Advancing and Retreating in the AIDS Battle in Zaire Rate Stops Climbing, But Research Grants Are Imperiled

July 05, 1992|By CINDY SHINER

Kinshasa, Zaire. -- It's another hot Saturday afternoon in Kinshasa as Stephanie, Mireille and Rosy shuffle their tired teen-age bodies into the Domino bar on the Boulevard 30 Juin for a beer.

Stephanie is wearing the same backless red flowered dress she danced in at the Spikizy (pronounced speak-easy) the night before, and Mireille has been whistling the tune to the song, "Let's talk about sex, baby."

"I'm better off than before," says Stephanie, 18. "There was no work, the family didn't have anything, and I was obliged to do it," she says of the decision she made the day her mother died to leave school and become a prostitute.

The three teen-agers are among a growing number of young Zairean women who have decided to sell their bodies and risk fatal disease to survive in this economically crippled capital of 2.5 million, medical workers say. Unemployment is estimated at 70 percent and annual inflation has soared to 5,000 percent.

Almost half of Kinshasa's prostitutes are infected with HIV, the virus that causes AIDS. Although that rate sounds high, it is not high compared with other central and east African capitals such as Kigali, Rwanda, and Nairobi, Kenya, where up to 90 percent of prostitutes are infected with the deadly disease.

But unlike other countries in the region, which is in the heart of the continent's AIDS epidemic, the HIV prevalence in Kinshasa has stabilized, according to Mike St. Louis, a medical epidemiologist with the Atlanta-based U.S. Centers for Disease Control (CDC).

Determining how and why the occurrence of new cases has leveled off in Zaire could point health workers to strategies that might work in other countries. "It is a very big question, and a central question to understand AIDS in Africa," said Mr. St. Louis on a recent visit here.

But it is a question that may go unanswered. The CDC, a U.S. government funded agency, has withdrawn its financial support and its personnel from Project SIDA ("AIDS" in French), Zaire's AIDS program. The program is Africa's largest and most prestigious effort to combat the deadly virus, and medical workers say its closing could severely retard the continent's AIDS research.

The CDC says it is pulling out because the Zaire government cannot guarantee the security of CDC employees here. Medical workers were among 15,000 foreigners who were evacuated last September and October after unpaid soldiers led a looting spree throughout the country.

Tensions have continued to mount since last December, when President Mobutu Sese Seko refused to step down at the end of his fourth term in office. A growing democracy movement has demanded elections to choose a successor to the strongman ruler who seized power in a 1960 coup backed by the U.S. Central Intelligence Agency.

One CDC official, who spoke on condition of anonymity, says that some U.S. State Department officials were "thrilled" after the pillaging last year, because the disorder provided an excuse to carry out earlier plans to scale back the U.S. diplomatic presence in Africa and bolster it in eastern Europe.

Project SIDA received about $2.5 million in funding over four years from the CDC, Mr. St. Louis says. Other assistance came from the U.S. Agency for International Development (USAID), Medecins Sans Frontieres (Doctors Without Frontiers, a France-based group), the government of Belgium, the European Community, the World Bank and Zaire's Health Ministry.

The project was used as a model for fighting AIDS in other countries around the world. "The government of Zaire, with all of its frailties in the areas of politics and economics, has been very progressive in the area of AIDS," says Mr. St. Louis, noting that the Health Ministry has been open about acknowledging AIDS as a national problem and has encouraged foreign aid.

With support from the CDC, Zairian doctors were at the forefront of AIDS research in Africa, and Mr. St. Louis says they have become international-level scientists, despite the economic and political troubles that plague their country.

"This is a very bad, bad thing. We planned a lot of things to do in Project SIDA. And these things are cut off and we can't do anything now," says Mukadi Ya Diul, a researcher who studies HIV-positive patients with tuberculosis.

Project SIDA conducted epidemiology research at eight sights throughout the capital, including tracking HIV infection in prostitutes, treating tuberculosis in AIDS patients. and treating sexually transmitted diseases that facilitate the spread of the AIDS virus.

With USAID's assistance, Zaire also had an enormously successful education and condom distribution campaign. The brand most widely distributed, called Prudence, has become a word synonymous with safe sex. About 100,000 condoms were sold in Zaire in 1985. In 1989, 9 million condoms were sold, says Mr. St. Louis.

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