Incomprehensible

File this one under background notes on the epidemic.

One could be forgiven for wondering whether anything could possibly help Africa at this point. The hurdles are so massive, the ignorance so pervasive, the disease so embedded that really nothing is likely to have much effect. It is even possible to see where male circumcision could suddenly sound reasonable in such an environment. Even if it is not. Too little, too late anyhow.

Note to readers: The last paragraph is a puzzle. The rest is worth the read.

Fair use Der Spiegel article next page with a link to the original (as always).

EPIDEMIC OF IGNORANCE: The Difficult Struggle Against AIDS in Africa

Millions in Sub-Saharan Africa are infected with the HIV virus which causes AIDS. But efforts to curb the disease continue to fail due to disinformation and bad politics. What can be done?

It's a story, set in the tiny, Western African country of Gambia, that would almost be funny -- if it weren't so outrageous and tragic.

The country, clinging to the banks of the Gambia River as it winds toward the coast, is ruled by 41-year-old Yahya Jammeh, an autocrat who has a thing for white garb. And he aims high -- he has resolved to transform his country into an African version of the rich, Asian city-state Singapore by 2020. Quite a goal for a country of 1.6 million with a low literacy rate and 75 percent of the population living off the land. But compared to Jammeh's most recent vision, reinventing Gambia as a center of trade and finance sounds almost plausible.

Jammeh -- a military officer who staged a successful putsch in 1994 -- is not just the president. He's also a healer on a divine mission. In January of this year, he summoned a number of his acolytes together with foreign diplomats and revealed to them that he had made an extraordinary discovery. He announced that, in addition to asthma, he was now capable of healing Acquired Immune Deficiency Syndrome (AIDS) -- the epidemic that ravages sub-Saharan Africa like no other region of the world. More than 15 million Africans have already died of AIDS, and a further 25 million are infected with the HIV virus which causes the disease.

On Thursdays -- Jammeh's healing powers are only available to him on that day of the week he says -- the president frequently allows Gambian television to film him as he defeats AIDS: Patients lie flat on their backs as the president whirls around them and mumbles verses from the Koran. He slaps green sludge onto their skin, sprinkles liquid from an old Evian bottle over them and gives them a brown broth to drink. A quick banana snack completes the therapy.

That's it. Thanks to the power of the Koran and seven secret herbs this treatment, repeated over the course of several weeks, leads to the patient being cured of the lethal virus "with absolute certainty," as Jammeh says. But two requirements need to be met for it all to work. First: His patients have to renounce alcohol, tea, coffee and sex for the duration of their treatment -- as well as theft. And second: Whoever is taking anti-viral medication has to stop doing so immediately, according to Jammeh.

Even more disturbing is that the Gambian minister of health supports his president -- despite being a trained gynecologist educated in Ukraine and Ireland. The country's other institutions, including the parliament, are doing the same. And on the streets of the Gambia, demonstrations can sometimes be seen -- not against Jammeh, but in support of him.

'Curing' AIDS with Herbs and Bananas

So far, one of the few within Gambia to voice any criticism has been the United Nations spokesperson there, Fadzai Gwaradzimba. She said there was no proof for the success of Jammeh's method and that no one should believe they would no longer be infected following treatment by the president. Jammeh was so enraged that he immediately declared the UN representative unwelcome and forced her to leave the country within 48 hours.

Earlier, two high-ranking AIDS educators had already announced their resignation in the capital city of Banjul. They explained that, in light of Jammeh's healing mania, it was impossible to teach the population about the dangers of HIV and AIDS. Meanwhile Jammeh continues to up the ante. In early April he announced he has now acquired the ability to heal diabetes, and that -- just as with asthma -- he needs only five minutes to do so. Not all his subjects believe him -- but quite a few do.

Abysmal governments and spooky despots: just two of the many reasons why HIV can rage almost unchecked south of the Sahara. Only a handful of African states have adopted a rational approach to AIDS. Senegal, Ghana and especially Uganda have achieved impressive results in their struggle against the spread of the virus. But in other African societies conditions often prevail that actually help HIV spread -- even now, 25 years after the discovery of the lethal disease.

Everything is connected: superstition, illiteracy, poverty, disinformation, isolation, corruption, migration, prostitution, promiscuity, polygamy -- and, of course, the silence. Even though AIDS represents a grade-A catastrophe in many parts of sub-Saharan Africa, the issue has remained taboo. No one speaks about it, no one confesses to being affected by it -- neither those infected nor their relatives, neither religious leaders nor politicians.

Those who know they are infected prefer to claim they're not suffering from AIDS but only from the plethora of diseases that take hold thanks to the weakening of the immune system -- tumors, for example, tuberculosis or pneumonia. Some even claim to have been bewitched. Everything is better than AIDS, since AIDS is still considered the disease of shame.

The eldest son of former South African President Nelson Mandela died of the effects of AIDS at age 54, in early 2005. His father made the affliction public and urged his compatriots to finally speak openly about the epidemic -- to no avail. In many parts of Africa, those who admit to being HIV-positive must fear being ostracized along with their relatives. Some have even been killed by angry neighbors after making their HIV-positive status public.

Disinformation, Corruption -- and Silence

It's bizarre how so many countries succeed in denying an epidemic that sends masses of young people to the grave and hollows out entire societies from within. Farmers afflicted with AIDS are too weak to work in the fields. Teachers no longer teach. Soldiers die. Truck drivers, engineers, doctors and ministers, their wives and their children -- they are all affected. AIDS is costing many countries all the economic progress made during the last 25 years.

Some companies routinely hire two applicants for a job opening because they know very well that soon only one of them will be left. Burials have become the most frequent family occasions in many regions. Twenty-five years ago, life expectancy in Botswana was still above 60. Now it has sunk to little more than 40. Twelve-million children have become orphans due to AIDS. Many of them were infected with the virus before they were born or from their mother's milk.

Hardly any of these countries has even a semi-functional health system. Scientifically trained medical practitioners are rare and most of the ill seldom come into contact with them, if at all. Doctors can only estimate the overall infection rate, for example, by means of testing those they do come into contact with -- pregnant women for example. And what they've found is breathtaking even for pessimistic experts. Every fifth person in Zambia, every fourth person in Namibia and every third birth in Zimbabwe and Botswana is HIV positive. With the exception of India, the absolute number of people with HIV is nowhere higher than in South Africa. The figure is above 6 million. More than a thousand South Africans die of AIDS every day.

Africans still go to their highly respected traditional healers for medical aid, healers that follow the tradition of their forefathers by tackling all ills with herbs and magic. In the best possible scenario, these healers could help solve the AIDS problem, and in many countries aid organizations are trying to recruit them for necessary educational work. But often the messages spread by such healers are part of the problem. In southern Africa, for example, millions of men are convinced an HIV infection can easily be cured -- by means of sex with a virgin.

Persistent Legends

That condoms offer protection is far from common knowledge, and many of those who have heard don't believe it. Some believe condoms are irreconcilable with masculinity or even take them to be a conspiracy by white men aimed at lowering the African birth rate. Many also believe that condoms are infected with HIV by the West to reduce the African population. Many tribal leaders and traditional healers warn against the use of condoms -- as does the Catholic Church. Under such circumstances, messages of prevention are often ignored.

Tragically, the HIV virus strikes people who are especially predisposed to it in Africa. Other venereal diseases such as syphilis, herpes or gonorrhea are also still widespread in the region -- and they tend to make those who suffer from them more susceptible to the AIDS virus.

In addition, many women in Sub-Saharan Africa have for generations been engaging in sexual practices that dramatically increase their own risk of infection. Before having sex, they use herbs, powder or cloths to remove all moisture from their vaginas. Men supposedly appreciate this practice because it makes the vagina dry, hot and tight. But so-called "dry sex" often leads to minor injuries to the mucous membrane, which facilitates HIV infection. AIDS educators are trying to encourage women abandon this custom, but with only limited success.

In theory, South Africa is the country that should be best equipped, in terms of economic power and infrastructure, to fight the epidemic. But South African politicians seem to be doing all they can to help the virus spread. They may not be quite as flamboyant as Gambia's presidential virus slayer, but they come close to being as dangerous. Thabo Mbeki, Mandela's successor as president, has repeatedly flirted with the long discredited ideas of the "AIDS dissidents," according to whom, AIDS is not caused by a virus, but by poverty and malnutrition.

The Shower Method

Mbeki's former vice president, Jacob Zuma, has had unprotected sex with a woman who was HIV positive at the time. There was hardly any risk of infection, Zuma said publicly, since he showered immediately after having sex. It's astonishing that Zuma isn't more knowledgeable about the spread of HIV; he was, after all, previously the director of a national AIDS organization.

And the South African minister of health, a med-school graduate, advises those infected not to take anti-viral medication in favor of a mixture of garlic, lemon, potatoes and red beet. That's better, she says, because the side effects are less severe. "Dr. Red Beet," as she is mockingly called, also sympathizes with German miracle healer Matthias Rath, who sells vitamin drinks in South Africa as an alleged alternative to established HIV medication.

In wealthier nations, AIDS has long ceased leading inevitably to death. The disease may not be curable, but modern medication can battle the viruses so effectively that it can no longer be detected in the blood. For a long time, however, the therapy was so expensive that only some 100,000 Africans benefited from it in 2003.

But things have changed -- and this is the only positive piece of news about AIDS in Africa. Many countries and organizations provide billions of dollars to purchase medication at drastically reduced prices. Last year, about 1.3 million AIDS victims in sub-Saharan Africa had access to the medication they need to survive for the first time.

In other words, almost a third of those in need already receive help. By 2010, the UN wants to ensure that every afflicted person receives treatment.

The end of the epidemic could be near for African HIV patients. But the hurdles remain high: For the afflicted to be cured, their blood first needs to be examined by qualified personnel -- of which there is a considerable lack. Hardly 10 percent of the population have taken an AIDS test in the most severely affected African countries.

The others often don't even know that such a thing exists.

Reference

Evers, Marco. Epidemic of Ignorance: The Difficult Struggle Against AIDS in Africa. Der Spiegal Online. June 8, 2007.

http://www.spiegel.de/international/world/0,1518,485715,00.html