Africa / AIDS

AIDS is devastating Africa. Yet while the West's drugs are too expensive and its scientists unwilling to change their minds, individual African leaders sweep the disease under the carpet. Ferial Haffajee demands a Pan-African response.

As the world got ready to celebrate the turn of the millennium on 31 December last year, Mazibuko was dying. At seven years old, he had lived longer than most other AIDS babies who are brought, destitute, to the Cotlands sanctuary in Johannesburg.

'He was everybody's special child,' smiles Cotlands director Jackie Schoeman. 'He fought death.' He held out until he got to see the sea - a cherished dream. Mazibuko still beams out at the world from the line of portraits of children who have died from AIDS and which line the entrance wall at Cotlands. With a snazzy haircut and dressed in denims, he seemed even to disguise the ravages of AIDS until the very end.

Mazibuko touched hearts. Talk about him yields a rare sentimentality from caregivers like Schoeman who have developed an unnerving stoicism about AIDS and death. My pen stumbles as she rattles off the Cotlands death toll on the morning we meet: 'We average a death a week. We had three last week. Friday, Saturday and Sunday.' The hospice only has 18 beds and it averages a 400-per-cent turnover.

One more bed will soon be empty. A tiny baby lies dying as the winter sunshine streams over him. A drip attached to his nose provides only palliative care because Cotlands doesn't prolong life for children with AIDS. Its drug cupboard contains no triple cocktails (the drugs which are helping HIV-positive people in the West live long and fairly healthy lives) and no antiretrovirals like AZT and Nevirapine which can stem infection in babies.

There aren't free drugs because the national budget cannot stretch to funding them. So the baby at Cotlands lies dying - he is an everybaby on a continent that is home to nine in ten children born with AIDS annually.

Their brothers and sisters - AIDS orphans - roam the streets from Lusaka to Lagos, a human time-bomb waiting to explode. These children of the 13.7 million mothers and fathers who have died from AIDS are also being left to God's mercy. With no family structure and little chance of education, they are a young underclass. The continent stands in danger of losing tomorrow's generation at the same time as today's productive workforce also succumbs. HIV/AIDS has had an easy ride on the coat-tails of underdevelopment.

Life expectancy across the continent is plummeting specifically as a result of deaths attributed to AIDS. 'By overwhelming the continent's health and social services, by creating millions of orphans, and by decimating health workers and teachers, AIDS is causing social and economic crises which in turn threaten political stability,' UN Secretary-General Kofi Annan said in January. Yet at the special session of the Security Council called to discuss the AIDS catastrophe in Africa, Annan was like the stablemaster of a horse that's already bolted.

Like Mazibuko, Africans have been dying quietly from AIDS, hidden both because the disease is still largely stigmatized on the continent and because Africa has slipped from the international news and political agenda. That, in turn, has allowed the rich world to get away with merely paying lip service to the awfulness of the disease - everybody is decrying the development costs of AIDS, but nobody is putting their money where their mouth is.

Transnational pharmaceutical companies made a huge play in May of their decision to cut the cost of AIDS drugs by 75 per cent, despite their previous years of inaction. But not a single African state has accepted the offer because even the new, reduced price tag is unaffordable. What is necessary, says Professor Salim Abdul-Karim of the Medical Research Council in South Africa, is that the drug companies 'sit down and negotiate a level at which drugs will be genuinely affordable'. Even for relatively wealthy South Africa, the price-tag cannot be much above cost plus five per cent, he believes.

For Africans to benefit in any serious way from the revolutionary AIDS cocktails which have downgraded the disease from 'killer' to 'chronic' status in the West, pharmaceutical companies should allow local licensing and production of their drugs. 'I don't think we should be asking for money for drugs,' believes Abdul-Karim. 'What the pharmaceutical companies should be saying is "we'll give you this drug on licence".'

Yet negotiations like these to work around the intellectual property laws that make the global economy tick are at such a preliminary stage that it will take years - longer perhaps than Africa has - to find a solution.

AIDS infections in sub-Saharan Africa last year outstripped by 300 per cent the next highest region (South and South-East Asia). This statistic - and the stasis of the disease in the rich world - demands a Pan-African response to the single biggest crisis facing the continent.

This is a fact which South African President Thabo Mbeki has cottoned on to as he develops his identity as an 'African Renaissance' leader in a presidency he has dubbed Faranani - 'towards an African century'.

Mbeki went cyber-surfing and stumbled on the websites of the so-called dissident AIDS scientists led by the American Peter Duesberg. He was seduced by Duesberg's view that 'African and American and European AIDS are totally different things'. Duesberg blames the severity of the African strain on 'malnutrition, parasitic infection and poor sanitation'. Mbeki convened a Council on which Duesberg was invited to sit. But he excluded key local scientists, invoking the wrath of the AIDS lobby. The lobby and the Government are at loggerheads after a series of policy gaffes. In practical prevention work, the South African Government has stumbled from one crisis to the next and Mbeki has been maligned for what many perceive to be just a hobby-horse.

In an impassioned letter to US President Bill Clinton, Mbeki explained his foray thus: 'It is obvious that whatever lessons we have to and may draw from the West about the grave issue of HIV/AIDS, a simple superimposition of Western experience on African reality would be absurd and illogical.' Swatting off his critics, Mbeki added: 'We will not ourselves condemn our own people to death by giving up the search for specific and targeted responses to the specifically African incidence of HIV/AIDS.'

A recent issue of African Agenda (March/April 2000) devoted its cover story to exactly this: interrogating the world's understanding of AIDS in Africa. To read it is to begin to understand what Mbeki may be getting at. Science is far from providing all the answers about AIDS in Africa. The historian Charles Geshekter, for example, points out that major global health agencies use very different AIDS figures. 'It is important for African social scientists to gather data, weigh and interpret evidence and verify the accuracy of claims made by international AIDS experts,' he says, throwing down the first challenge.

The second: the definition of AIDS in Africa is very different to that accepted in the rest of the world. Less exhaustive and scientific, it consists of a bunch of symptoms for health workers to identify instead of the thorough diagnosis and tests which people in the West undergo. These symptoms include ubiquitous and lingering problems of poverty like weight-loss and the symptoms of malaria, tuberculosis and cholera.

This definition in turn has led to what Geshekter calls the 'medicalization of sub-Saharan poverty' where the diseases of poverty are treated as if they were only about HIV-infection and AIDS. In his view, better hygiene, vitamin supplements and a wholesome diet would have the same impact as the billions that have been spent on prevention and safe-sex programmes. In Kenya, says Geshekter, HIV-positive children in a hospice called Nyumbani responded well to a cocktail of love, good nutrition and clean surroundings. 'As a result of their care here, they put on weight, recover from their infections, and thrive,' the founder Angelo D'Agostino is reported as saying.

Yet back at Cotlands in Johannesburg, sun shines in through the squeaky clean windows. The curtains are fresh and the nurses sterilize the baby bottles before their morning feeds. Two-year-old Lucky blows bubbles and squeals with delight, his chubby tummy heaving with joy. Love, care and good food are not in short supply at Cotlands, as they are not in much of Africa, and still the children die.

So while the dissident thinking about AIDS in Africa suggests that a distinctively African approach is required, the active combatting of the disease cannot be put on hold. In Uganda, the methods of President Yoweri Museveni's government could provide a model for the rest of the continent. Simple and home-grown, Uganda's success lies in regular, though confidential, testing to measure the progress of the disease; as well as in destigmatizing AIDS. Huge billboards line the streets imploring sexually active people to use condoms. 'From the highest political level, every possible medium has been used to get the message out,' reports UNAIDS. 'As a result Uganda has seen the levels of infection, which were climbing very fast, stabilize and in some instances decline.'

There are other bright spots. Truckers through Southern Africa now get sex education and free condoms at their pit stops. Sex workers, a mushrooming economic sector in a global age, are getting down to business as well. In Nairobi's red-light district on Majengo Road, condom use is up from 0.2 per cent in 1985 to 80 per cent today. Monica is a timeworn woman who's been working the streets for over a decade and who recently learned to say no. 'Men who take a lot of beer don't want to use condoms. If I get one like that, I forget him!'

The good practice on show in every corner of the continent provides a basis of tradable skills that could be harnessed and used in other countries - if only there were a co-ordinated Pan-African approach. For two years, a team of African scientists have been working to find a vaccine suitable for the African strain of the HIV virus and trials begin next year. This scientific co-operation could be expanded to include a search for answers about definitions, prevalence and statistics, to build our own body of knowledge and practice... then perhaps we could begin to talk about an African Renaissance.

is senior editor of the Financial Mail in Johannesburg, South Africa. [email protected]