AFRICA CONFRONTS THE AIDS PANDEMIC

We were both standing on the sidewalk, watching the convoy of returning soldiers on their way to the military hospital in Victoria Island, Lagos, Nigeria. Amid the noise from the heavy-duty military vehicles and down-town traffic, my companion, Mohammed Farouk Auwalu, a former soldier in the Nigerian army, shook his head and muttered, "Many of them will most likely die soon or be out of the army like me with little or nothing to show for it. A lot of people don't know that many have died, others are dying, and many are walking in the shadow of death."

The convoy was returning from one of Nigeria's many peacekeeping missions elsewhere on the continent, but African wars were far from Auwalu's mind. He was talking about the specter of AIDS. In his mid thirties and married, Auwalu is now retired, not because he cannot perform his assigned duties, but because he is living with HIV. He currently heads the Nigeria AIDS Alliance, an awareness group formed by people living with HIV/AIDS.

THE PANDEMIC

So far, AIDS has killed 17 million Africans. It has orphaned about 12 million children. And about 25.3 million Africans (about 9% of the continent's total population) now live, like Auwalu, with HIV. According to the World Bank, the HIV infection rate in pregnant women in Blantyre, Malawi, increased from less than 5% in 1985 to over 30% in 1997. In Francistown, Botswana, the rate climbed from less than 10% in 1991 to 43% in 1997. New figures from the United Nations Joint AIDS Program (UNAIDS) show that 3.8 million people in sub-Saharan Africa became infected with HIV during 2000. Mean-while, 2.4 million Africans died of AIDS that year.

From the Horn of Africa to the Cape of Good Hope, HIV/AIDS is crippling national economies. Many African countries now face the enormous costs of fighting the epidemic and caring for the millions orphaned by AIDS, even as the most productive generation is decimated by the disease. A study published in the South African Journal of Economics in July 2000 concluded that, as a result of HIV/AIDS, South Africa's national income would be 17% lower in 2010 than it would have been otherwise. Overall, the World Bank estimates that HIV/AIDS has cut economic growth in Africa by about two thirds.

"The AIDS situation in Africa is catastrophic and sub-Saharan Africa continues to head the list as the world's most affected region," says Dr. Peter Piot, executive director of UNAIDS. "One of the greatest causes for concern is that over the next few years, the epidemic is bound to get worse before it gets better." AIDS has struck virtually all sectors of society. Families have been devastated; husbands, wives, brothers, and sisters are dead or dying. Women, young people, and children are among the hardest hit.

How did it get this bad?

* Migrant labor. The prevalence of migrant labor in Southern Africa has greatly contributed to the high infection rates in Botswana, South Africa, Malawi, Namibia, Zambia, and Zimbabwe. As migrant laborers move from one work site to another, leaving their families behind, many engage in multiple sexual relationships.

* Low social status of women. Women account for half of Africa's HIV-positive population, according to the UN, and the infection rate for women is on the rise. Data from several African countries show infection rates for teenage girls five to six times the rates for teenage boys. Poverty forces many girls and women to trade their bodies for money. Meanwhile, the low social and economic status of women, argues UN Secretary General Kofi Annan, results in a "weaker ability to negotiate safe sex."

* Lack of open discussion. Cultural and religious inhibitions on the discussion of sex-related issues hindered AIDS prevention at an early stage. Repression against the media also inhibited the flow of information. At an HIV/AIDS meeting in Mexico in 1988, U.S. journalist and science writer Laurie Garrett saluted by name a Kenyan journalist who had broadcast AIDS in formation over an independent radio station. He was arrested within hours. The Zimbabwean and South African governments have also routinely targeted journalists disseminating information about AIDS.

* Lack of quick government action. Olikoye Ransome-Kuti, a pediatrician and former health minister of Nigeria, says that, even in the mid 1990s, the Nigerian military regime allocated a mere $3,000 annually to AIDS control programs. Now, 5.4% of Nigerians between the ages of 15 and 49 -- about 2.6 million people -- live with HIV/AIDS. In many African countries, political turmoil and war contributed to a delayed government response.

* Weak health-care systems. In the mid 1980s, most African countries achieved child-immunization rates, to take just one indicator of basic public-health provision, of over 80%. In the following decade, rates fell below 20% in many African countries. Lack of access to basic health services has increased the rate of non-sexual (mother-to-child) HIV transmission.

* Economic austerity programs. The AIDS epidemic began its full onslaught in the mid-to-late 1980s, when the International Monetary Fund imposed structural adjust ment programs (SAPs) on many African countries. Under the SAPs, national currencies were devalued and subsidies to critical sectors of the economy discontinued. With minimal funds available to governments, social infra structure and services, including health services, suffered. Keith Hansen, deputy head of the World Bank's AIDS Campaign Team for Africa, admitted that SAPs had weakened African economies. Austerity has deprived African countries of the means to fight the epidemic.

* The high cost of drugs. Pharmaceutical companies like Bristol-Myers Squibb of the United States, Glaxo-SmithKline of Great Britain, and Boerhinger Ingelheim GMBH of Germany sell their patented AIDS drugs for $10,000-15,000 per patient per year, three to five times the per capita income of South Africa (the highest in Africa).

Uganda, the place where AIDS first struck in Africa, now offers a model for combating the epidemic. The Ugandan government has helped bring about a mini-sexual revolution. In the mid 1980s, it began prevention campaigns on HIV/AIDS and other sexually transmitted diseases, and started promoting sex education generally. President Yoweri Museveni personally championed the AIDS-control program. Meanwhile, some debt relief and the creation of an anti-poverty program has resulted in a revival of the health system.