Death Stalks A Continent

Sunday, Feb. 04, 2001 By JOHANNA MCGEARY
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Doctors bow to social pressure and legal strictures not to record AIDS on death certificates. "I write TB or meningitis or diarrhea but never AIDS," says South Africa's Dr. Moll. "It's a public document, and families would hate it if anyone knew." Several years ago, doctors were barred even from recording compromised immunity or HIV status on a medical file; now they can record the results of blood tests for AIDS on patient charts to protect other health workers. Doctors like Moll have long agitated to apply the same openness to death certificates.

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The Truck Driver
Here, men have to migrate to work, inside their countries or across borders. All that mobility sows HIV far and wide, as Louis Chikoka is the first to recognize. He regularly drives the highway that is Botswana's economic lifeline and its curse. The road runs for 350 miles through desolate bush that is the Texas-size country's sole strip of habitable land, home to a large majority of its 1.5 million people. It once brought prospectors to Botswana's rich diamond reefs. Now it's the link for transcontinental truckers like Chikoka who haul goods from South Africa to markets in the continent's center. And now the road brings AIDS.

Chikoka brakes his dusty, diesel-belching Kabwe Transport 18-wheeler to a stop at the dark roadside rest on the edge of Francistown, where the international trade routes converge and at least 43% of adults are HIV-positive. He is a cheerful man even after 12 hard hours behind the wheel freighting rice from Durban. He's been on the road for two weeks and will reach his destination in Congo next Thursday. At 39, he is married, the father of three and a long-haul trucker for 12 years. He's used to it.

Lighting up a cigarette, the jaunty driver is unusually loquacious about sex as he eyes the dim figures circling the rest stop. Chikoka has parked here for a quickie. See that one over there, he points with his cigarette. "Those local ones we call bitches. They always waiting here for short service." Short service? "It's according to how long it takes you to ejaculate," he explains. "We go to the 'bush bedroom' over there [waving at a clump of trees 100 yds. away] or sometimes in the truck. Short service, that costs you 20 rands [$2.84]. They know we drivers always got money."

Chikoka nods his head toward another woman sitting beside a stack of cardboard cartons. "We like better to go to them," he says. They are the "businesswomen," smugglers with gray-market cases of fruit and toilet paper and toys that they need to transport somewhere up the road. "They come to us, and we negotiate privately about carrying their goods." It's a no-cash deal, he says. "They pay their bodies to us." Chikoka shrugs at a suggestion that the practice may be unhealthy. "I been away two weeks, madam. I'm human. I'm a man. I have to have sex."

What he likes best is dry sex. In parts of sub-Saharan Africa, to please men, women sit in basins of bleach or saltwater or stuff astringent herbs, tobacco or fertilizer inside their vagina. The tissue of the lining swells up and natural lubricants dry out. The resulting dry sex is painful and dangerous for women. The drying agents suppress natural bacteria, and friction easily lacerates the tender walls of the vagina. Dry sex increases the risk of HIV infection for women, already two times as likely as men to contract the virus from a single encounter. The women, adds Chikoka, can charge more for dry sex, 50 or 60 rands ($6.46 to $7.75), enough to pay a child's school fees or to eat for a week.

Chikoka knows his predilection for commercial sex spreads AIDS; he knows his promiscuity could carry the disease home to his wife; he knows people die if they get it. "Yes, HIV is terrible, madam," he says as he crooks a finger toward the businesswoman whose favors he will enjoy that night. "But, madam, sex is natural. Sex is not like beer or smoking. You can stop them. But unless you castrate the men, you can't stop sex--and then we all die anyway."

Millions of men share Chikoka's sexually active lifestyle, fostered by the region's dependence on migrant labor. Men desperate to earn a few dollars leave their women at hardscrabble rural homesteads to go where the work is: the mines, the cities, the road. They're housed together in isolated males-only hostels but have easy access to prostitutes or a "town wife" with whom they soon pick up a second family and an ordinary STD and HIV. Then they go home to wives and girlfriends a few times a year, carrying the virus they do not know they have. The pattern is so dominant that rates of infection in many rural areas across the southern cone match urban numbers.

If HIV zeros in disproportionately on poor migrants, it does not skip over the educated or the well paid. Soldiers, doctors, policemen, teachers, district administrators are also routinely separated from families by a civil-service system that sends them alone to remote rural posts, where they have money and women have no men. A regular paycheck procures more access to extramarital sex. Result: the vital professions are being devastated.