AFRICA’S DEATH SENTENCE : Husbands Infect Their Wives, Mothers Infect Their Children. By the Late 1990s, an Estimated 15 Million People Will Be Dying of AIDS.
LIKE MOST IMPORTANT LESSONS of life in Zimbabwe, Angeline Ndhlovu’s begins with a story. It is the tale of two teen-age monkeys, a time-worn allegory for the 1990s and the story of Ndhlovu’s life.
One day, the two young monkeys tell their father they want to go to the river to play. But he discourages them, warning that the river holds a dangerous animal with a mouth as big as a hippo’s mouth, teeth as sharp as a lion’s teeth and a tail as strong as an elephant’s tail.
The young monkeys aren’t convinced, though. So they ask the hyena, who scoffs at the father’s warning. “Go ahead,” the hyena says. “Your father is just trying to stop you from enjoying yourself.”
The vulture agrees: “Ha, ha, ha,” he says. “There’s nothing like that in the river.” So the monkeys go to the riverbank, where a pair of beady crocodile eyes watches them from atop the water. Quietly, the crocodile begins to move. His huge tail sways. He moves faster and faster until, before the monkeys can even squeal, they are swallowed up.
Angeline Ndhlovu ( inn-DLO-voo ) pauses as several hundred 14- and 15-year-olds, sitting cross-legged on Lord Malvern School’s auditorium floor, wait breathlessly for the name of this evil crocodile. “There is a big crocodile called AIDS out there,” Ndhlovu says, “and he is coming to swallow the whole human race.” What the former nursery school teacher doesn’t say, though, is that she, at age 28, is among the millions in Africa who have been bitten by the crocodile and are waiting to die.
Women in Africa, in fact, are more likely to get AIDS than women anywhere else in the world. Four of every five women with AIDS live on this continent, where, not coincidentally, women have little power in the boardroom and even less in the bedroom. Their subservient status in these societies is one reason AIDS is spreading 100 times more rapidly in Africa than in the United States or Europe.
Angeline Ndhlovu’s case is depressingly typical. She contracted the AIDS virus from her husband but was powerless to divorce him because he had paid her parents the equivalent of $150 for her hand in marriage. Their child, Felicity, lived two painful years before dying of complications from AIDS in her mother’s arms. At the funeral, the father’s family blamed Angeline.
She was fired from two teaching jobs when her employers discovered she had AIDS, and, later, she tried to hang herself with an electrical cord. She now has found some peace by warning schoolchildren about the disease. But she remains tormented by thoughts of her 8-year-old son and 6-year-old daughter, healthy children soon to be orphans.
“I would love to see my children through a good life,” Ndhlovu says, her gentle, round face revealing a newly discovered self-assurance. “But I think that I have not much time left to live.” She shakes her head slowly. “Life is bad,” she says.
Life is very bad these days in Africa, where the World Health Organization estimates that AIDS has killed 1 million men, women and children and where the AIDS virus has infected at least 6 million more, imperiling weak economic systems, arresting Third World development and forever altering the cherished and steady rhythms of African society.
And the holocaust has just begun.
AFRICA IS HOME TO MORE THAN A TENTH OF the world’s people, yet it has 64% of the AIDS cases, according to WHO. The agency forecasts that by the late 1990s, 15 million people in Africa will be infected with the human immunodeficiency virus, or HIV, which causes AIDS and for which there is no known cure. Because nearly all adults develop the fatal symptoms of AIDS within 10 years of infection, WHO estimates that a fourth of black Africa’s work force will be wiped out within 20 years. And the average life span in Africa, once expected to reach 60, will fall to just 47 years, according to the World Bank.
The contrast between the AIDS epidemics in Africa and America is striking. In the United States, the disease has primarily affected homosexuals and intravenous drug users. Despite its recent upsurge, heterosexual transmission still accounts for only 6% of U.S. AIDS cases. American men with AIDS still outnumber women patients 7 to 1, and AIDS in young children remains a rarity.
In Africa, though, AIDS is a family disease, afflicting roughly equal numbers of men and women. Of all the cases in Africa, 80% are transmitted by heterosexual sex, and nearly all the others are transmitted from mother to child during pregnancy or birth, epidemiologists working on the continent say. (Homosexuality and IV drug use account for less than 1% of AIDS cases in Africa.)
WHO predicts that 3 million African children will die of AIDS in the next decade. Ten million more will lose one or both parents.
The epidemic does not discriminate between rich and poor in Africa. It reaches into mansions and grass huts, striking down company directors, government ministers and army generals as well as mechanics, air-traffic controllers, factory workers, bank tellers, homemakers, farmers, tailors, ditchdiggers and street beggars.
To one degree or another, nearly all the countries located on the vast savannas and amid the thick forests south of the Sahara Desert are grappling with the epidemic. So far, the greatest impact has been in central Africa, from Congo to Zaire to Uganda, where the disease is the most advanced.
In the past two years, though, the disease has begun to spread south from Uganda through Zambia, Malawi, Mozambique and Zimbabwe, destined for South Africa and the tip of the continent. Each of those countries reports a rapid rise in AIDS cases, and experts say it will get worse, much worse, before it gets better.
“Things are going to get so bad in Africa in the next two or three years that we are going to see TV pictures of vast numbers of people succumbing to this disease, like we saw during the Ethiopian famine,” says Dr. Paul de Lay, a WHO expert on AIDS based in Malawi.
Perhaps. But, in Zimbabwe, for now, AIDS is a curiously silent killer.
Zimbabwe is not the steamy Africa of Joseph Conrad but rather the Africa of Isak Dinesen--vast green plateaus of thorn trees, grazing rhinoceros and elephant, and low blue mountain ranges rippling beneath dry blue skies. Harare, the capital, has the vibrant tempo of a modest-sized European city, with crowded thoroughfares and parks, luxury hotels and airline flights to dozens of countries. The signs of impending disaster in Zimbabwe are hidden in the clinics, in the swelling cemeteries and in the piles of reports and studies atop the desks of government bureaucrats.
The Zimbabwe government estimates that 700,000 of its 9 million people already have the AIDS virus. Some diplomats, doctors and independent epidemiologists put the figure at nearly twice that. Either way, the estimates mean that at least one of every 10 people--and one of every five sexually active adults in a population equal to Los Angeles County--already has the disease.
But very few are willing to admit it, even to their family members. So far, only one public figure, David Mankaba, of the pop group the Bhundu Boys, has acknowledged his affliction--by asking his family to announce it after his death.
“When a person dies of AIDS, we make excuses,” says David Chanaiwa, executive director of the Employers Federation of Zimbabwe. “And when someone says their relative has died of ‘pneumonia,’ you are supposed to politely keep your mouth shut.”
In the past two years, Chanaiwa has attended the funerals of six senior personnel managers and one leading entrepreneur. All were in their 40s and 50s. None had admitted they had AIDS, even to their wives.
“When you say ‘AIDS’ here, people think ‘sexual intercourse,’ ” Chanaiwa says. “And the victims tend to be treated as someone who has been unfaithful, careless or stupid. To see a friend, someone who has a lot to contribute to the country, just wasting away from AIDS, it’s humiliating.”
The secrecy of its victims is one of the reasons AIDS has such ferocious potency in Africa. Also to blame are poor health care, untreated sexually transmitted diseases and the migrant work force--a byproduct of industrialization that brought tens of millions of men to the overcrowded cities and left wives behind on the farms.
But perhaps the most important reason for the rapid spread of AIDS in Zimbabwe and elsewhere on the continent is the Africans’ own culture. Women are the safety net for society, caring for the young and the sick, but the same tradition that leans on them so heavily also keeps them subordinate to men. And their low status is killing them, says David Wilson, a psychologist at the University of Zimbabwe. “You cannot have a heterosexual AIDS epidemic in which women have power or close to equality.”
A WOMAN IN ZIMBABWE COULDN’T do much better with her life than Nyarayi Zvarayi ( zev-yar-RYE ). The tall, slender 23-year-old had married a college-educated computer-systems analyst and produced a boy they named Tatenda, or “Thank you, God,” because it was a boy.
But the marriage turned sour soon after the baby’s birth, when Zvarayi’s husband began spending nights away from their apartment in Zimbabwe’s capital. She suspected he was cheating on her, and she worried about AIDS, but she was powerless to demand that he stop or to refuse his sexual advances.
On the few occasions when she complained of his nighttime absences, he reminded her: “I paid the lobola .” And, indeed, he had paid Zvarayi’s family 1,850 Zimbabwe dollars, or nearly $1,000. For that, Zvarayi became part of her husband’s family and part of a system that expected her to provide her husband with emotional support, sex on demand and plenty of children, preferably boys.
Zvarayi had few options. She had a seventh-grade education, no job and, under the rules of African tradition, no say in the future of the relationship. “You cannot have a divorce until your husband says, ‘Pack and go,’ ” she explains. “Then you say, ‘Praise God.’ ”
A few months ago, Zvarayi began breaking out in sweats, and she noticed enlarged lymph nodes appearing like grotesque lumps under her cheekbones and armpits. She went to three doctors, and each diagnosed AIDS. A blood test confirmed it.
Zvarayi’s husband refused to go in for a blood test, contending that he did not have AIDS. They quarreled constantly. “I was really angry,” Zvarayi remembers. “I told him, ‘I got it from you.’ And he knows it’s true. The men of Zimbabwe are always straying.” She asked for a divorce, and he refused.
On a trip to their rural hometown, on grazing land about 200 miles west of Harare, their families took up the battle. Her husband’s family accused her of infecting Tatenda and demanded that she give her son to them.
Although Tatenda had been sickly, no one knew for sure whether he had AIDS. At his age, the doctors said, a blood test could produce false positive results. Without strong symptoms of a depressed immune system, an accurate diagnosis would be difficult. It might be several years before those symptoms appear, they said.
Zvarayi’s mother paid a visit to her husband’s mother. “If my daughter dies,” Zvarayi’s mother said, “I will come and leave the body at your door.”
Then her mother took Zvarayi to the local traditional healer. His diagnosis: Zvarayi had been bewitched by her mother-in-law. The healer poured a gray powder from an old whiskey bottle, mixed it with water and gave it to Zvarayi to drink. Then, using a razor blade, he made long, shallow cuts in her swollen lymph nodes and applied a black powder to the open wounds. The swelling diminished, temporarily.
Her husband said she was foolish to listen to the healer or the doctors. “Now you are crying all the time because you know you are going to die,” he said. “It is better to die and not know.”
Soon after their return to Harare, Zvarayi took Tatenda to a halfway house for AIDS patients run by two nuns from the Little Company of Mary, an international order that works with the terminally ill. The house is located in a quiet, middle-class suburb five miles outside of Harare and identified by a small sign as Mashambanzou, “Dawn of a New Day.”
Now, she and Tatenda stay in a windowless room next to the garage. The slogan “Give me courage when the best things fail” is tacked to the wall. “I like that message,” she says.
The weak position of women such as Nyarayi Zvarayi in African society, and the absence of any significant women’s movement on the continent, has created fertile ground for AIDS. One of the ways it has spread so quickly in Africa is through a sexually transmitted disease called chancroid, which commonly appears as an open sore on the sex organs--and allows unobstructed passage for the virus. In Western societies, a man with open sores on his penis would find few willing sex partners.
But, in Africa, married women find it difficult, if not impossible, to refuse the sexual advances of their husbands. Although that attitude is slowly changing, it remains the norm.
In Zimbabwe, women account for only 8% of the formal work force. But even the working woman finds that tradition governs her behavior at home. “Even if a woman is the managing director of a company, when she gets home, she has no say,” says Helen Tinker, the public relations director of a large Zimbabwe textile firm. “They can’t force their husbands to wear condoms. Even a woman who can see sores on the man’s penis cannot say, ‘Hands off.’ ”
Elizabeth Matenga, a former nurse and director of the AIDS Counseling Trust in Zimbabwe, says women don’t accept their status without complaint. “But it’s a matter of a lack of alternatives,” she says. “They have to swallow a lot of . . . I don’t want to use a bad word. But they say, ‘How am I going to live without a husband to support me?’ ”
In traditional Zimbabwe society, polygamy was a way of keeping families together and ensuring that plenty of children would be around to work the family’s land and carry on the family name. Even in polygamous relationships, faithfulness was encouraged, and society frowned on philandering spouses.
“Men can have many wives, but it’s understood they must be faithful to them,” says Margaret Makadzange, the health-education officer for the Zimbabwe Banking Corp. “We don’t call that sleeping around.” But, she adds, “to divorce your husband because he’s had an affair is still not acceptable.”
The traditional African family structure began to break apart when colonialists built cities and factories in the bush and lured men away from their families and subsistence farms to steady jobs paying hard cash in the cities. With housing in short supply, most of those men had to leave their families behind and, during their long months of separation, sought comfort with the small number of women in the cities.
Although prostitution is illegal in Zimbabwe, it is a flourishing trade. Many of these women, whom the researchers call “commercial sex workers,” are unemployed mothers who engage in prostitution part-time to support their families.
They are highly vulnerable to the AIDS virus, and if they contract the disease, it is then spread to a large group of men. More than half the employed men in Zimbabwe’s cities visit prostitutes, according to one study, but it also is common for married men separated from their wives to have “city girlfriends”--women they help support but don’t pay specifically for sex.
“We want to encourage women to stand up for their rights, but it’s difficult,” says Father Ted Rogers, a Catholic priest on the National Council for AIDS in Zimbabwe. “If a woman has condoms in her handbag, her husband still thinks she’s up to something bad.”
Yet some people are trying to change the hardened attitudes. “Men already have been empowered by the nature of them being men,” says Evaristo Marowa, a physician and coordinator of Zimbabwe’s National AIDS Control Program. “Now we want to empower the woman, to give her power to protect herself, to decide on her own. And this is where we need something. Perhaps a woman’s condom. Otherwise, it will take a long time.”
Angeline Ndhlovu, who uses the tale of the crocodile to get the attention of her school audiences, warns the young girls that even the most clean-cut men may bring them untold misery.
“You can’t judge a book by its cover,” Ndhlovu tells the students at Lord Malvern School. “You girls must know about these ‘sugar daddies,’ who want to spoil 25 girls to prove they are really men. In the end, they will find a virgin to marry. You must respect your bodies.”
THE GOVERNMENT HOSPITAL IN Mutare is on the eastern flank of Zimbabwe, sealed off from the rest of the country by a mountain range and perched on a misty escarpment that overlooks the vast, war-scarred plains of neighboring Mozambique.
In the cacophonous pediatric ward, Geoff Foster, the province’s pediatrician, is making his morning rounds in the thrift-store-casual look favored by so many whites in Africa: short-sleeve shirt, open at the collar, worn cotton slacks and soft-soled shoes. A 38-year-old father of three young children, Foster has the playful, innocent face of a schoolboy beneath a mop of graying hair.
As Foster moves from bedside to bedside, he is watched by dozens of tired-looking mothers in borrowed hospital robes, each waiting anxiously by their small children. It is early morning, but the hands on the wall clock are stopped at two minutes to 12.
Sharon Phiri, 4 months old, had been admitted the day before. She breathes with difficulty, and her patchy hair and loose skin indicate weight loss. The swollen lymph nodes Foster finds under both the baby’s and the mother’s arms strongly suggest AIDS.
“We should do a blood test on baby and mother,” Foster tells the nurse. “Please ask the mother to see me after rounds.” She translates the doctor’s instructions.
Two beds away is Abedmigo, 3 months old, who is losing weight and also suffering from tuberculosis. “This is almost certainly retrovirus,” Foster whispers to a visitor. HIV is a retrovirus, but the doctor uses the word retrovirus , rather than AIDS or HIV , to avoid frightening the mother. AIDS has become part of every Zimbabwean’s vocabulary.
Abedmigo’s health is improving this day, though, and Foster decides against a blood test. “If the child’s getting better, what’s the point of diagnosing it now?” he says. “You’re busy. It costs money. And just knowing doesn’t seem to help anyone.”
He moves on to 9-month-old Moses Chivunya. Moses has thrush, a fairly common infant ailment. But his mother died a few months earlier, and although the family doesn’t know what caused her death, Foster now thinks it was AIDS. “We’re going to do a blood test,” he tells the child’s grandmother, “to find out why little Moses is so sick.”
Pretymole, 9 1/2 months old, is losing weight and has an abscess on his shoulder, yet another symptom of a weakened immune system. “This is the sort of thing we don’t expect to see in children,” Foster says. Unless they have AIDS.
What makes Foster’s daily discoveries in Mutare’s pediatric ward so frightening is that they are not unusual. As in Harare and Lusaka and Kampala and thousands of other cities and villages in Africa, children are dying of AIDS in ever-increasing numbers.
Since 1987, Foster has diagnosed 600 cases of AIDS in children in his 36-bed ward. Few live longer than a year after the diagnosis. New cases are appearing at the rate of 15 a month, and the ward’s death rate has leaped from one in 20 admissions to one in 10, solely due to AIDS.
If a child has AIDS, the mother must have AIDS, and the father may well also have the disease. For most mothers and fathers, the child’s diagnosis is the first time they learn their own fate.
“It’s very disheartening work,” says Dr. John Sanders, a pediatrician in Harare’s Parirenyatwa Hospital and, like Foster, a father of three. “When you see a 2-year-old with AIDS, and the mother is already pregnant again, it’s depressing.”
HIV-positive mothers, experts have found, will pass the disease along to at least 30% of their children, and almost all of those will die before their fifth birthday. The remaining 70%, although free of the disease, are certain to lose their mothers to AIDS--and possibly their fathers as well.
Throughout history, Africa’s orphans, whether created by war, natural disasters or disease, have been comfortably absorbed by families, usually cared for by grandmothers or aunts. But AIDS has created a burden beyond the capacity of most families. A UNICEF-funded study of 10 central and southern African countries has predicted that, during the 1990s, between 6% and 11% of the children under 15 will be orphaned by AIDS. Zimbabwe researchers predict nearly 2 million AIDS orphans by the end of the decade, and the first signs already are appearing.
“These days, you go to a man’s funeral, and you see children 3, 4 or 5 years old who have been left behind,” says Marowa, the National AIDS Control Program coordinator. “Then, six months later, you go to the mother’s funeral, and you see the kids, and of course they haven’t grown an inch in such a short time.”
The most difficult part of Foster’s job comes after the rounds, when he closes the door of an anteroom in the pediatric ward for private talks with his patients’ mothers. He asks permission to test some for AIDS and gives HIV test results to others. The task never gets easier.
Goodlaw Muchimika, 9 months old, is folded into his mother’s arms as she listens to Foster. Goodlaw was losing weight and had pneumonia when he was admitted to the hospital a few months ago. He and his mother were both tested for AIDS.
“We have the results of your blood tests,” Foster says, waiting for a nurse to translate his English into Shona. “Both you and baby are positive for AIDS,” Foster continues. “It’s because of AIDS that your baby has not been gaining weight.”
Tears well up in 22-year-old Chipo Muchimika’s eyes, and two drops streak down her cheeks. She lifts the baby’s yellow towel to dry them away. Seeing his mother’s distress, Goodlaw begins to cry softly. She pats him absently, her thoughts far away.
“What we can do, we can give you some medicine to stop his symptoms,” Foster says. “We can try to keep the child as well as possible.”
The mother says she is worried about telling her husband. The counselors will later urge her to bring her husband into the hospital, so they can explain it to him.
“Have you explained to her that the child is not ever going to be well?” Foster asks the nurse.
“She’s avoided mentioning death,” the nurse says. “But she understands.”
ZIMBABWE, A LANDLOCKED NATION the size of California, emerged from white-minority rule just 12 years ago, when it changed its name from Rhodesia. The new black rulers inherited, and have largely maintained, one of Africa’s more stable and industrialized economies as well as a modern road network, a high literacy rate (74%) and a good standard of living. Zimbabwe’s economic engine is fueled by 14,000 companies operating with a work force of 1.2 million in agriculture, mining, manufacturing, construction and the service industry.
And yet, herbalists, spiritual healers and witch doctors outnumber modern doctors 15 to 1, polygamy is legal and practiced, and most brides are purchased with a lobola of cattle or hard cash.
The first AIDS case was discovered here in 1983, several years after cases in the United States. In the beginning, Zimbabwe wrestled mightily with accusations in the modernized West that Africa was the birthplace of the worldwide AIDS epidemic.
No one in the government was more reluctant to recognize the significance of Zimbabwe’s AIDS problem than the minister of health. He contended that the HIV virus in Africa was a nonfatal variety and that results of the blood tests for AIDS were skewed by the high incidence of malaria.
The country’s blood bank, which began screening donors for the AIDS virus in 1985, drew the special ire of the health minister, a former army brigadier, when it banned the country’s 50,000 army soldiers from giving blood after discovering that well over half had tested positive for AIDS.
Largely as a result of that feud, Zimbabwe was the first country in the world to revise its AIDS figures downward, with the health ministry changing the official AIDS death toll in 1988 from 300 to 119.
In 1989, though, President Robert Mugabe, an ardent Marxist but also one of Africa’s more practical leaders, summarily replaced his health minister with a London-born physician, a member of the ruling party but also a leading critic of the government’s AIDS cover-up. The new man, Timothy J. Stamps, a tall, commanding 55-year-old with long, wavy white hair, proceeded to launch a multimillion-dollar AIDS education program and began an earnest attempt to record the AIDS damage.
The official figure of AIDS deaths shot up, to nearly 9,000 in 1991, even though the government admits that the fatality rate is still underreported. Cases of sexually transmitted diseases, which make the AIDS virus easier to transmit, have doubled to more than 1 million in just two years.
The forecasts are dire. The government conservatively predicts that 1.7 million--or twice the population of the largest city--will be infected with the AIDS virus within eight years. That’s when the death rate will soar, killing enough people every day to fill a Boeing 747.
The predictions give economists nightmares. They dread the loss of leaders and intellectuals in government service as well as the doctors, nurses, teachers, mechanics, accountants, craftsmen and other skilled workers who anchor every developing African country’s hopes for the future.
And while trained workers are the backbone of Zimbabwe’s economy, it is experience that makes the country run. Zimbabwean mechanics routinely repair ailing automobiles, tractors and machinery without the ready access to spare parts as in the industrialized West. That kind of experience, nurtured by years of necessity, will not be quickly replaced.
Dr. Michael Merson, director of the WHO global program on AIDS, bluntly told African officials meeting in Namibia recently, “AIDS is no longer just a health problem. We’re talking about the loss of elites in the urban work force. That’s where AIDS has been hitting the hardest, and economic planners must begin taking it into account right now.”
LOOKING BACK, THE EXPERTS IN Zimbabwe agree that they made a critical error in their zeal to shock people into protecting themselves against AIDS. The mistake was their first slogan: “AIDS Kills.” The message went up on posters all across the country in 1989, and those brave enough to admit they had AIDS were frequently ostracized by frightened friends and family.
“We did some damage by making people with AIDS feel so guilty,” admits Marowa of the National AIDS Control Program. “It just shows how ignorant we were of the nature of the pandemic and of the social and psychological consequences.”
In fact, Zimbabweans are not accustomed to blaming themselves for diseases. Disease has traditionally been viewed as a family problem, a sign of disharmony among the ancestors. But, with AIDS, everyone accused the victims. “The worst part with a person suffering is the way they suffer,” Marowa says. “They feel that people are blaming them.”
As a result, AIDS patients have been reluctant to seek medical treatment or counseling. Many are afraid to tell their families. That puts thousands of spouses or lovers unknowingly at risk of getting AIDS and denies Zimbabweans the chance to hear victims who can, like pro basketball star Earvin (Magic) Johnson in the United States, persuade their countrymen to protect themselves.
Tendai Mudarikiri, 25, and her husband, Maxwell, 29, a health technician in Harare, both have the AIDS virus, as do two of their three children. Maxwell had been ill off and on for more than a year before he tearfully admitted to his wife that he had probably infected her.
Maxwell lost his job when his employer learned he had AIDS, but the couple then decided to stay together. Yet they are not telling their parents. “To tell or not to tell is a big problem in Zimbabwe,” Tendai says. “In our culture, if you tell someone, they will chase you away.”
Gaile Chitakatira, a nurse in Mutare, gave this bit of advice to a young mother recently found to have AIDS: “This is your and your husband’s secret,” she said. “Don’t spread it to anyone. A secret can’t be kept in more than two hearts.”
Zimbabwe’s health officials are trying to undo the damage of the “AIDS Kills” campaign. Their program encourages young people to maintain mutually faithful, lifelong partnerships as the ideal but tells those who refuse to change their sexual behavior that a condom should become part of their routine.
New posters plastered on the walls of government buildings and company offices read: “Your next sexual partner could be that very special person. The one that gives you AIDS.” The message on a farm worker’s T-shirt in northern Zimbabwe warns: “I can look after myself. I don’t need any AIDS from you.”
Fifty million condoms were distributed in Zimbabwe last year, almost all of them donated by Western aid agencies. But condoms still are used only irregularly, and at least 150 million would be needed every year to meet the country’s needs.
Zimbabwe industry has been slow to take a role in AIDS prevention and education. Although dozens of firms now have AIDS education officers, many more think that trying to change the sexual behavior of their workers is a waste of time.
“In the long run, our AIDS education programs may not help,” admits Margaret Makadzange, health-education officer of the 1,500-employee Zimbabwe Bank. “But at least you feel you’re doing the moral thing. At least no one dies of ignorance.”
A rare success is the AIDS program run by Peter Fraser-MacKenzie on his 21,000-acre commercial farm, two hours’ drive north of Harare. Five years ago, Fraser-MacKenzie set up an AIDS advisory committee among his 160 workers and began distributing condoms to laborers and their families. Within months, sexually transmitted diseases diagnosed at the local clinic had fallen from a dozen a month to one or two.
But few farmers have followed Fraser-MacKenzie’s lead. Only about 500 of the 5,000 commercial farms in Zimbabwe give condoms to their workers. Some farm operators don’t see the need. Even if AIDS wipes out large numbers of productive Zimbabweans, they point out, the current high rate of unemployment will ensure a steady supply of farm workers.
But Fraser-MacKenzie believes AIDS education makes economic sense. “If this country’s economic infrastructure collapses, there’ll be no place for us commercial farmers,” he says. The three stores, four butcher shops, filling station and post office on Fraser-MacKenzie’s farm give away 52,000 condoms a month, which he receives free from U.S. and other international aid donors. The countertop displays of condoms, often with the message, “A condom a day keeps the doctor away,” has made them an everyday topic of discussion. Reluctant customers are urged to page through a well-worn copy of an American book that shows AIDS patients in advanced stages of the disease. And soon, they, too, are asking for the “gumboots.”
“At first the men were too shy to ask me for condoms,” says Marie Tikamuka, 44, who runs a butchery on Fraser-MacKenzie’s farm. “But when I show them that book, they believe me.” Now Tikamuka’s shop is the largest condom distributor in the area.
“Everybody realizes the disease is there,” Fraser-MacKenzie says. “What is left is for them to change their behavior.”
WHEN MEN IN THE PRIME OF life first began to die of AIDS, many Zimbabweans didn’t suspect a strange new disease. Instead, they attributed the deaths to an ancient one-- runyoka . Runyoka is caused by a spell cast by witch doctors on women whose husbands suspect them of infidelity. Once under the spell, women pass a fatal stomach ailment to all the men, other than the husband, with whom they sleep.
“We had to explain that AIDS kills women as well as men, whereas runyoka only kills men,” says Felix Sixpence, the 24-year-old principal of a farm school.
Although the misunderstanding was cleared up, it indicated just how important Zimbabwe’s 30,000 traditional healers remain in society. Now, with a disease that modern medicine admits it cannot cure, the spiritualists, herbalists and medicine men--collectively known as nyangas --are doing a booming business in cities as well as rural villages.
On the patio of her Harare apartment, Grace Chihuri dispenses what she says is the cure for AIDS from an array of old liquor bottles. Her business card identifies her as “Dr. Grace Chihuri, medical practitioner.”
Chihuri keeps a list of “people I have helped” in a red book, and she reckons she’s successfully treated 100 people for AIDS symptoms, primarily diarrhea and enlarged lymph nodes.
She thinks she’s completely cured some of them, although so far none of her HIV-positive patients has yet undergone a second blood test to confirm Chihuri’s claim.
Sophie Chikondo, a 35-year-old obstetrics nurse and mother of four, was one of Chihuri’s first patients. Chikondo fell ill two years ago, and a blood test confirmed that she was HIV-positive. She thinks she contracted the disease while delivering babies at the clinic.
Chikondo had never been to a traditional healer. But when her doctors said they could do nothing for her, she was frightened and grasping for alternatives. She knew her clinic had occasionally referred patients to traditional healers, so she decided to give one a try.
She went to the Zimbabwe National Traditional Healers Assn. office in downtown Harare, where she was referred to Chihuri. After several months of treatment, the swelling and diarrhea disappeared. Although she has been sick several times since then, Chikondo says Chihuri’s potions always have brought her back to health.
But Chikondo is reluctant to be tested again for AIDS. “I don’t want to know,” she says. Chihuri is confident she has found the AIDS cure. “If I hadn’t treated this woman, she would have been dead long ago,” Chihuri says.
Gordon Chavunduka, the president of the Traditional Healers Assn. and acting head of the University of Zimbabwe, isn’t so sure that any of his healers has a cure for AIDS. But, he says, “there is a possibility they might find something. I don’t take it as a joke.”
Even if they haven’t found a cure for AIDS, traditional healers believe their emotional support and counseling can be more effective than all the resources of modern medicine in making an AIDS patient’s last days easier.
“The difference between traditional healers and modern doctors is that we will say we have no cure for AIDS, but we will try something,” Chavunduka says. “For a patient in this condition, that is more satisfying.”
But whether the healer uses modern drugs, powdered roots or animal skins and bones, he cannot treat the pervasive feeling of doom that grips Zimbabweans, who find themselves at more and more sickbeds and more and more funerals. Three large cemeteries already are full in Harare, and city officials predict that the two remaining ones will be full within four years. “It’s like a glacier. Great chunks of youth are falling into the lake,” says Fraser-MacKenzie. “How are we going to control this thing? What chance have the youth got?”
The swelling orphan population and the deaths of mothers and aunts and grandmothers are straining the capacity of Zimbabwean families. State orphanages, a rarity in Africa, may soon become a necessity. The future looks especially grim to the new generation of young Zimbabweans, including those teen-agers listening to Angeline Ndhlovu at Lord Malvern School.
Ndhlovu’s cautionary tale of the crocodile and the monkeys is followed by the testimony of Patrick Dzadza, a reed-thin, slump-shouldered 42-year-old laborer.
“There is no doubt that I am going to die of AIDS, and there are those worse off than me,” he says, his words suspended in the hushed hall. “This is a terrible disease,” Dzadza continues. “It is different from any other disease that has come onto the world. Don’t doubt it. There will be no population left if you don’t listen to us.”
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