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Date: 2024-02-24 Page is: DBtxt001.php txt00001912

Health, Society and Economy
The crisis of AIDS in Africa

In Kenya, a nation of 31 million, 15 percent of adults have AIDS or HIV, U.N. statistics indicate.


Peter Burgess

NAIROBI -- The preacher's message to his 3,000-member congregation inside the Kenyan Local Believers Evangelical Church on a rainy Sunday was a simple one: Condoms don't protect against AIDS.

The crowd responded with a ringing 'Eh,' meaning yes, nodding as they clapped and rocked to his confident voice and his message.

'In fact, if you have sex using a condom 10 times, you will get 10 percent of the AIDS each time,' thundered the pastor, Solomon Ndoria, wearing a mustard-colored three-piece suit and pumping his hands in the air. 'Then you will actually have AIDS. So just abstain from sex.'

One day later, Lucy Wanjiku's message to the man in her dark metal shack, standing beside her thin foam mattress, was a simple one, too. But she mumbled it.

She needed cash. She had to feed her 4-year-old son. So the 30-year-old woman who usually sold African crafts was selling her body.

Wanjiku, one of the many members of Ndoria's church who live in Kangemi, a Nairobi slum, had listened to her pastor's words. But she had also heard discussions at the local health clinic and seen posters downtown, and she wanted her client to use a condom.

He refused, slapping her face. Then in the dark must of her room, on her cot, with her son crying nearby, they had sex, she said. Afterward, she had enough money for pounded maize. Now she has the virus that causes AIDS. She said she believes she will die soon.

The preacher and the prostitute exemplify the emotional debate over AIDS in Africa and its life-and-death consequences. As of the end of last year, an estimated 29.4 million people in sub-Saharan African had AIDS or HIV, according to U.N. estimates. About 3.5 million were infected during 2002, and an estimated 2.4 million people died of AIDS complications that year.

In Kenya, a nation of 31 million, 15 percent of adults have AIDS or HIV, U.N. statistics indicate. An estimated 500 to 700 Kenyans will die each day this year from AIDS-related causes. Yet after two decades of outside assistance and internal debate, Kenya, like most of its neighbors, has yet to find an effective strategy for preventing the disease or for treating those who contract it. And AIDS continues to kill entire villages, to wipe out generations.

When the country's first free and fair elections in December brought an end to 24 years of autocratic rule by Daniel arap Moi, many hailed it as a decisive moment not only in Kenya's political history but in its fight against AIDS. The new president, Mwai Kibaki, proclaimed a 'total war on AIDS.' He has committed his government to help pay for the treatment of 40,000 patients and abandoned Moi's self-described 'shy' policy about condom use, taking a stand supporting condoms in addition to abstinence until marriage.

After Kibaki's election, more than 500,000 condoms were distributed in western Kenya, where HIV infection is most prevalent. Kibaki's government ordered 50 million condoms from German prophylactic maker Condomi, and Kibaki said he will now implement the country's dormant AIDS prevention strategy, which long included plans to distribute condoms in hair salons, banks, restaurants and bars in addition to health facilities. Kibaki said the government will use a $100 million 'soft' loan from the World Bank to pay for 300 million condoms over a four-year period.

Kibaki maintains that if the AIDS problem is not tackled, none of his government's other programs will matter. 'We must all come out and fight and eradicate this disease, because there won't be any point of improving the welfare of people who are going to die,' he said last month. 'I would want us to look back and say, 'That is the disease that used to kill us.' '

Anti-AIDS crusaders say they hope Kibaki continues to follow a path that diverges sharply from the practice of many African governments to keep silent about condom use and AIDS. Ghana and Rwanda, largely Christian nations, are still unclear about prevention policies. In contrast, Botswana, with its tiny population of 1.6 million and its massive infection rate of 36 percent, has been aggressive both in rhetoric and treatment.

The most widely praised example in Africa is Kenya's neighbor, Uganda, where the policies of President Yoweri Museveni are credited with helping bring HIV infection rates down from 30 percent to 5 percent. Museveni set up aggressive and candid campaigns that included condom distribution and a national plan to attract aid donors to the country of 24.7 million.

'I think saving these lives is feasible in Kenya -- right now,' said Christa Cepuch, a Kenya-based pharmacist with the French medical aid group Doctors Without Borders. 'I think with political will anything can happen. If Kibaki sat down at his desk and made this happen, it would be a different country in 10 years. Uganda did it and now Kenya can, too.'

In Africa's impoverished countries, the debate over whether to tackle AIDS by trying to prevent it, through abstinence or condom use, or by treating it with expensive antiretroviral drugs, or both, is a complicated tangle that involves every level of society -- preachers, prostitutes and their clients, farmers, orphans, drug companies and politicians.

As AIDS drugs decrease in price and advocates around the globe lobby for more funding for their purchase, some AIDS experts say they are seeing the first signs that treatment might become affordable for poor countries. But at the moment, they say, prevention is the more pressing issue.

Few Kenyans take issue with the idea that abstinence from sex is an almost foolproof way to avoid AIDS. But in a country where more than half the people live on less than a dollar a day, it's not always that simple.

Because rural jobs are scarce, many Kenyans migrate to the cities for work, leaving their families behind in small villages. When spouses are separated for long periods, sexual relations outside marriage become common. Or when there are no jobs, it is not uncommon for a woman to sell her body -- perhaps just a few times in a lifetime -- to feed her family for a few days.

'Let's not be so naive and so bashful as to think people are not going to have sex,' said Wilson Ndgu, an energetic Kenyan doctor who distributes condoms at bars and in health clinics around the slums of Nairobi. 'People are having sex, so we should be promoting condoms as a way to save lives. That is the ethical and, frankly, the most Christian response.'

Most Kenyans -- 78 percent -- practice Christianity, and most Christian denominations in Africa oppose condoms, some on the grounds that they promote sex outside marriage, others because they are a form of birth control. Only a few socially liberal church leaders have come out in favor of condom use.

'To be honest, Kibaki is in for some real serious work here. The scale of the epidemic and complete lack of response to it has created a nation where a lot of people feel they are helpless,' said Chris Ouma, a Kenyan who is national coordinator for the Action AIDS/HIV program. 'There is a lot of education to do and a lot of working with the churches. I've never seen such prominent leaders pray for people's lives and then tell people not to use condoms.'

The All Africa Conference of Churches, with 168 members from all branches of Christianity, is torn on the issue of promoting condom use and backs a plan that tells worshipers to wait until marriage to have sex. But Kibaki is now asking church leaders to spend the first 15 minutes of every Sunday sermon preaching the policy of ABC.

ABC stands for 'Abstain, Be faithful or use Condoms,' the approach successfully adopted in Uganda and copied by other countries. President Bush, who has pledged $15 billion to help pay for drugs in Africa and the Caribbean, has made ABC official U.S. policy. The U.S. Senate approved a $15 billion bill Friday that earmarks $3 billion a year for the next five years for programs in Africa that include education about condom use and promotion of faithfulness and abstinence.

Still, some church leaders refuse to support ABC, saying it goes too far. 'This issue may be tougher than even finding affordable drugs for AIDS patients,' said Melaku Kifle, outgoing general secretary of the All Africa Conference of Churches. 'And Kibaki is trying to take a stand by pushing the ABC policy. What will happen? No one really knows. Kibaki's leadership in the coming years will be critical.'

As times change, there are signs that attitudes may be changing, too. On the television soap opera 'Saints and Sinners,' the characters talk about AIDS. In newspapers and on the radio, the new government has launched an ad campaign that talks about it, too. The ads say: 'Three people die every five minutes from AIDS in Kenya. What are you doing about it?'

Kenyan doctors now hand out condoms in bars and talk about prevention over warm Tusker beer. Even the national museum is addressing the issue, running an exhibit this month on how treatment and prevention improve the lives of patients.

'All of my friends say using condoms is like eating a banana with the skin on,' said Walter Koga, 22, a jobless man who was hanging out with his friends at a barbershop in Kangemi. 'Men just won't wear them because of stubbornness. People say it's not manly. But attitudes are changing. People don't want to be diseased, suffer horribly and die. I actually thought I would never wear one and now I do. I've changed.'

As a group of Koga's friends gathered to joke about how they still don't want to use condoms, Lucy Wanjiku hovered nearby, listening. She folded her arms over her chest and rolled her eyes. She told a group of women standing nearby about a friend of hers who had asked a man to use a condom and ended up getting beaten. She wanted to tell Koga's friends to stop joking, but she didn't. Instead she went inside her dark metal shack to rest. She was too sick and weak to fight with them.

© 2003 The Washington Post Company

Matunda Nyanchama, e-mail:

By Emily Wax ... Washington Post Foreign Service
Wednesday, May 21, 2003
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