KINSHASA, ZAIRE — THE World Health Organization (WHO) says at least one-third of the world's cases of AIDS are women, many of them in Africa. Their numbers are growing rapidly, leading some countries to start AIDS-education programs aimed specifically at women. Officials say one such program in Zaire appears to be saving lives.
WHO estimates that 1 in 40 women in sub-Saharan Africa is carrying the AIDS virus, compared with 1 in 500 in Latin America and 1 in 700 in North America.
AIDS-prevention experts say that because so many African women are poor and of lower social status than men, they are more vulnerable than men to AIDS.
Realizing this, prevention experts in this capital city have turned part of their attention to working with prostitutes, who are said to be one of the highest-risk groups.
Studies have shown that many women engaged in prostitution do so because they have no other way to make enough money to survive. Zaire, with enormous unemployment, is one of the poorest countries in the world.
"Here prostitution is a basic way of survival for a very large segment of the young female population," says Bill Martin of the US Agency for International Development office here.
Some women turn to prostitution to supplement their meager legitimate incomes. Just before midnight, above the loud music at one of this city's many nightclubs in the Matonge section, Nina, 24, says: "It [prostitution] is not my preference. It's for necessity."
By day she sells vegetables in a local market, earning very little. Working as a prostitute, she can earn $20 a night, compared with typical factory wages of about $30 a month.
In May 1988, with international funding, the government opened a small health center aimed at prostitutes. Some 1,300 prostitutes agreed to participate in the center's programs, which offer free monthly checkups and counseling. Thirty-seven percent of them already had been diagnosed as carrying the AIDS virus, says Dr. Nzila Nzilambi, deputy director of the project which runs the center.
Later studies among the same women, who were offered information about AIDS and condoms, showed that an additional 14 percent per year were diagnosed as carrying the AIDS virus. But that rate is only about half of what it might have been without the counseling and education given to the women, says Dr. William Heyward, director of an AIDS project here.
"You're slowing down the [spread of AIDS]," Dr. Heyward said in a Monitor interview, attributing the slowdown to a greater use of condoms.
"The most important thing is education," says Manoka Abib Thiam, a doctor at the health center. "When we started here, very few of the women were aware of the AIDS problem and the existence of methods of protection," she says. "Now about 50 percent of the women use [condoms.]"
One low-income woman being helped at the center says her work as a prostitute "is the only means I have to earn my living."
She says she has tried several times to find other work but failed. "I have four children, plus a mother and a grandmother who are my responsibility." She says what money she managed to save to help them always ran out before she could find other work.
Jay Drosin, who works here for Population Services International, says the degree to which prostitutes use condoms often depends on their level of education and income, with poorer ones more likely not to insist on condom use.
He says the prostitutes in Zaire can include teenage school dropouts, secondary school students, women with other sources of income who are part-time prostitutes, and more affluent ones who solicit tourists. By knowing more about each category, specific AIDS-education messages and condom-sales programs can be tailored for them, Mr. Drosin says.