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Has Africa defined Hiv/Aids adequately enough to effectively confront it?
Merab Kiremire
Extracted from Pambazuka News 196
March 03, 2005

http://www.pambazuka.org

Pambazuka News No. 195's Editorial on 'HIV/AIDS - The dilemma of the inevitable' by Kiiza Ngonzi, not only served as an 'awaking bell' for all of us Africans grappling with HIV/AIDS and its direct impact on our lives, but threw a real challenge to the strategies we are employing to combat a disease that is already devastating our populations.

Indeed, what a tragedy and an amazing puzzle it is that almost two and half decades since HIV/AIDS hit Africa, Africa continues to be devastated by this determined killer disease. In all our faces, HIV/AIDS is on the rampage, going about its business infecting and killing millions of Africans, old, young, pretty, ugly, big, small, rich, poor, educated, illiterate, urban, rural, professional, unprofessional at free will. To Africans HIV/AIDS seems so powerful that it has overcome our intellect and control, leaving us with our heads buried in the sand.

The impact of HIV/AIDS on our lives can hardly be over-estimated. By this time, there is hardly anyone in Sub Saharan Africa who has not been touched by HIV/AIDS. All of us know what it is to be afflicted by this dreadful disease, because if we have individually not been afflicted, we have had relatives, friends, or colleagues who have been directly or indirectly affected. We have seen it often enough since it killed its first victim in Uganda in 1979, and hospitalized its first patient in Zambia in 1982.

The impact on our social services is already real. Our hospitals are overwhelmed by the numbers of terminally sick and the dying, while our mortuaries and graveyards are littered with the dead.

The extent, magnitude, ravages and devastation of HIV/AIDS is best illustrated by the long term effects on our nations, reflected in the situation of African children. UNAIDS already estimates that there are as many as 11 million orphans in sub Saharan Africa, 1 million of whom are in Nigeria, 890,000 in Kenya and 780,000 in Zimbabwe. South Africa is expected to have up to 1.5 million orphaned children by 2010, while in Zambia 1.8 million children are increasingly vulnerable as HIV/AIDS continues to destroy the traditional family social safety net, causing massive school dropouts and chronic malnutrition.

The overall impact of HIV/AIDS on the African Continent is manifesting itself not only in reduced quality of human life, but dramatically reduced life spans, already believed to have dwindled to a low of 32-37 years of age, compared to an average of 57 in the post independence Africa of the mid 1970s, and 78 years of life in the Western World. This practically means that one has a period of 32 years in which to grow, acquire an education and life skills, develop a career, raise a family and contribute to national development before life terminates. How possible is this? Today, in most of our countries, every child born is assumed to have a significant chance of contracting HIV and dying of AIDS. HIV/AIDS has clearly become a national emergency in most of our countries

And yet HIV/AIDS is a behaviour disease and a human being can control its behavioral spread, and its infection. He/she can refuse to allow HIV into his/her body, and it will effectively stay away and if he/she is already infected, he/she can determine to live with it, hold a dialogue with it, talk to it, agree to accommodate it in his/her body, but ask it to give him/her time to live, to accomplish certain tasks, and together, they can plan to allow him/her to complete his/her career, plan for his/her children, build them a house. This is not possible with a motor or aircraft accident, heart disease, meningitis, cancer, TB, pneumonia, cholera, malaria, even child birth.

But perhaps it is not far fetched to say that the on-going status of HIV/AIDS in Africa is an indicator of a bigger and far deeper problem. As the saying goes, 'the way you define a problem determines your ability to confront it'. The question is, 'has Africa defined HIV/AIDS adequately enough to confront it head-on?'

Recently, ten 16-29-year old community outreach volunteers, comprising four females and six males with educational backgrounds of 6th to 12th Grades, spent two weeks walking about markets, schools, churches, streets, bars, taverns and restaurants of Mtendere Compound, one of Lusaka's largest townships, trying to find out what ordinary community people thought and brought these findings:

1. Whereas most people talked to knew that HIV/AIDS is a killer disease that still has no cure, they had difficulty with its identity, its name, 'HIV/AIDS' (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome), which they felt was in itself a contributing factor to its un-halted spread since it is too scientific and therefore, too complicated for the majority of ordinary people to understand.

This was believed to be the reason for a variety of configured nicknames such as Uganda's 'Slim Disease', and Zambia's 'Long Illness' or 'Kangundende', which sounded like mockery and ridicule and served to increase stigma. Many said that whereas they could clearly identify other diseases with symptoms specific to them, such as coughing blood in TB or sores on the genitals in syphilis, there were no specific symptoms for HIV/AIDS apart from a variety of so-called 'opportunistic infections'. Consequently, a lot of people were confused and resort to associating HIV/AIDS with witchcraft, while many others have given up even trying, and resolved to leave 'HIV/AIDS as a disease like any other, made and sent by God and that if God has determined that one will die from it, it will happen'; while others still said, 'every one on earth has AIDS; if it is your day it is!'

2. The team further found that our current popular prevention and mitigation strategies against the spread and impact of HIV/AIDS such as ABC (Abstain, Be faithful, and Condomize) and VTC (Voluntary Testing and Counseling) were themselves greatly challenged since a lot of youths strongly believe that:

• Sex has become just like a game among young people, 'if you don't practice sex, then you are left out with this world;
• Condoms cause cancer;
• HIV/AIDS test accuracy is questionable. As one 19-year old woman expressed, 'my brother tested positive at one testing center after testing negative twice at another centre;
• Rampant/indiscriminate alcohol abuse among the youth does not facilitate abstinence or safe sex;
• Economic difficulties take far more precedence over a disease.

3. Some cultural/traditional beliefs/practices, many embedded in male supremacy, continue to hamper ordinary people from freely and openly discussing sex with their sex partners. There was no or little evidence to show that society had come to terms with the nature and transmission of this life destroying disease.

4. Some concerned parents and elderly people be-moaned HIV/AIDS sensitization teams which come into communities, talk about the disease and are never seen checking to see if what they preached was being practiced; while yet others blamed the escalating rates of HIV/AIDS infections on indiscriminate distribution of condoms among young people, which was giving them false trust in the power of the condom and eroding and corrupting their morals.

Clearly, HIV/AIDS remains too mysterious for ordinary Africans to understand and to relate to. There is absolutely no reason whatsoever for a disease which is destroying life in the millions, hampers people's ability to dream of the future, and dramatically reduces life spans, to be given tantalizing baptismal or beautiful nick names which only serve to confuse local community people, and limit their ability and efforts to combat the disease.

Indeed, we at MAPODE strongly believe that if Africa is to combat this horror disease, there is absolutely no need for people to be apologetic about it. A disease that, unlike its potential victims has no fear (is brave), is not embarrassed, not hidden, not ashamed, not shy, and has already rendered human sex a 'life and death' affair deserves no gentility. Therefore, Trust in love is no longer enough! There is a need to be absolutely sure of safety before one commits themselves to engage in the sex. Authentic safety is a must.

Indeed, we at MAPODE concur with Kiiza Ngozi that if Africa is to combat this horror disease, HIV/AIDS messages need to be communicated in a language best and easily understandable to us Africans who are its hardest hit victims, a task we cannot leave to others to do for us. It is high time we woke up to the truth that HIV/AIDS has also become a source of huge profits for big trans/multi-national industries, and is creating un-precedented employment opportunities for multi-lateral agencies. Therefore, left this way, chances of finding a practical solution within the near future will remain as remote as a pipe dream, a likely replica of our economies already brought to their knees by inappropriate experimental external policies. It is for this reason that we strongly feel that Africa, through its political and community leadership, working together with traditional elders, scientists, spiritual leaders and teachers, are all challenged to demystify and simplify HIV/AIDS so that our people can individually and collectively deal with it head-on rather than continuing to use kid-glove methods. Unless we are content to wait for another two decades!

* Merab Kambamu Kiremire (Mrs.), a Development Worker/Researcher is the Initiator/Director of MAPODE (Movement of Community Action for the Prevention and Protection of Young People Against Poverty, Destitution, Diseases and Exploitation), a Community-based Youth-at-Risk focused Non Governmental Organization (NGO) that implements child/youth prevention and protection programmes in Zambia and Uganda. She was one of the 6 University of Cape Town (UCT)'s African Gender Institute Rockefeller 2004 Associates.
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