart, coercive sex. Transactional sex: sex as a gift, sugar-daddy sex. Extramarital sex, second families, multiple partners." Men rarely agree to use condoms and women often engage in dry sex to please their partners, both practices significantly increasing the risk of contracting or transmitting HIV. Children orphaned by AIDS "only add another complex dimension to Africa's epidemic," Time says, because communities are becoming "saturated" with them, as families cannot afford to take on additional children. Most orphans "sink into penury, drop out of school, suffer malnutrition, ostracism, psychic distress ... girls fall into prostitution and older boys migrate illegally to South Africa, leaving the younger ones to go on the streets." The death toll from AIDS in Africa threatens to "wreak the region's frail economies, break down civil societies and incite political instability."

Where's the 'Missing Ingredient'?
According to Time, the "essential missing ingredient is leadership. Neither the countries of the region nor those of the wealthy world have been able or willing to provide it." The article points to the South African government, which prohibits pregnant women from receiving AZT and only recently agreed to permit the distribution of nevirapine to leading public hospitals to prevent vertical HIV transmission. Furthermore, African health systems need assistance from Western nations to prescribe and monitor complex antiretroviral drug regimes, and if there ever is to be a vaccine, "the West will have to finance discovery and provide it to the poor. The cure is not national, but international." Time adds, "The region is in a double bind. Without treatment, those with HIV will sicken and die; without prevention, the spread of infection cannot be checked. Southern Africa has no other means to break the vicious cycle, except to change everyone's sexual behavior -- and that isn't happening." The article concludes, "The deep silence that makes African leaders and societies want to deny the problem, the corruption and incompetence that render them helpless, is something the West cannot fix. But the fact that they are poor is not. The wealthy world must help with its zeal and its cash if southern Africa is ever to be freed of the AIDS plague" (McGeary, Time, 2/6).

Also in Time
In addition to its cover story, Time also features several sections on specific aspects of the epidemic. To view an article on financial lending to people devastated by AIDS in Africa and the use of microcredit schemes, type http://www.time.com/time/2001/aidsinafrica/tree.html into your Web browser (Robinson, Times, 2/6). A discussion of government and commercial entity responsibilities to pay for antiretroviral AIDS "cocktails" can be viewed at http://www.time.com/time/2001/aidsinafrica/drugs.html (McGeary, Time, 2/6).