Canada and the World

'The Slim Disease'

Canadians are helping to fight Africa’s deadly AIDS epidemic

Tom Fennell July 10 2000
Canada and the World

'The Slim Disease'

Canadians are helping to fight Africa’s deadly AIDS epidemic

Tom Fennell July 10 2000

Debra Dhodo is dying—but it is her daughter’s life she desperately wants to talk about. Dhodo, 30, has AIDS, and as she ventured outside from a clinic for the terminally ill near Harare, Zimbabwe, her shoulder blades seemed ready to poke through the thin green smock covering her emaciated body. She contracted AIDS, which has infected more than 20 per cent of the population in many parts of Africa, from her husband, who subsequently died. “I was really angry at him,” she told Maclean’s as she struggled to sit up in the shade of a purple-flowered jacaranda tree. “Now I just want to get better so I can help my daughter.”

Without a miracle, Dhodo’s 10-year old daughter will soon be orphaned—left to fend for herself as the grim AIDS epidemic sweeps across Africa. More than 13 million Africans have already died of the disease, two million in 1999 alone; more than 10 million children have lost either one or both parents. When Dhodo dies, her body will be taken to an overcrowded graveyard, perhaps Warren Park Cemetery in Harare. So many AIDS victims have been buried there that it resembles a battlefield—not a single blade of grass remains, only mounds of freshly turned earth. Dr. Josef Decosas, a balding, mustached Montreal doctor who has spent the last 16 years working with AIDS patients in Africa, has seen hundreds of people die. “The friends you make who have AIDS may not be around next year,” says Decosas in his neatly organized second-floor office in downtown Harare. “But you also realize that these people have a life, they’re not statistics. They are funny, happy and sad—not walking corpses.”

The numbers are overwhelming—nearly 1,800 Africans a day are dying of the sickness known as the “slim disease” for the skeleton-like appearance of its victims. And on July 9 in Durban, South Africa, at the 13th International Conference on AIDS, western governments are expected to announce that they will pour millions of dollars into new programs to slow the disease’s advance—and counter the instability they fear as a result of so many dying. Canada has already boosted the amount of money it spends fighting AIDS in Africa from $20 million to $60 million a year, and is expected to unveil an even broader public-education effort in Durban. “This a war,” says Maria Minna, Canada's minister for international co-operation, who will address the Durban meeting. “We don’t see the shelling, but the bodies are accumulating faster than in any war.”

When a Maclean’s reporter recently visited Warren Park Cemetery, 12 funerals were under way. Nearby on the streets of Harare, AIDS orphans in rags followed westerners and pleaded for money. And always, there were the red-rimmed eyes peering from the hollowed faces of dying adults—their hacking coughs a sign that tuberculosis or pneumonia had overcome their AIDS-weakened immune systems. “It’s extremely disheartening,” says Maria Hatzipantelis, 26, who moved to Harare last year from Sault Ste. Marie, Ont., to co-ordinate Ray of Hope, an AIDS awareness campaign. “I hear people saying stuff like, ‘Everyone is still dying, so why should I care? What can I do?’ ”

The disease first emerged in the Rakai district near Lake Victoria in southeast Uganda in the early 1980s. Since then, it has marched relentlessly across Africa, cutting down millions of people in their prime in more than 23 of the continent’s 29 sub-Saharan countries. Of the 32 million people in the world with full-blown AIDS or HIV, the virus that causes AIDS, more than two-thirds live in Africa. The average lifespan on some parts of the continent will plummet from 64 to 47 over the next 10 years. And perhaps the most painful statistic of all: in 10 years, as many as 40 per cent of all African children will be orphaned. No corner of sub-Saharan Africa has been spared. In the worst-hit countries, Botswana, Namibia, Zambia and Zimbabwe, 26 per cent of the population is infected. In Ethiopia, Kenya, Mozambique, South Africa and Tanzania, up to 20 per cent have the virus.

The impact on the health system is crushing. In the main hospital in Kigali, the Rwandan capital, 70 per cent of patients have full-blown AIDS.“We are facing a silent and devastating epidemic,” says Rwandan Health Minister Ezechias Rwabuhihi. “Our hospitals are overwhelmed. This is not bearable.” It is more than a health crisis. President Benjamin Mkapa of Tanzania said in a recent speech that some government departments are losing 20 employees a month to AIDS. In Zambia alone in 1998, 1,300 teachers died of the disease—the equivalent of two-thirds of the new teachers trained in a year. The Washington-based World Bank estimates that if the disease continues to spread, the economic output of hard-hit countries like Tanzania and Zimbabwe will shrink by up to 25 per cent by 2015.

The rapid spread of AIDS has been fueled by poverty, ancient cultural traditions surrounding sex and simple ignorance of the devastating consequences of contracting the virus. “AIDS is a completely different issue here than it is in Canada,” says Decosas, who also works as an AIDS specialist with the Canadian International Development Agency in Africa. “People in Canada are not having less sex than people in Africa. There is such a multitude of factors at work here.”

For one, the lack of public education surrounding sex, particularly the use of condoms, has left the population vulnerable. But ancient traditions have also allowed AIDS to flourish. In some parts of Africa, all the young men in a village are routinely circumcised on the same day with a communal knife, leaving them exposed to the virus. One study in the Democratic Republic of Congo also found that nearly one-third of all women take special care in order to ensure a dry vagina—a sexual cultural norm in many parts of Africa. But Decosas notes that a dry vagina during sex also causes abrasions on both men and women—which could allow the deadly virus to enter the bloodstream.

The spread of AIDS has been fuelled by poverty, ancient traditions and ignorance

The AIDS virus is also prevalent among large numbers of migratory workers across Africa. At one gold mine in Carltonville, South Africa, home to some 52,000 transient workers, a survey of 500 local prostitutes found that three-quarters of the women, and one in five of the miners, were infected. Tragically, when the workers return home they carry the infection to their wives and communities. “People are away from their families and they’re lonely,” says Sara Page, a Canadian volunteer with Southern African AIDS Information Dissemination Services in Harare. “So they seek comfort in sex.”

Irene Mutumbwa, a Zimbabwean social worker based in Harare, spends her days trying to break the deadly cycle of ignorance surrounding the disease. Maclean’s recently accompanied Mutumbwa, who lost both her brother and sister-in-law to AIDS, on a visit to Bindura, 100 km north of Harare, where about 1,000 people gathered to watch a play about AIDS prevention. Hecklers shouted at the actors imitating a man who cheats on his wife and passes the virus on to her. A few others laughed loudly at the mock funeral of the victim. “I have several friends whose husbands have died from AIDS, but they won’t talk about it,” says Page. “They won’t even get tested. They don’t seem to understand the repercussions.”

As the death toll rises, those left behind are also victims. Seven-year-old Solomon lost his father to AIDS in 1995; his mother succumbed two years later. He went to live with his grandparents, laborers on a farm about 100 km north of Harare, where 20 other orphans are also cared for. “Solomon should be in Grade 1 this year,” says Sarayi Banda, a health worker. “But they don’t have enough money.” Sadly, Solomon’s story is all too familiar as families across Africa struggle to adjust to the additional financial burden of caring for extra children. And the most unfortunate female orphans are often taken advantage of by older men, who believe marrying a child bride will ensure they do not contract the deadly virus.

Deeply embarrassed by the epidemic, some African leaders have refused to launch public-health campaigns. In South Africa, the government of Prime Minister Thabo Mbeki, who is deeply suspicious of all but his closest advisers, has been particularly slow to act. Mbeki has even been reluctant to make AZT available— even though the drug has been clearly shown to prevent the transfer of the virus from pregnant women to their babies. He also angered scientists when he suggested in March that HIV may not actually be the source of AIDS—South Africa is one of the most powerful countries on the continent, and how it reacts to the epidemic is closely followed in neighboring states. “The message that HIV is the cause of AIDS,” says Dr. Mark Wainberg, president of the McGill University AIDS Center and chairman of the International AIDS Society, “needs to be blared out. Mbeki should be taking a lead.”

Even without influential African leaders like Mbeki onside, western governments are stepping up the fight. U.S. President Bill Clinton has asked Congress to double its funding for combating AIDS to $370 million this year. And Minna says Ottawa plans to focus money now being spent by CIDA in Africa more clearly on combating AIDS. In total, the federal agency will spend $288 million on projects of all types in Africa this year. Now, anything receiving CIDA funding—a water project, for example—must include an AIDS education component for workers on the site.

Most of the CIDA money is being channeled through three Canadian agencies, including a successful program operated by the University of Manitoba in Kenya. Researchers from the university are spending about $1 million a year to boost AIDS awareness among prostitutes and other high-risk groups. The results have been positive, with the rate of women under the age of 20 infected with the virus dropping from over 18 per cent in 1993 to about 12 per cent. “This may be a marker that things are changing,” says Dr. Stephen Moses, an associate professor of medicine at the University of Manitoba in Winnipeg. “We have made some inroads.”

There is other evidence that public education is by far the best weapon. In 1993, Ugandan officials launched a massive campaign that bluntly explained how to prevent AIDS; the number of people with the virus in Uganda has dropped from a high of 30 per cent of the population in the early 1990s to 10 per cent. Western countries also hope to step up the use of drugs. But the cost of supplying pharmaceuticals, says McGill’s Wainberg, remains an obstacle. And in the end, Wainberg believes public education is the only way to halt the plague. “Every single leader of an African country has to start speaking about AIDS,” says Wainberg, “They have to tell their people, AIDS is our greatest enemy.’ ” Until they do so, the slim disease will continue to exact its tragic toll.

Death stalks a continent

Percentage of population between the ages of 15 and 49 infected with AIDS or HIV, the virus causing the disease, in Africa’s hardest-hit countries—and a comparison with selected nations:

Zimbabwe 25.8

Botswana 25.1

Namibia 19.9

Zambia 19.1

Swaziland 18.5

Malawi 14.9

Mozambique 14.2

South Africa 12.9

Rwanda 12.8

Kenya 11.6

0.82 India

0.69 Argentina

0.43 Brazil

0.27 United States

0.13 Canada

source: UNAID * represents all age-groups