Africa on Offensive Against AIDS. World Health Organization plays crucial role in continent-wide battle. FROM DEBATE TO ACTION
HARARE, ZIMBABWE — AFTER years of controversy and denial, Africa has begun to address a very sensitive subject - its growing problem of AIDS (acquired immune deficiency syndrome.) In association with the World Health Organization (WHO), every African country has launched a national program to fight, primarily through education, the spread of this disease.
This marks a dramatic change for Africa. Until recently, most of the continent's attention focused on a debate over the origins of AIDS. Westerners originally concluded that the virus began in Africa - a notion supported by questionable evidence and deeply offensive to most Africans.
But scientists in the United States have since withdrawn their hypothesis that AIDS jumped from a monkey to human beings in central Africa. Researchers have admitted that early research in Africa was faulty, and the international scientific community now generally accepts that AIDS is as new to Africa as it is elsewhere.
Overall, the WHO estimates that 2 million to 3 million Africans are infected with the virus, known as HIV (human immunodeficiency virus) said to cause the disease. The highest incidence is in east and central Africa, where the virus appears to have flourished in conditions of war, poverty, and physical dislocation, spreading south along established trade routes.
In the long term, according to the WHO, if the spread of the virus continues, AIDS could lead to a negative population growth rate in Africa.
Fighting AIDS in Africa presents several problems:
Because homosexuality and drug abuse are relatively uncommon, the virus is transmitted almost exclusively through heterosexual intercourse. It affects men and women, and is increasingly reaching children under five, as infected women give birth.
Spread of the disease through blood transfusions and hypodermic needles - seen as a common cause in the West - is relatively rare here.
The sensitive nature of the subject has hampered an all-out education effort. ``Because of the confidentiality which surrounds the disease,'' says Rose Mandebvu, a health education specialist in Botswana, ``we have yet to create an atmosphere in which HIV positive people will be willing to talk and take the lead in education activities.''
Financial constraints limit the effectiveness of health educators' programs. Ms. Mandebvu bemoans the lack of visual material depicting the plight of AIDS victims in an African setting. Most of her material, she says, has been developed in the West. Its emphasis on homosexuals and drug users ``only goes to emphasize the view here that AIDS is a `foreign' disease,'' she says.
IN many countries, there is also a debate over the content of education programs. While governments have taken a secular approach - stressing the need to limit the number of one's sexual partners and to use condoms - the older generation and churches see in AIDS a chance to revive traditional Christian values of chastity and one marriage partner for life. In Uganda, the Roman Catholic Church has modified the government slogan - ``love carefully'' to its own - ``love faithfully.''
Condoms are increasingly seen by health professionals and government officials here to be of limited help. Says one doctor: ``They have a short shelf life in the tropics, they are not foolproof, they are unpopular as a contraceptive, and it is virtually impossible to ensure their constant supply in rural areas.'' Monogamy, most Africans are beginning to agree, is the safest insurance policy against AIDS.
The other side of the prevention coin - identifying carriers of the AIDS virus and encouraging them to modify their sexual activity - is also tricky.
COMPULSORY testing is almost unanimously rejected. It is costly, would have to be repeated every six months, and raises ethical questions. It is generally agreed that a test with such potentially devastating implications should not be administered without counseling.
Over and over in interviews, doctors - who might have to serve the needs of up to 25,000 patients - have said they simply don't have the time to spend on counseling. A senior Kenyan health official says training counselors is the single biggest challenge facing the AIDS campaign in his country. Kenya is among several African countries that, with WHO's help, will be training an army of volunteer counselors in 1989.
As more cases appear, health officials are also turning their attention to care for AIDS patients - which can be difficult. In some countries, where AIDS patients take up to one quarter of hospital beds, the disease is placing a heavy strain on resources.
Finally, the spread of AIDS may have far-reaching economic costs for Africa. An underdeveloped continent with few university-educated people, Africa could suffer tremendously from a disease which has targeted its elite. The best and brightest of Africa - who tend to live in cities, where the disease has spread most quickly, and who have the money to hire prostitutes (who have a high risk of having the virus) - have been hit hardest by AIDS.
Despite these significant hurdles, AIDS control programs are now clearly in evidence across the continent. Many have been generously funded by Western donors - some would say disproportionately so, since AIDS is still far from being the biggest cause of death here.
For example, on World AIDS Day last month, virtually every African country held some kind of seminar or exhibition, or produced a play or released a song to mark the occasion.
In Uganda, four bands paraded through the capital city, Kampala, followed by processions of health workers, students, and factory workers bearing banners with such messages as: ``Dance, prance, but don't chance,'' and ``One God, one man, one woman, one life.''