Continent is being ravaged by AIDS

September 20, 1990|By New York Times

Perhaps no scene in Africa today is sadder than the elderly in the unnatural activity of burying their grown sons and daughters.

"I'm already weak, and we are too poor," says a despairing 68-year-old woman near Masaka, Uganda, who has lost three of her four children to acquired immune deficiency syndrome.

She faces her final days with one surviving son and 28 grandchildren, some of whom have AIDS too.

The AIDS epidemic continues to course through Africa, outracing the prevention campaigns that have been started by every government.

About 500,000 Africans already have died in the epidemic and perhaps 5 million adults carry the AIDS virus. Studies indicate an overall infection rate of 80 people per 10,000 population -- more than 13 times the rate in the United States (six people per 10,000; 87,644 deaths since 1981) and in Maryland (also six per 10,000; 1,742 deaths since 1981).

In several cities -- including Lusaka, Zambia, and Kampala, Uganda -- more than 20 percent of adults have the deadly virus.

And in many other cities where 5 percent of adults are infected, as in Nairobi, Kenya, or 10 percent, as in Abidjan, the Ivory Coast, the numbers still are rising steadily.

In some city hospitals, AIDS patients take up a third or more of the medical beds, and only the lucky patients get even simple antibiotics and salves.


Once thought to be largely confined to urban areas of central and eastern Africa, AIDS spread rapidly in the late 1980s to huge new parts of the continent and, ominously, from city to countryside, where most people live.

In contrast with the pattern in the United States, where gay men are the predominant victims, AIDS in Africa is spreading mainly through heterosexual intercourse. The spread is propelled by long-neglected epidemics of venereal diseases, whose genital sores act as pathways into the body for the human immunodeficiency virus, which causes AIDS.

AIDS is striking men and women alike, the rich and the poor, and ravaging society on a scale unmatched anywhere else.

In Africa, the growing misery was evident during weeks of reporting in seven countries.

Where the disease spread earliest and large numbers have already died, as in Uganda, frightened young men and women are starting to realize that even marriage may be risky.

"The government says have one partner," says Dr. Sam Kalibala, a 30-year-old doctor who volunteers much of his time to treatment of AIDS patients. "But even if you get married, you have a one in four chance your partner will be infected. So marriage is not really a solution."

Because so many people were infected so recently and the virus often takes years to kill, the worst lies ahead. With perhaps 5 million adults in Africa carrying the virus, and hundreds of thousands of infants, disease rates will soar.

While data on the spread of AIDS remain far from complete, hundreds of studies of one group or another have now been completed, often confirming the worst fears.

"There's virtually only bad news," says Dr. Peter Piot of the Institute of Tropical Medicine in Antwerp, Belgium, who was one of the first doctors to describe AIDS in Africa. "With every conference I'm becoming more pessimistic. There are new groups infected, new countries, increases in the infection rates."


A "very conservative" estimate of infected African adults as of 1989 is 5 million, says Dr. James Chin, chief of AIDS surveillance at the World Health Organization.

And the epidemic has scarcely begun. "The clinical avalanche will be in the 1990s," says Chin.

In no other continent is the burden nearly so great. Africa accounts for more than half of an estimated worldwide total of 8 million virus carriers.

In the mid-1980s, as the world first became aware of the new epidemic in Africa, experts in their more optimistic moments could hope that AIDS might be contained within certain social and geographic boundaries.

It appeared largely confined to cities, and to several adjacent countries of central and eastern Africa. In these regions, AIDS began to explode sometime in the late 1970s, about the same time the virus began to race through the homosexual population in the United States.

Now, the boundaries have been breached.

Cities are still the hardest hit, and the virus has continued surging in many urban areas. The infection rate among pregnant women in Blantyre, Malawi's largest city, jumped from only 2 percent in 1984 to 22 percent in early 1990; in Lusaka, from 11 percent in 1987 to 22 percent.

In Kigali, Rwanda, there is hope that the infection rate for pregnant women is stabilizing at about 30 percent.


Far from being a special burden of elites, as some once predicted, AIDS is reaching everyone. If anything, say doctors in the Ivory Coast, the disease appears to be taking the harshest toll among the working class and the poor.

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