Cover Story

Africa's affliction

Health officials call it an epidemic, folk doctors call it the plague, and church workers believe it is a divine opportunity. Can Africa beat AIDS?

Issue: "AIDS: Africa's affliction," Sept. 9, 2000

At a mission church in Ivory Coast, AIDS victims receive front-row seats. Each Sunday the young congregation in Abidjan reserves its best view for those who may be too ill to appreciate it. Blankets and pillows are ready if they are too sick or too weak to sit or stand through the long singing and worship service. But the seats are usually filled because AIDS sufferers say it is that rare place where they feel socially welcome.

Out of that simple gesture the Abidjan congregation, with the help of American missionary physician Tom Edwards, operates a thriving home health ministry, where volunteer church members visit with and counsel AIDS patients.

AIDS may be killing Africa, but it is not out of the closet. Although 2 million Africans die of AIDS each year, and between 70 and 90 percent of all the world's AIDS cases are in sub-Saharan Africa, the illness remains taboo as either a topic of conversation or the subject of public-service campaigns.

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In many areas, even cities like Abidjan with its population of 3 million, people with AIDS suffer on in denial or ignorance. "Often they don't even realize that they have it," said Dr. Edwards. Some believe they have tuberculosis and don't realize they carry a disease that can be transmitted through sexual contact or breastfeeding a child.

The dimensions of the epidemic, however, are unavoidable. During President Bill Clinton's August tour of Africa, meant to spur economic development, AIDS kept breaking into the agenda. Traveling with the president was Sandra Thurman, director of the White House National AIDS policy office, who told reporters on Aug. 27 in Nigeria, "We all are beginning to understand in a very real way that AIDS is a plague of biblical proportion. It's been declared the worst public health crisis since the bubonic plague. I think that's absolutely true."

It certainly seems that way in Africa, which more and more looks like a laboratory for the world's deadliest sexually transmitted virus. Political upheaval accelerates the disease. Women raped by invading militants during Rwanda's Hutu-Tutsi conflict in 1994 are now testing positive for AIDS. The same is true in the Democratic Republic of Congo. Economic upheaval breeds a similar trend. In Mozambique, men leave home for extended periods in search of employment. Finding prostitutes along with a job, they return to pass on AIDS to their wives. Holdover tribal customs, which favor polygamy and trading brides for cattle, plow a fertile ground for the virus.

When sickness finally comes, no safety net exists. A United Nations study in Ivory Coast found that families with an AIDS patient cut spending on their children's education in half and reduced food consumption by 40 percent. "When they have spent what they can on medical care," said Dr. Edwards, "there is nothing left for the family to do." So while AIDS patients in the West have ever increasing access to clinical trials and drug cocktails, in Africa their choices are fewer and more bleak: to waste away alone in an Abidjan shack or die slowly on the hard floor of an overcrowded Nairobi hospital ward. Rates of infection may be declining in the West, but AIDS in Africa is on a rocket-like trajectory. Over 22 million Africans are infected with HIV, the virus that leads to AIDS, compared to 1.5 million Americans.

Faith-based organizations that have been fighting AIDS for years are frustrated by its sheer demographics. Many countries have seen life expectancy drop by 10-20 years already due to the virus. And the epidemic is taking its greatest toll on young people: 80 percent of sub-Saharan Africa's population is between 15 and 49 years old. In countries like South Africa, half of its youth are infected with the virus. AIDS deaths have orphaned 13.5 million African children. AIDS orphans are expected to number 44 million by 2010. "We still have 30, 40, even 50 years to face in this epidemic," says Debbie Dortzbach, director of HIV/AIDS programs for World Relief.

Now, bipartisan legislation could put faith-based organizations to the test in Africa's battle against AIDS. The new law would create a World Bank trust fund worth $600 million in two years to fight AIDS worldwide. Most of that money would go to Africa, lawmakers say. It would also increase existing overseas AIDS relief through the U.S. Agency for International Development (USAID) to $300 million over two years.

The legislation is a boiled-down version of half a dozen proposals floating around Capitol Hill since January. This one received support from conservatives who normally shun mammoth public health projects, including Senate Foreign Relations Committee chairman Jesse Helms (R-N.C.). President Clinton signed it into law on Aug. 19.

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