SPECIAL REPORT

A Plague In The Tropics

CHRIS WOOD August 31 1987
SPECIAL REPORT

A Plague In The Tropics

CHRIS WOOD August 31 1987

A Plague In The Tropics

SPECIAL REPORT

At Nyamapanda, a forlorn strip of flyblown shops and sun-bleached houses on Zimbabwe’s border with Mozambique, the economy revolves around truckers, beer and sex.

Between 50 and 100 trucks pass through the town every day, and most drivers pause for a drink in one of Nyamapanda’s saloons. Many also hire one of the local prostitutes. But since January, truckers entering Zimbabwe have been required to do more than display their passports and vehicle documents to border officials. Now they must also submit to a medical inspection of their genitals at a makeshift roadside clinic. Zimbabwean health officials do not expect the cursory examinations to detect AIDS. But they say that the brief check for venereal disease may alert the truckers—33 per cent of whom may have been exposed to the virus—to the dangers of casual sex.

Plague: That program is directed against an AIDS epidemic that in some parts of the world—particularly Africa and the Caribbean—is terrifyingly reminiscent of a medieval plague.

Said Zimbabwean epidemiologist Dr. Richard Munochiveyi: “It could be like the black plague in Europe. That killed millions.” In almost a dozen countries in central and west Africa, as well as a handful of nations elsewhere in the developing world, AIDS has had a devastating effect. In such countries as Haiti and Zaïre, already among the world’s poorest, the fight against AIDS threatens to overwhelm pitifully small national health budgets. In many others it has provoked resentment against North Americans and Europeans—because they are widely regarded as carriers of the deadly virus.

Indeed, estimates of the potential death toll in Africa alone begin at one million over the next decade and reach

into the tens of millions. So far, such forecasts are based on only 5,148 officially reported cases, on lessthan-comprehensive testing at blood banks, and on studies of a few highrisk groups. Still, the indications are alarming, and some experts estimate that 50,000 Africans have already died of AIDS.

In the Zairian capital of Kinshasa— where the first known sample of AIDSinfected blood was taken in 1959—researchers report that seven per cent of the city’s three million people are now carrying the AIDS virus. In the tiny neighboring nation of Burundi, some hospitals have devoted 40 per cent of

their beds to AIDS victims. And in Haiti the director of the country’s main treatment program predicted that within four years the virus will have infected 15 per cent of that nation’s six million people.

Deserted: The recent history of one Ugandan community is vivid testimony to the devestating effects of AIDS. Five years ago more than 600 people lived in the fishing village of Kasensero on the shore of Lake Victoria near the Tanzanian border. Discos lined the parched main street and bar girls did a brisk trade in sex. Now, many of the town’s huts are deserted. Since 1983 one-quarter of Kasensero’s people have

died of AIDS. Said village official Joseph Ssebyoto-Lutaya: “People think God is very angry.”

Contaminated: The rising toll of tropical AIDS reflects patterns of infection and symptoms markedly different from those found in North America— where victims are still mostly homosexual men. For reasons that are not entirely understood, in both Africa and the Caribbean AIDS strikes roughly as many women as it does men. One factor in the spread of the disease is the re-use of contaminated needles at poorly equipped medical facilities. But for the most part it is spread there by heterosexual intercourse. Many Africans in what is known as “the AIDS belt” across the centre of the continent deny that promiscuous sexual behavior is the cause of the problem. Still, many acknowledge that some widespread tribal customs, such as the ritual of a woman having intercourse with her husband’s closest male relative soon after becoming a widow, has contributed to the spread of the virus.

For AIDS victims in many Third World nations, where health-care budgets are minimal, the prospects are particularly grim. Many of them, especially in rural areas, die without ever having seen a doctor.

Even those who do get medical attention frequently discover that it offers little relief. One Kinshasa hospital now routinely discharges AIDS victims as soon as they are diagnosed so that other patients with better chances of survival can use their beds.

Disaster: As AIDS sweeps through Africa, some observers have expressed particular concern that the disease will undermine efforts of developing nations to take charge of their own affairs. Declared Dr. Jonathan Mann, director of the World Health Organization’s AIDS program: “In a country that is just beginning to develop, how many young movers and shakers can you lose?” Others, including British-born physician Dr. Wilson Carswell, express similar concerns. Carswell practised in Uganda for almost 20 years before being deported earlier this year after he predicted that onethird of that nation’s 15 million people might eventually die of AIDS. Said Carswell: “It is difficult to comprehend a disaster of such magnitude. It is beyond the scope of one’s experience, one’s imagination.”

Still, several of the hardest-hit nations have downplayed the

AIDS epidemics within their borders— even to the point of outright denial of its presence. Zambia has forbidden scientists and journalists alike from publishing reports on the disease, and Zaïre has yet to report any AIDS cases to the World Health Organization (WHO). And in Kenya, authorities recently threatened to deport foreign reporters who were seeking information about the disease, because tourism is a major contributor to the country’s economy.

As a result, African government officials say privately that continuing publicity about AIDS could cause economic harm. And indeed, that official concern seems well-founded: Haiti’s once-prosperous tourist trade declined dramatically during the early 1980s, when U.S. researchers initially—and mistakenlyplaced Haitians with such high-risk groups as homosexuals and intravenous drug users.

Indeed, many residents of developing countries put AIDS on their list of grievances against the prosperous nations of the world. For their part, some Haitians now blame their country’s AIDS epidemic on holidaying North American and European homosexuals who treated the island as a sexual play-

ground during the 1970s. In Costa Rica the country’s first 16 victims were hemophiliacs who received blood from North American blood banks before blood screening started in 1985. And last year thousands of Honduran citizens demonstrated against the U.S. military presence in their country after American soldiers allegedly infected several local people with the virus.

Advice: Still, most governments have now begun to fight the viral plague. Zimbabwe, one of Africa’s wealthiest black nations, with a health budget of $20 per citizen, was among the first to act, recently acquiring a blood-scanning machine in order to screen supplies for AIDS. And as part of a government information campaign about the disease, a sound truck frequently rolls through the capital, Harare, blaring out advice about safe sex. In the same way, Uganda has instituted a countrywide “love carefully” public education campaign.

But officials directing those programs say that lack of money and difficult local conditions frequently hamper their efforts. WHO co-ordinated a $6million international donation to an anti-AIDS campaign in Uganda. But then local authorities still faced the problem of translating the message into 22 dialects. In Zimbabwe, an estimated 250,000 men live apart from their families in mining, manufacturing and construction camps. Many of those workers succumb to the temptation of prostitutes, and few seem to have learned much from a national safe-sex campaign. Asked one graphite miner in the northern town of Karoi, after spending a night with a prostitute: “Can I get AIDS from walking where a sick person has walked?”

Such ignorance is discouraging to many of those who are struggling to slow the disease’s lethal advance. So, too, is the casual—and misplaced—confidence of people like Coster Ndalama, one of the drivers who passed through Nyamapanda’s clinic last month. After a brief examination Ndalama emerged, smiling and adjusting his scarlet trousers, to declare, “I’m okay.” But as AIDS spreads its shadow over Africa and other parts of the developing world, even those who are healthy now have reason to fear the future.

CHRIS WOOD

DAN BAUM

MARGARET KNOX

JAMES FISH

MARK KURLANSKY