SUB-SAHARAN Africa, one of the world's poorest and least-educated regions, has more than half the world's estimated 6 million to 8 million cases of AIDS, according to the World Health Organization (WHO). Most of the 2 million women WHO estimates will die of AIDS in this decade live in sub-Saharan Africa. Some of the hardest-hit countries are in Central and Eastern Africa. But in Zaire, a coordinated prevention campaign appears to be making progress.
The challenge is great. Besides the large number of deaths they attribute to AIDS, officials say the disease has serious economic consequences as well.
A study in Zaire estimated that annual loss of income because of illness was about $400 for an AIDS patient. (Per capita income in Zaire was about $170 in 1988, according to the World Bank and the Population Reference Bureau in Washington, D.C.) And since most income earners in Africa support large families, a patient's incapacity has an economic effect on many others.
With African economies practically stagnant at present, and per-person spending on health care ranging from only $1 to $10 a year, most African countries can not afford the extra burden of medical care for AIDS cases.
At the same time, many African countries have been slow to recognize the AIDS challenge and even slower to do something about it. But a few, including Uganda and Zaire, were quick to acknowledge the problem and are in the forefront in efforts to prevent the spread of AIDS.
Prevention specialists in Zaire are claiming progress on two fronts: greater awareness among the public about AIDS and changes in sexual behavior that doctors say can reduce the risks of transmission.
"I feel progress is being made - a lot of progress," says Bill Martin of the United States Agency for International Development (USAID), an important funder of AIDS-prevention programs in Zaire. "The average person who lives in Kinshasa, Zaire, knows more about AIDS, how it is transmitted, how it is prevented, than the typical American," Mr. Martin claims.
In one of the most extensive educational campaigns in Africa, Zairians since 1987 have been blanketed with radio, television, poster, drama, and brochure messages about AIDS and how to prevent it.
"We look for creative ways to reach people,' says Julie Convisser, who heads a small AIDS-education team here for Population Services International (PSI), a private organization based in Washington. The program is funded by USAID.
DOCTORS say AIDS in Africa is most commonly spread through heterosexual sexual relations, often outside marriage. (In the US and Europe, on the other hand, experts say the disease has affected primarily homosexuals and intravenous drug users.)
The message of many church-sponsored and other AIDS-awareness campaigns is clear: The best prevention is premarital chastity and marital fidelity.
As part of the USAID-funded campaign in Zaire, a drama group presented a skit for national television in which villagers protested the advances of a man trying to seduce a married woman.
According to surveys taken after AIDS-awareness campaigns here, many urban Zairians say they are reducing their promiscuity. But researchers say they can't verify this.
So while continuing to promote high standards for sexual behavior, many educational campaigns in Africa, including Zaire, also offer information about and distribution of condoms.
The sale of condoms - which most men in Zaire once strongly resisted using, as do men in many other African countries - has climbed from about 900,000 two years ago to 9 million last year. AIDS-education specialists here expect sales to reach 15 million this year, as condoms are made more widely available at a USAID-subsidized price: the equivalent of a few US cents each. Earlier efforts to give them away proved fruitless as potential users were suspicious of anything free.
This increase in condom sales represents "a significant change of behavior, which has definitely, I think, at least impeded" the spread of AIDS in Zaire, says William L. Heyward, an AIDS researcher.
Dr. Heyward, who works for the US Centers for Disease Control in Atlanta, heads an AIDS research project here supported by USAID and the Belgian Institute of Tropical Medicine, in cooperation with the government of Zaire.
Condoms, once available mostly in pharmacies, are now sold by walking street vendors and in small shops, bars, and hotels. There are plans to sell them on river barges, through sports clubs, taxi drivers, traditional African healers, and associations of prostitutes, says Jay A. Drosin, who heads the PSI condom-marketing project here.
BUT much remains to be done in the AIDS-prevention effort, a Zairian official says.
"It's the young who are the most hit by [AIDS]," says Mpoke N'kumu, who is in charge of the Zairean government's AIDS programs. "We think it's with the young that we ought to concentrate the work of the fight against AIDS."
Mr. N'kumu says that young people are now quite familiar with the disease, but too many people still have not yet changed their behavior accordingly. The television and radio AIDS campaign is aimed at teenagers and people in their 20s.
Heyward praises the government-sanctioned information campaigns on AIDS and Zaire's "very bold and courageous step in 1983 to allow AIDS research to be conducted in their country 201&gt; at a time when fingers were pointing between countries over where did it come from, and who was to blame."
"Today, a lot of what we know about AIDS in Africa has come out of Zaire," he says.