June 2001

Views expressed are those of the authors, not necessarily of the AFSC.

HIV/AIDS in Africa:
A Social Time Bomb

Ntsiki Kabane-Langford, a native of Johannesburg, South Africa and longtime human rights and social justice activist, was the organizer of the Free South Africa Movement in Boston, and has now joined the struggle against AIDS, "the new enemy," in Africa. She has also written a concept paper on African AIDS Orphans.David Scondras, longtime community activist and educator, is the founder of Search For A Cure and lead writer of Search For A Cure's HIV treatment series, Reasons For Hope. Scondras is helping to facilitate the creation of an antiretroviral treatment plan for the country of Malawi, coordinating the US delegation at the request of the Malawi government. To support Search For A Cure's work in Malawi, please send checks to Search For A Cure, 34 Edgerly Road, Boston, Massachusetts, 02115; <hope@sfac.org> www.searchforacure.org

Africa is living in the midst of a viral holocaust. It is hostage to a killer without a cure. No other place on the planet has been hit by AIDS in the way Africa has. The disease is exterminating whole segments of the society; emptying schools; swallowing families, communities, and hope; tearing social fabrics tattered by generations of poverty and neglect; and we are silent about it. This raises up, once again, the idea of expendable persons.

Morgue, Malawi. Photo: David Scondras

Although it was barely on Africa's radar screen just a few years ago, AIDS in Africa accounts for 70% of the 36 million cases worldwide. More than 18 million people have died since the epidemic began. Of the 25 million people infected with HIV in sub-Saharan Africa at the end of 2000, 4.8 million are in need of treatment, the UN estimates. Of those 4.8 million, all but 30,000 can expect to die without the drug cocktails that have to some extent transformed AIDS into a chronic illness in the West.

More than anywhere else in the world, AIDS in Africa has been met with apathy. We pay sporadic attention, turning on the spotlight when an international conference occurs, then turning it off. Good-hearted donors donate; governments acknowledge that more needs to be done. But think how different the effort would be if what is happening here were happening in the West.

What can your life be? You are one of the 25 million people who labor against this pandemic, desperately sick without access to a doctor or clinic or medicine or food or blankets or even a kind word. You are ostracized by your family and community. You know you are dying, you have small children and no one to care for them. What can your life be?

Funerals have become a way of life seven days a week here, grave after grave without name or number. Corpses stack up in morgue as funeral homes run out of coffins, which bereaved families often cannot afford in any case.

Along with its costs in human suffering, HIV/AIDS is draining scarce resources from all other sectors in embattled African communities to care for the growing numbers of sick and dying. The disease strikes the young and healthy, it is destroying the most productive segment of the continent's workforce and reducing growth and economic productivity. Sex education for young adults is critical in Africa. "Meat For Meat," that's what they all say--those who refuse to use condoms.

Generation of Orphans

The caregivers of AIDS patients are overworked, fearful, and suffer intensely from the grief of caring for patients who die. Some of them are themselves HIV positive. AIDS is striking the professionals. Teachers are dying. Worse yet, the disease jeopardizes the future of Africa by turning its youth into a generation of orphans, lacking the social supports provided by parents and family. The famous African expression, "It takes a village to raise a child," has lost its meaning. That whole village is imperiled by IDS/HIV.

A huge numer of the world's orphans are African children, largely because their mothers did not have access to expensive drugs and healthcare that can prolong lives and block transmission. Currently there are 10 million orphans in Africa because of AIDS; many are infected, and some live on the streets in deep poverty. No one cares for them, By 2010, the number of AIDS orphans in Africa will reach a staggering 44 million.

Denial, Abandonment by families, Lovers, and Friends.

A culture of silence prevails. The word not spoken here is AIDS. Denial exists even among the medical profession. The story of AIDS is a sociological story about misfits. It is presumed if you get AIDS you have a curse, you have done something wrong. Nobody wants the stigma, so people pretend that they don't know why people are dying. The victims don't cry out. Doctors and obituaries do not give the killer its name. Families recoil in shame. Often the religious communities cluck about people getting from God what they deserve.

Most do not know how or when they caught the virus, many never know they have it. But what's the sense of announcing or admitting you have AIDS since you cannot get any medication? If the choice is to know and get nothing, why tell and risk ostracism?

Pharmaceutical Companies and Social Time Bombs

Drug companies have tried to protect their enormous profits and monopolies while Africans die. Even at new reduced prices, the cost of AIDS drugs exceeds the ability of poor countries to pay, and the cost of the clinics and training necessary to deliver the drugs makes the challenge even tougher. Less than one percent of Africans have access to the drugs that can prolong their lives and stem transmission.

Persons with AIDS are social time bombs. Their potential destructiveness is greatly increased by the fact that they have no access to prompt or good health care, and nowhere to go. Many hospitals and clinics are not ready to perform blood profiles or do diagnoses, often simply treating the opportunistic secondary infections that kill AIDS patients.

The victims are then turned out of the hospital to continue--for as long as they are able--their routine lifestyle, usually marked by many intimate contacts. They generally end up in an alley weighing only a few pounds. The cause of death on the certificate reads "pneumonia." It should have been "neglect" or "indifference" or "no one gives a damn."

African countries are in various stages of grappling with the reality of dismantling post-settler, colonial governance infrastructures. They are beset by such a roster of perils--the chains of debt, famine, war, the violence of desperation, illnesses of poverty, the dangers inside mines or on the roads, that the delayed risk of AIDS ranks low.

International Apathy

The cure for this epidemic is not national but international. The deep silence that makes African leaders and societies want to deny the problem that render them helpless is something the West cannot fix. But the fact that they are poor is not. Wealthy international governments must help. Debt cancellation is a prerequisite to African development. International governments and communities must come out to join this struggle. The Bush administration has shown little or no interest in leading an international effort to fight the scourge. When the history of our time is written, how do we tell future generations that we watched the death of 40 million people, at least half of which we could have prevented, and did nothing?

To quote the Washington Post's April 20 editorial, "It is this indifference, echoed to varying degrees in capitals throughout the world, that is the real scandal of the international system."

These are the facts, the appalling numbers--the numbers who are sick without care, the orphans, the numbers of the dead, the numbers of the infected. But to comprehend the full horror AIDS has visited on Africa, I talked to David Scondras who has just returned from a trip to Malawi. Here is David's account:

In the fall of 1999, I flew into Malawi, a small country of ten million people shaped like a string bean. One third of Malawi is a big lake where people get most of their protein from fish. The lake is beautiful, and reminded me of the great lakes, except for the hippos of course. In the background there were volcanoes, and the land changes from brown to green as the seasons shift. Malawi is beautiful.

But, Malawi is dying.

I met with the Vice President of this little democracy, who heads up the effort to combat HIV on the part of the government. Justin Malewezi is a sad man. A graduate of Columbia University, he says the crisis is an emergency and he wants an end to talk and feasibility studies. "Action, action, action" is what he says and what he wants. "The impact of this disease is tremendous. We will lose not just a generation, but a nation." Malawi will not survive unless the people of Europe and the United States help.

Malawi, "...the crying of her grieving which is the sound of Africa." Photo: David Scondras

The President of Malawi, Muluzi Bakili, danced with fifth graders at the opening of the country's official prevention effort. It was televised. The saddest thing I heard was the President saying he knew there were medicines that could treat this illness, but Malawi was too poor to afford them.

The democracy of Malawi is less than ten years old. It lost an opportunity to lessen the impact of the disease when the previous strong-man rule refused to allow the word AIDS to be used, much less allow a prevention program to get off the ground. Now Malawi faces a crisis of survival. The people of Malawi invest their hopes for the future in their children. The Vice President pointed out they are losing 8000 teachers a year to AIDS and cannot keep up with replacements. This means the most important symbol of hope for the future is crashing down.

When I went to Lake Malawi, one of the most beautiful places on earth, staying for a few days at a resort that rich foreigners came to, people would quietly come to me asking if I could help this or that person close to them.

I could not say no.

A year later, I gathered a group of doctors to come with me to Malawi. We had a meeting with everybody who was involved in any way with health care in the country. Malawi invested in this group, now called the Technical Working Group (TWG), the responsibility to create a countrywide plan to use antivirals to stop the AIDS epidemic in Malawi. Of course without the money to pay for the plan, it will be a bitter promise, unfulfilled.

During my stay I visited churches resonant with the voices of people living on hope. I heard a woman who had just lost her baby to AIDS--the crying of her grieving which is the sound of Africa. I went to a building in the countryside where four grown-ups are trying to take care of several hundred orphans. The building was as small as the suburban tract houses we built after WWII, and needed a roof.

I went to the hospital in Lilongwe. In 1982, they had closed the TB wards. By 1999 all were open again, and it was not useful to talk about beds because there were people on the floor, under the cots. Families would bring in blankets to wrap the dead who were piled up until coffins were available to take them to the funerals that are the most common social event in Malawi.

Malawi has two major cities and many tribal villages. In the Malawi countryside, people in villages farm the land. The problem is that the people who do the farming and fishing are dying. In the cities there are traffic jams, ATM machines, malls, discos, internet cafes, a medical school, a university. Those who say that there is not enough infrastructure need to understand first that Malawi, the poorest of countries, still has some places that are well developed. In the city of Blantyre there are companies that manufacture antibiotics. Blantyre could make antivirals. I called Jussef Hamied, the owner of the Indian drug manufacturing giant CIPLA who agreed to try to help, including training people in Malawi on how to produce antivirals.

I went on a search for monkeys with a group of young people who told me how sad they were to hear of the great plane crash in Nantucket. They were referring to the downing of the Egypt Air plane in the USA that I had not heard about. When I asked them how they knew about this, it turns out that they had seen it on an internet connection. The young people I am talking about were twenty miles from Lilongwe, the nearest city, and it was clear they were up on the latest music and news and connected to the world community. Malawi has infrastructure.

I visited the DOT TB (directly observed therapy tuberculosis) program in Malawi. It actually gives out TB medicines to people with TB, thousands of them, and 70% of them are also infected with HIV. They told me if they don't get antivirals, the TB work will fail, for HIV makes TB hard to cure. TB in Malawi is the biggest opportunistic infection of HIV.

The underlying international issue is simple: there needs to be a fund that makes it possible for everyone on our planet to get access to medicines that save lives and limit suffering. To stand by and let millions feel sick every day and then die and leave children and the elderly without food when a few pennies from the treasury would solve this problem is an act of barbarism that will be remembered for a thousand years. The greatest single ethical crisis of the millennium is how rich countries react to this crisis, for it would take a very small percent of the surplus that the rich are debating how to give back as tax rebates to save the world from TB, AIDS, and Malaria.

George Bush wants to give back more than a trillion dollars in a tax rebate. A program to stop AIDS, Malaria and TB around the world would cost one percent of this give-back program, once percent of what the government says is left over after all the bills are paid. Once percent of the surplus. One penny out of every surplus dollar. George Bush continues to be obsessed with giving away this trillion dollars while the elderly in Minnesota and Maine make a choice between their food bill and their heart medicines, and millions of Africans continue to suffer and die.

 There can be no pride in an America that lets children die, and nations fall, in order to save a few cents. The US must say yes. The US must donate one percent of the tax rebate. That would be enough to help stop this plague."

Some ways to help:

Call Colin Powell to demand real funds to fight global AIDS

• The developed world is largely silent. AIDS in Africa has never commanded the same attention the West has brought to other, sometimes lesser, disasters. So far, support has come from individuals, from nongovernmental groups like Doctors Without Borders, and from the international pressure that shamed the drug companies to back off from the law suit against South Africa on the generic drug issue. Secretary of State Powell joined President Bush May 11 to announce the shameful proposal for a mere $200 million supplemental budget request towards the new UN AIDS trust fund--a fund which needs 7-10 billion dollars. Call of fax Secretary of State Colin Powell TODAY to demand immediate action (202-647-5291; Fax: 202-647-2283). Powell must:
• Publicly demand a $2 billion contribution to the UN fund.
• Require allocations to have equivalent support for both treatment and prevention.
• Support global drug distribution and procurement at lowest prices including access to generics.
• Fight for debt cancellation to enable countries to redirect resources to fighting AIDS.

For more information on the Bush Administration response, read Health GAP's report card on the first 100 days of the Bush Administration at www.globaltreatmentaccess.org

You can contribute

Visit www.Netaid.org, an arm of the UN. If you prefer to send a check, an address is available on the Netaid site. AOL members can go to keyword Breaking the Silence. Example: You could keep an AIDS orphan in school for a year with a donation of $50, and make the difference between having a future and having none.

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