A Times Editorial

Preventing AIDS in Africa

© St. Petersburg Times, published July 3, 2000

Worse than any flood, any famine, any war, AIDS is laying waste to the people of sub-Saharan Africa. In a statistic so daunting it can barely be fathomed, the United Nations has predicted that half of all 15-year-olds in the worst-hit countries in Africa will die of AIDS, even if by some miracle the rate of infection is slowed. An entire continent of adults is dying of a disease that's eminently preventable. And while much of the West wrings its hands over how such poor countries will ever afford anti-retrovirals, such as AZT, medical professionals in Africa know the solution there is much more complicated.

It is hard to get your mind around how many people are HIV-infected in sub-Saharan Africa. But if you add the entire population of Florida and Michigan, you'll be close. In some countries, especially around Africa's "Southern Cone," HIV infections are spreading so quickly through the heterosexual community that 20 percent of adults are currently walking around with the disease, and most don't know it.

The disease is spreading with such vengeance because of a combination of variables that has marked Africa for disaster. Culture, behavior, ignorance and poverty have combined to cause this explosion, and only by changing those variables can this epidemic be contained.

When Thabo Mbeki, president of South Africa, recently questioned whether the HIV virus truly causes AIDS, he was espousing a suspicion of Western medicine widely held in the continent. Most Africans still receive their health care through traditional healers or witch doctors who have spread dangerous misinformation.

There is the horrifying "virgin cure," in which AIDS sufferers are told that sex with a virgin will "cleanse" the disease. That myth has been blamed for an upsurge in child rapes across Southern Africa. Then there are healers who claim to cure AIDS with herbal remedies, and those who blame AIDS transmission on poorly performed rituals as opposed to unprotected sex.

Africa's male migrant labor patterns also contribute to the disease's spread. Men returning from the diamond mines and oil fields return to their wives and girlfriends HIV-positive, and because women have relatively little social power, they are not able to demand safe sex practices.

In countries such as Mozambique, where the infrastructure is less developed, AIDS has not spread as quickly. But in Botswana, where modern roads criss-cross the country, 35 percent of adults are now infected. Health officials say follow the truck routes if you want to track the disease's introduction into rural communities.

While anti-retrovirals can help in limited ways, such as in preventing mother-to-child transmission, just shipping boatloads of AZT to Africa would not be the panacea some First World do-gooders suggest. The cocktail of medications prescribed to HIV-positive patients in the United States has significantly prolonged many lives, but it is a complicated regimen. Even when those drugs are available, the medical infrastructure doesn't exist in most of sub-Saharan Africa to administer treatment properly. That could change in the long run -- but there is no long run. This crisis is here now, and it has the potential to grow exponentially every year.

No, short of an inoculation or a cure, prevention is the last, best hope. A massive seachange in personal behavior has to come about if this epidemic is to be contained, with the governments themselves leading the charge. Uganda, for example, has successfully slowed transmission rates from 14 percent in the early 1990s to 8 percent today, by launching a serious, broad-based education campaign.

Containing the spread of AIDS should be at the top of the world's agenda. Certainly, the wealthier nations, such as ours, should contribute mightily to the cause, but to rein in this plague, African countries have to make it an overriding priority. These countries are confronting a future in which entire generations of their citizens will be wiped out and the labor force will be decimated. Parents will die, leaving more orphans than can be cared for.

This is an international tragedy on the scale of a world war. It deserves the attention, commitment and resources such a war would bring.

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