Death Stalks A Continent

Monday, Feb. 12, 2001 By JOHANNA MCGEARY

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But to comprehend the full horror AIDS has visited on Africa, listen to the woman we have dubbed Laetitia Hambahlane in Durban or the boy Tsepho Phale in Francistown or the woman who calls herself Thandiwe in Bulawayo or Louis Chikoka, a long-distance trucker. You begin to understand how AIDS has struck Africa--with a biblical virulence that will claim tens of millions of lives--when you hear about shame and stigma and ignorance and poverty and sexual violence and migrant labor and promiscuity and political paralysis and the terrible silence that surrounds all this dying. It is a measure of the silence that some asked us not to print their real names to protect their privacy.

Theirs is a story about what happens when a disease leaps the confines of medicine to invade the body politic, infecting not just individuals but an entire society. As AIDS migrated to man in Africa, it mutated into a complex plague with confounding social, economic and political mechanics that locked together to accelerate the virus' progress. The region's social dynamics colluded to spread the disease and help block effective intervention.

We have come to three countries abutting one another at the bottom of Africa--Botswana, South Africa, Zimbabwe--the heart of the heart of the epidemic. For nearly a decade, these nations suffered a hidden invasion of infection that concealed the dimension of the coming calamity. Now the omnipresent dying reveals the shocking scale of the devastation.

AIDS in Africa bears little resemblance to the American epidemic, limited to specific high-risk groups and brought under control through intensive education, vigorous political action and expensive drug therapy. Here the disease has bred a Darwinian perversion. Society's fittest, not its frailest, are the ones who die--adults spirited away, leaving the old and the children behind. You cannot define risk groups: everyone who is sexually active is at risk. Babies too, unwittingly infected by mothers. Barely a single family remains untouched. Most do not know how or when they caught the virus, many never know they have it, many who do know don't tell anyone as they lie dying. Africa can provide no treatment for those with AIDS.

They will all die, of tuberculosis, pneumonia, meningitis, diarrhea, whatever overcomes their ruined immune systems first. And the statistics, grim as they are, may be too low. There is no broad-scale AIDS testing: infection rates are calculated mainly from the presence of HIV in pregnant women. Death certificates in these countries do not record AIDS as the cause. "Whatever stats we have are not reliable," warns Mary Crewe of the University of Pretoria's Center for the Study of AIDS. "Everybody's guessing."

THE TB PATIENT

Case no. 309 in the Tugela Ferry home-care program shivers violently on the wooden planks someone has knocked into a bed, a frayed blanket pulled right up to his nose. He has the flushed skin, overbright eyes and careful breathing of the tubercular. He is alone, and it is chilly within the crumbling mud walls of his hut at Msinga Top, a windswept outcrop high above the Tugela River in South Africa's KwaZulu-Natal province. The spectacular view of hills and veld would gladden a well man, but the 22-year-old we will call Fundisi Khumalo, though he does not know it, has AIDS, and his eyes seem to focus inward on his simple fear.