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AIDS and Africa
Charles R. Larson
September 2003

What happens when a country's population is reduced by 25 percent and its doctors, educators, civil servants, police and military are not there to keep order?

Finally, it appears, the AIDS epidemic in Africa can no longer remain unacknowledged--either by Africans themselves or by Western governments, which have essentially written off the entire continent as best left alone. The denial of AIDS was also true at the beginning of the scourge in the United States, both by government officials, who waited an inordinate time to appropriate adequate funds to address this modern plague, and by the gay community, which didn't want to admit that certain forms of sexual activity are high risk. In some things, Africa has learned well from Western models--denial being one of them. African countries waited too long to acknowledge the magnitude of this international curse. Most of them have now reached the beginning stages of admission: there's a problem out there, even if few are able to do much about it.

AIDS hoax and other perceptions
The unspoken issue of African AIDS (which for the most part is transmitted heterosexually) has often been connected to Western perceptions of African sexuality. If Westerners say anything disparaging about African sexual practices, the statement will be regarded as a racial slur. As recently as 1995 the cover of an issue of Transition, an African journal published in the United States, proclaimed "The African AIDS Hoax," accompanying the thesis of the lead article with the bemused face of an African woman who is watching two disembodied hands slipping a prophylactic over an amply proportioned dildo. The caption inside the magazine, which shows the entire photograph (four women sitting at a table), embellishes the context: "Traditional healers are given dildos and condoms to demonstrate safe-sex practices to their patients." The cropped photograph of the woman on the cover seemingly attests to the insignificance of AIDS in Africa. No problem. Another Western hoax to exploit peoples of the global South?

Charles Geshekter, author of the Transition article ("Outbreak? AIDS, Africa, and the Medicalization of Poverty"), was especially concerned with Western perceptions of African sexuality. Africans are no more promiscuous than Westerners, he argues; the definition of AIDS, for Africa, is different than it is for countries in the West. "WHO's clinical case definition for AIDS in Africa ... is not based on an HIV test or T-cell counts," he says, "but on the combined symptoms of chronic diarrhea, prolonged fever, ten percent body weight loss in two months, and a persistent cough--none of which are new or uncommon on the African continent. These conditions are not sexually transmitted; they are caused by environmental risk factors to which many Africans are regularly exposed."

Geshekter speculated that by inflating the number of African AIDS cases, the West will find it easy to justify testing new drugs in Africa, because Africans are uninformed and therefore more likely to become willing guinea pigs. He argued for alleviating African poverty rather than altering the sexual practices of the continent's population.

There is no question about the extent of African poverty. Civil wars, drought, disease, disastrous leaders--all have contributed their share to the backbreaking lives that many of the continent's people endure. For most Africans, income hovers around a dollar or two a day. Add to that corrupt governments, along with the flow of profits from oil and diamonds into the pockets of military (and civilian) governments, and the situation is not encouraging. These chronic problems have also become convenient excuses for further exploitation of Africans by Western corporations and individuals, who are quite willing to take from the continent but give nothing in return. In most civil wars, the diamonds and the oil get through, just as the necessary military hardware gets sold to both sides. And the average African's life becomes ever worse, so bad that even the old days of the colonial era begin to look pretty good. There are numerous current speculations that in many countries of the continent, life expectancy will slip by twenty-five or thirty years.

Geshekter's fear that Africans will be exploited, become human guinea pigs if drugs are tested for an AIDS vaccine, is premised on the assumption that Africans are less informed than Westerners. Yet ignorance about AIDS has been universal, continuing to this day, with Africans showing no monopoly here. Until the last few months, the average American believed that AIDS is no longer a problem anywhere because Americans who are HIV positive are living much longer than before. Seemingly, medicine has solved the earlier problems. This misperception is simply a logical extension of earlier denial of the problem. Only homosexuals, drug addicts, and Haitians (plus an occasional hemophiliac) get AIDS, which means that it isn't a middle-class white problem.

Five years ago, when I started returning to southern Africa on a fairly regularly basis, little in the African media drew attention to AIDS. Government-controlled newspapers in Zimbabwe, for example, which often detailed sensational stories of sexual abuse (rape, pedophilia, sodomy), rarely mentioned the existence of AIDS. What little coverage there was was buried inside the paper or in the back pages, while the latest rape trial commanded front-page coverage day after day. A similar denial of the existence of AIDS operated within the general public. No one talked openly about sexuality. No one, in fact, ever died of AIDS. The latest death was always the result of tuberculosis or the other diseases of poverty mentioned in Geshekter's article.

Geshekter's major concern (and the causal issue for Western myopia about AIDS) is promiscuity. To acknowledge in 1995 that millions of Africans were dying from AIDS was to admit that those people are sexual beings. Inhibiting discussion of the frightful existence of AIDS in Africa was the fear of saying something offensive.

Higher risk
In the United States, the legacy of Puritanism survived the sexual revolution of the 1960s and '70s, ironically because of the outbreak of AIDS a decade later. Africans and Asians--traditionally not Christians--have regarded sexuality without the inhibitions of the West, which is to say that sexuality and religion in many parts of the world have been mystically and even pragmatically connected rather than separated, as they have been in the West. Might not Christianity be described as a religion of denial and therefore consistent with the denial of AIDS?

Before the advent of Islam and Christianity, many Africans were animists, ancestor worshipers. Millions of Africans still are, though they may also profess to being Christians or Muslims. If you worship your ancestors and therefore assume that your own descendants will pay homage to you, then you must procreate. Children are an absolute necessity if the linkage with the ancestors is to remain unbroken. If you do not have children, if you do not procreate, then your ancestors will curse you. No wonder, then, that it has been all but impossible to convince many African women (and others in the world who are animists) that birth control should be practiced, since it goes against inherent beliefs. Such traditions also imply that when infant mortality rates are high (as they always have been in Africa), you must have as many children as possible so that some will survive, outlive you, and produce their own children.

Westerners are typically ignorant of these beliefs, which can be simply restated: if you must have children, then there must be sexuality. Hence, also, polygamy, since traditionally men died in warfare and there were more adult women than men. Procreation is at the heart of much of African sexuality--not pleasure, which is at the center of Western sexuality. To keep the ancestors happy, one marries not to sanction passion or legitimize love but to channel sexual need and obligation.

In times of rapid social change--urbanization, family breakdown, increased affluence and mobility--sexual mores also change rapidly (sex with an increasing number of partners, as we witnessed in the United States in the 1960s and '70s), but some attitudes remain the same. Though Hollywood films and, most recently, American pornography have made Africans aware of Western sexual obsessions in a way earlier generations were not, traditional sexual practices may not always have changed that much. An American friend of mine who married an African woman thirty years ago tells of the first time he kissed his wife's breasts. "No, no. For baby," she told him. The example is significant.

To be more direct, despite our belief that foreplay, including kissing, is universal, for much of traditional Africa, sexual activity is intercourse only. And no foreplay meant, and continues to mean, no lubrication, which means a greater possibility of a man's passing the AIDS infection to a woman during intercourse. The term in southern Africa is "dry sex," supposedly asserting masculine dominance. Thus, in contrast to the United States, in Africa more women than men are HIV positive (55 to 45 percent). One man may infect several women, all of whom may be his wives. He himself may have been infected by a prostitute in the area where he works to make money for his wife or wives at home; or simply by a casual relationship with a woman, who, even if she does not derive her livelihood from prostitution, still may have had several sex partners. Do these cultural and religious practices make Africans more promiscuous than Europeans and Americans? Certainly not, though today they entail elements of higher risk. Just as Americans' awareness of safe sex brought the sexual revolution to an abrupt halt, one can speculate that the same will eventually be true in Africa--except that the casualties on the African continent are going to be much greater than in the United States. We are only at the beginning of the AIDS catastrophe. Even by 2010, we may not have reached the epicenter.

AIDS literature
It should come as no surprise that one group of Africans--the continent's writers--has tried for years to highlight the deadly risks of unprotected sex. Those who say that nothing good has ever come out of Africa are clearly unfamiliar with the continent's art, music, and literature. When governments were still refusing to admit that AIDS existed, the writers were playing the role that African writers have always played: critics of their societies. In the early to mid-90s, plays that openly dealt with the issue were presented in South Africa. One of Zimbabwe's award-winning writers, Alexander Kanengoni, used his story "Effortless Tears" as the title for his collection of short fiction published in 1993. Two novels of the same time pioneered the issue of AIDS in African fiction:Confessions of an AIDS Victim, by Carolyne Adalla, published in Kenya in 1993; and Waste Not Your Tears, by Violet Kala, published in Zimbabwe in 1994. More recently, the floodgates have opened, and dozens of Africans are writing about the issue.

These three works--by Kanengoni, Adalla, and Kala--are quite different from the AIDS fiction that appeared at the beginning of the U.S. epidemic. The fact that the two novels were written by women is particularly revealing. Kanengoni's "Effortless Tears"--the most accomplished of the three--is about the burial of George Pasi, the narrator's cousin. "Almost everyone ... knew that George had died of an AIDS-related illness but no one mentioned it," the narrator explains in the opening paragraph. "AIDS finally caught up with us." He continues, mentioning "sealed wards" in the country's hospitals, "teeming with people suffering from AIDS," but the primary issue is that "AIDS had finally knocked on our doors," an especially revealing statement for 1993, when almost nothing was said publicly about AIDS anywhere in Africa.

The elders connect the scourge to the country's ongoing drought, "the strange doings of this earth." The cattle are thin but no thinner than George at his death, both victims of "an invisible enemy that had sneaked into our midst and threatened the very core of our existence." Yet by the story's end, the curse on the land (the drought) and on man (AIDS) is projected onto the living, who will have to deal with both the drought and the epidemic. "We were not weeping for the dead. We were weeping for the living."

Kanengoni is one of Zimbabwe's so-called literary writers and the author of works regarded as "difficult" for the average Zimbabwean reader. By contrast, both Confessions of an AIDS Victim and Waste Not Your Tears are popular fiction, written for readers interested in sensation. Both novels touch on prostitution as well as the fast pace of city life vis-ê-vis more traditional village life. Both novels chronicle the events that lead to the main character's (a woman's) infection.

Confessions of an AIDS Victim takes the format of a lengthy epistle, written in installments by Catherine Njeri to her friend Marilyn, in the Netherlands. Catherine learns that she is HIV positive because of a blood test required for graduate study in the United States. The letter traces her process of self-awareness, as she describes her sexual experiences during the past six years. Though didactic, it is totally convincing, a warning to others to avoid the casual relationships with men that have led to her downfall. Waste Not Your Tears is much more a finger-pointing account of a young girl's intentional infection by her HIV-positive older lover, who wants to entrap her so she will take care of him during his declining days. Roderick, the villain, bears a number of similarities to cads in Western romances. He's lazy, vindictive, and abusive. Above all, he knows how to manipulate the system--an AIDS clinic in Harare--where he seduces Loveness and more or less enslaves her for his sexual needs.

Catherine Njeri tells us about her numerous sexual relationships, as well as her more lengthy relationship and love for Brian, who impregnates her. When her parents prohibit her from marrying Brian because of his differing tribal origins, Catherine searches for a more satisfactory lover. By the time of the blood test for her visa, she has been Alex's lover for three years. Informed of her infection, Alex not only becomes verbally abusive but beats and abandons her. Her attempts to convince him to be tested are futile; he would prefer not to know if he is HIV positive because he might have to alter his sexual activities.

By contrast, Loveness' love/hate relationship with Roderick--after he has infected her--approaches masochism. When she becomes pregnant, all that Roderick can think about is that a woman might finally bear him a son (his earlier six "wives" bore him daughters). The baby is, indeed, a boy but dies almost immediately from AIDS. That hardly matters, for Roderick now knows that Loveness can produce male babies, so he quickly makes certain that she becomes pregnant again. Fortunately, the second pregnancy is naturally aborted, yet Loveness continues to have intercourse with Roderick, justifying these unions because at least he won't be infecting anyone else. In the aftermath of complications from her miscarriage, however, she nearly bleeds to death because Roderick refuses to take her to a hospital. After his death, Loveness acknowledges her fate, determined to live "each day as it comes, as positively and effectively as she can."

At the end of Confessions of an AIDS Victim, Catherine--who refers to her story, her several affairs, as "a fairly normal life for a girl in Kenya"--awaits her inevitable decline and her own death. From her friend in the Netherlands, she borrows a metaphor to describe the increasing worldwide plague: "I can't help likening the AIDS infection to the underground trains. I can envisage many people boarding the trains daily from various stations all over the world. Their destinations? These underground trains will take those aboard to their graves, swiftly if I may add."

Central to each story is the African woman's second-class status, particularly with regard to sexual activity. What's an African girl going to do, especially one with any curiosity and an awareness of the limited future for women who remain in the bush? As Catherine tells us, "AIDS has come to exploit the low status of the women in African society. Even by the family, the girl is treated as being more lowly than the boy. She is just an investment, a flower that will blossom in spring, yield dowry and wither in autumn. She grows up to be a wife whose rightful place is in the kitchen, with due submission and allegiance to the husband."

Earlier in her story, Catherine talks persuasively about the necessity of African mothers educating their daughters about human sexuality. But tribalism, she asserts, is also a cause of the female's lowly status. Despite Catherine's university education, her parents prohibited her from marrying the man of her choice. Still, Catherine suggests the changes that will be necessary to bring an end to the African woman's second-ranked status: an end to group circumcision, "where the circumcision blade is never sterilised between each individual circumcision"; an end to the inheritance of "an otherwise healthy wife, after the death of a husband possibly from AIDS"; and, above all, an end to polygamy. "I know of a man who had three wives and sixteen children. He contacted the AIDS virus and somehow infected all his three wives. The man died two years ago and has since been followed by two of his wives. I guess the third is still on the underground train, with one foot in the grave. Soon, sixteen children from one home will need an orphanage."

Waste Not Your Tears is equally relentless in its attack on men and their treatment of women as objects of convenience. Roderick literally refers to himself as a lady-killer. African women have had few alternatives besides marriage and mothering, while the men have been free to move from partner to partner. In one of the novel's most revealing incidents, Loveness overhears her stepmother talking to her baby girl: "'Useless, useless. What good are you? Withering up my breasts, taking my nourishment. And for what? When I am old, you will be taken up with your husband. You will look after some other parents in their age. And me? Who will care for me? Useless."

AIDS: what is to be done?
Is the fact that AIDS is caused by sexual activity a myth?

No one can deny the horrific extent of African poverty and the international community's myopia about Africa's increasing needs. But these two women writers, Adalla and Kala, offer a completely different view of African sexual patterns than those proposed by Geshekter and the other deniers of African AIDS. Both stories are competently written accounts of women as victims, as losers in a system that perpetuates the double standard, whether the men be husbands or lovers. Both novels contain references to safe sex (condoms), but the men are not interested in using protection. Furthermore, it would be difficult to imagine African readers as being titillated by either story. Though Kala's publisher told me that her novel has not sold well--because of its AIDS theme--both writers intend their stories to be taken as warnings that traditional sexual practices can no longer be tolerated.

Five years ago, when I first visited Zimbabwe, the beggars I encountered in the cities were the blind, discreetly begging for alms while silently reading their copies of the Qur'an in Braille. During my more recent trips, the beggars have increased exponentially; they are now typically children, especially young girls ten, eleven, or twelve and their younger siblings. Those I have talked to have told me that their parents have died of AIDS and that they beg to provide for their younger brothers and sisters. These young girls have suddenly become heads of households. Some churches in the United States and Europe are assisting them, but the begging on the street will only increase as huge numbers of adults between the ages of sixteen and forty-five die from AIDS.

Recent demographic information about AIDS in Africa has reached the unimaginable level. At the beginning of this year, there were 1.1 million orphans in Uganda because of AIDS. In Ethiopia, there were 700,000; in Zimbabwe, 360,000. It's going to get much worse, as millions of HIV-positive adults continue to die, leaving more and more orphans. And the figures about HIV-positive adults in many countries in southern Africa keep getting worse. Twenty-five percent of Zimbabwe's adults are estimated to be HIV positive. That's for the entire country, though for the cities the figures are estimated to be much higher--50 percent in Harare, the capital, for example. AIDS can no longer be kept hidden away, out of the country's consciousness.

What can be done at this stage?
For those not yet infected, the recent campaigns about safe sex are about all that one can expect. In Uganda and Senegal, where the governments have made a concentrated effort to raise people's awareness of the epidemic, there has been measurable success. NGOs in some countries have also been successful in their attempts to expose and stem the growing horror. The Woman and AIDS Support Network in Harare, for example, has been selling a book called We Miss You All, the autobiography of a Ugandan woman named Noerine Kaleeba, whose husband died of AIDS. The lengthy account of her husband's disease and death sells for the equivalent of ten American cents and is therefore within the budget of most African women. With each copy, the Woman and AIDS Support Network includes a copy of its latest newsletter, with a condom attached to it.

For those who already have AIDS, even the ongoing battle to convince Western pharmaceutical countries to license drugs so they can be available to Africans cheaply may not solve the problem. American AIDS victims spend thousands of dollars a year, taking sophisticated drugs to prolong their lives. Most countries in sub-Saharan Africa have only a few dollars to spend on each person for medicine per year. Few Africans are rich enough to pay for the drugs themselves. If the medicine could somehow be made available for no charge at all (should pharmaceutical companies and Western governments be so enlightened), the medicine would still be unsuitable for many people. An African woman who is pregnant or breast-feeding may not have the basic nourishment to sustain her own health, let alone take a battery of toxic medicines.

That may leave only one real hope--the rapid discovery of an AIDS vaccine to prevent future infections. Though several vaccines are currently being tested, some of those in clinical trials are not for Africans, who have a different strain of HIV than Westerners. Geshekter and others have worried that Africans may be used as guinea pigs for such trials. Edward Hooper's recent study, The River: A Journey to the Source of HIV and AIDS, also picks away at a festering issue: was AIDS transferred to human beings because of a medical error? Hooper's compelling narrative speculates that some chimpanzee livers used to culture polio vaccine forty-five years ago were infected with HIV. When massive polio inoculations were undertaken in Africa, HIV may have been introduced. Though Hooper's speculations have been largely discredited, it doesn't help that for years people have argued that AIDS is a Western plot to control African populations. Nor do the recent pronouncements by South Africa's President Thabo Mbeki--that poverty is the problem, not the virus--help the cause.

Too many Americans believe that AIDS in Africa has nothing to do with them. Let the continent become what it will.

When did we become so callous to human suffering? Now that our economy is stronger than it has been for years and more Americans are living better than ever before, does that become the cache for our own self-centeredness, the sanction for ignoring the needs of the planet's forgotten? Sadly, our affluence has resulted in nouveau greed. There are billionaires in proximity to where I live who don't give a penny to philanthropy. And our own government--because of the pressures of congressmen and senators--has cut foreign aid to the lowest levels in a generation. Our nation's affluence has become an obscenity; history will not treat us favorably.

What happens when a country's population is reduced by 25 percent and all the doctors, educators, civil servants, police, and military are not there to keep order? Will this have nothing to do with our national security--let alone our sense of human dignity? Will the child militias simply take over all these countries (not solely in Africa but in parts of Asia where AIDS is ravaging with equal fervor)?

It is not unreasonable to expect a massive influx of illegal immigrants as soon as the conditions of daily life begin to reach zero in many of these countries. That won't be in 2010 but well before that. There's already a brain drain going on in many areas of Africa, but this outpouring of immigrants is going to be somewhat different, as hundreds of thousands of Africans who are not infected realize they have no choice but to flee a sinking ship. Are Europe and the United States ready for such a massive influx of new immigrants?

In Jean Raspail's futuristic novel The Camp of the Saints (1973), a flotilla of decrepit ships approaches Europe with 800,000 Indian passengers, fleeing the squalor of their lives. One sentence will suffice to set the context: "As the decks sprang to life with their myriad bodies--men, women, children, steeping in dung and debris since Calcutta--as the hatchways puked out into the sunlight the sweating, starving mass, stewing in urine and noxious gases deep in the bowels of the ships, the stench became so thick you could practically see it." No matter from what perspective the current African AIDS epidemic is examined, it's a tragic story that is about to get worse, much worse.

Visiting the clinics in Harare where children are dying of AIDS, talking to orphans on the street, I can't help thinking that our slow response to this major catastrophe isn't far removed from Western attitudes about Africans 150 years ago. In the nineteenth century, we needed Africans for our plantations in the South. Entire communities were decimated by the slavers, leaving those who survived (children and the aged) to fend for themselves. AIDS is the new version of slavery, devastating the entire continent. What's any different? Western corporations still get rich because of oil and diamonds and other resources, but little of the wealth is returned to the African continent. We are still willing to exploit Africa but do little to help in its worst hour of need. To paraphrase Alexander Kanengoni, we should not be weeping for the dead but for the living.

* Charles R. Larson is professor of literature at American University and president of the African Skies Library Foundation.

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