In AIDS--plagued Uganda, everyone talks about death

September 21, 1990|By New York Times

In the African city of Kampala, Uganda, a coffin maker says he sells more of his product for burying young adults than the elderly.

It is but one sign of how acquired immune deficiency syndrome is ravaging the continent. Already, AIDS has claimed at least half a million lives there.

In Uganda, the modern-day plague began to show up in the early 1980s.

"It all started as a rumor," says Dr. Sam I. Okware, one of Uganda's senior health officials. He remembers hazy reports in 1982 that a new affliction was causing Ugandans to waste away.

"Then we found we were dealing with a disease," Okware says. "Then we realized it was an epidemic. And now, we've accepted that it's a tragedy."

Okware is describing a process hauntingly similar to the stages, from denial to acceptance, that people go through when they learn they have a fatal disease.

But he is describing an entire country, one that perhaps more than any other has begun to confront the meaning of wholesale invasion by a deadly, sexually transmitted virus.

Uganda's AIDS epidemic may be no more enormous than that in several other African countries, but it seems to have started a bit earlier. More important, the country has for years been one of the most forthright in acknowledging the crisis.

As a result, in its problems and in its thinking about AIDS, Uganda is a bellwether for Africa, a case study of the future. The strange new questions Ugandans are brooding over will soon preoccupy people in many countries.

Kampala today is a city where, as a secretary says, "everyone is scared."

A graphic artist in his 20s agrees. "When you go out in the evening for a chat with your friends," he says, "you talk about the most recent death. It's very regular now."

And a 22-year-old married man who is HIV-infected is bursting with guilt and dread about the threat to his wife and child.

A few months ago, he read about a place where AIDS tests were offered, no names asked. "It took me a long time to get the courage to go," the man recalls. "When I got my positive result I got angry, and told them it must be a mistake. They did the test again."

There had been no mistake.

"I couldn't tell my wife," the man says. She is 17 and their baby is 18 months old.

He has no way of knowing if his wife is also infected, and cannot bring himself to suggest that she go for a test. He figured out a subterfuge for her protection.

"I told her that I think we should wait until our daughter is 5 before we have another child," he says. "Until then, I told her, I think we should use condoms." She suggested the pill instead, but he convinced her that it might make her sick.

"I'm so worried about our baby girl," the man says. "I brought her to the test center, but they said I would have to bring my wife, too, before they would test [the child]."

FUNERALS ALMOST DAILY

When someone dies in southern Uganda, a woman in Masaka says, "you don't have to ask why." In many southern villages, almost daily AIDS funerals are becoming a major burden.

Coping with death on a large scale is nothing new in a country of acute poverty struggling to recover from 20 years of ruthless rulers and civil wars.

But if death is familiar, the silent infection of a large share of the healthy with an incurable virus is a new kind of plague.

The government estimates that a million Ugandans of a total of 16 million are infected with the AIDS virus. That is one of every eight people 15 years old and over nationwide, men and women from all sectors of society.

In Kampala, close to one in four adults carries the virus, an infection level that several other African cities appear destined to reach if they have not already.

Among literate Ugandans, at least, the awesome implications are beginning to register. Terrifying issues arise, questions about testing and behavior and planning that few groups anywhere, except perhaps gay men in cities like New York and San Francisco, have had to confront with any real urgency.

The government has urged people to "love carefully," and many young people say they want to marry early. A women's legal aid group has even called for reducing traditional bride prices to make it easier.

But some people are starting to realize that, given the infection rate, even marriage carries risks. And they agonize over the possibility that they might already be infected.

FEAR OF MARRIAGE

Some say they have entered a frightened celibacy, afraid to date or marry. The issue of personal testing for the AIDS virus, not widely considered until now in Africa, is on many minds.

"Unless I find someone who will agree to go together with me for an AIDS test, I won't get married," says John Matovu, a student at a technical college in Kampala who has had one brother die and "so many cousins, nieces and nephews."

Like other African governments, Uganda has not encouraged AIDS virus testing, arguing that it would only demoralize people who could not be helped.

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