AIDS on the rampage

AIDS on the rampage
By Alan Brody
Copyright by The New York Times
Published: August 13, 2006


FLORENCE Swaziland

At the International AIDS Conference, which began Sunday in Toronto, there are bound to be various commemorations of the discovery of AIDS 25 years ago - if one can ever commemorate something so horrific.

When I arrived in Swaziland in 1999, no one even wanted to call AIDS by its name. "Silwane," people whispered, using a Siswati word for a fearsome animal, "Silwane got him." Others said it was witchcraft.

In some measure, it was the failure of Swaziland to recognize the disease that gave it the world's highest prevalence of HIV. More than 17,000 people in this tiny kingdom nestled in the hills of southern Africa have been dying each year of AIDS, in a population of about 1 million. At last count in 2004, 56 percent of pregnant women ages 25 to 29 had HIV.

The ascent was swift. HIV prevalence among pregnant women was less than 4 percent in 1992, when the takeoff began, 16 percent in 1994, 26 percent two years after that, and upward ever since. HIV bides its time, leaving young women looking beautiful and men feeling lusty for years before it wears down their immune systems and the debilitating infections of AIDS appear.

That has meant plenty of opportunity for those with HIV to spread the virus unknowingly, and sometimes knowingly. Policies imported from the West haven't helped to encourage widespread testing.

An "AIDS-unique" approach insists on counseling patients on their right not to be tested (thoroughly frightening them in the process); the focus on confidentiality is such that if patients are positive, not even their spouses are told. Not surprisingly, the ignorance and stigma that grew up around AIDS in the West made its leap to Africa.

Deaths on a large scale began here only in 2000. Suddenly the obituary pages of the national newspapers began to rival the sports pages in length, and the young as well as the old found their friends there. Funeral homes and coffin makers began their macabre ascendancy as this developing nation's foremost growth industry. A wave followed not just of orphans, but also of children impoverished because AIDS killed the breadwinners of extended families. Today more than 150,000 of these orphans and vulnerable children exist on the margins of survival there.

Society struggles to hold together in the face of all that. Evangelists, local and international, interpret hell-fire, promise salvation and pass the hat. Youths convinced that they are already infected act out with a violence and bravado that speaks of no tomorrow. Spouses accuse each other of bringing AIDS into the relationship, arguments punctuated all too often by violence or suicide.

This does not mean that gloom prevails everywhere. A radio soap opera and call-in show, "There Is Still Hope," tells amusing, lurid and tragic tales of HIV's inexorable march through a fictional village, creating a new understanding of how unprotected sex, multiple partners, rape, incest and intact foreskins have played their part in the nation's encounter with the virus. "If we had known all this 15 years ago," a caller says, "we would have acted differently."

Many communities have started to create refuges for the orphans and at- risk children they now call bantfwana bemamungo, "children of the community." At these places, situated close to their often troubled and sometimes empty homesteads, children can get guidance, health care and a daily meal.

Just before I left Swaziland, I visited a district called Mahlangatsha, which in the last year established 41 such sites. At ceremonies organized by the district chief, I sat for more than three hours among 300 of these children reciting poems, dancing and singing hymns.

As I looked at these young people drawing strength from one another, I was reminded that Africa cries for its dead and dying, but it will survive. This continent's energy and creativity and spirit of ubuntu, or humanity, are still alive, embers just waiting to burst into flame again.

Alan Brody was Unicef's representative in Swaziland from 1999 until May.