WP-Cycle of War Is Spreading AIDS and Fear in Africa

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Washington Post – 11-13-03

Cycle of War Is Spreading AIDS and Fear in Africa

Wax

Washington Post Foreign Service

13 November 2003

The Washington Post

The health care workers told the group of 30 teenage boys to put down their

guns. They asked the boys to sit in a circle. They warned them against

raping women. They showed them some unnerving photographs of young people

withered and feverish from HIV-AIDS. And they told them if they were going

to have sex that they should use a condom.

Then the lesson was over.

The workers with the aid group Population Services International,

recounting the session held last summer, said they knew they didn't have a

particularly attentive audience. They assumed many were HIV-positive.

" It's hard to convince an unpaid fighter to wear a condom knowing they are

going to go out and rape someone. It's hard to change that sort of

mind-set, " said Dieudonne Zirirane of the Bukavu-based aid group. " But this

is war. What else can we do? "

The men from the Congolese Rally for Democracy, the country's largest rebel

group, went back to their posts in the dense jungle, where they were

fighting other rebel groups. And this fall, the reports kept coming in --

from hospitals, from church health clinics and from the tin-roof shacks of

traditional healers. A great many women were being raped by fighters.

Of those who came to hospitals for treatment, about half were HIV-positive,

health workers said. In rural areas, tests are unavailable, so by the time

women fall ill with AIDS, most unknowingly have transmitted the disease to

their husbands and babies. Before the war, about 5 percent of the

population was infected with HIV. In the eastern parts of the country that

have suffered the most during the fighting, 20 percent of the population is

estimated to be infected, according to the U.N. AIDS program in Kinshasa

and the government's Health Ministry.

In Africa, the cycle of war is spreading HIV. In countries such as Liberia,

Sierra Leone, Congo and Sudan, where war has been more common than peace in

recent decades, HIV rates have ballooned during times of conflict.

In Liberia, less than 1 percent of the population suffered from HIV before

war broke out in 1989; 10 years later, around 8 percent of the population

was infected. After this summer's fighting, nearly 16 percent of the

population had the virus, according to the U.S. Agency for International

Development.

Estimates of HIV among the military in Angola range between 40 percent and

60 percent, while 3 percent of the general population is infected,

according to the U. N. AIDS program. In Zimbabwe, 50 percent of the

military is HIV-positive, while 25 percent of the general population

suffers from the virus. Eritrea's HIV rates also rose after its war with

Ethiopia.

Levels are astronomical in the military for reasons other than rape.

Prostitutes are often drawn to soldiers to make money in desperately poor

war economies, and casual liaisons are common among soldiers away from home

for lengthy periods, several reports have shown. Congo's war has been

particularly conducive to the spread of AIDS. At times, more than five

neighboring armies were drawn in. The fighters brought soaring rates of HIV

along with their weapons. Nearly a quarter of Ugandan soldiers who invaded

Congo 41/2 years ago and backed rebel proxy groups tested positive for HIV,

another USAID study said.

The war is officially over, with a fragile peace plan and a transitional

government in place under the leadership of ph Kabila. But in the

eastern reaches of the country, pockets of fighting continue, along with

kidnapping and rape.

" My body became cold after I was raped, " said Fabina Malibilo, 21, who was

suffering from pneumonia at a hospital in Kalima, in the heart of the

eastern Congo. " My husband tried to take care of me, but later on he got

sick, too. "

Malibilo is a friendly, even magnanimous woman, considering what she has

lived through. Seven rebels from the Mai Mai group kidnapped her in

September and held her for three months. Today, she doesn't know if she has

AIDS, although she suspects she does. Her doctors say quietly that they are

sure she does. They won't tell her though, because they have no treatment,

anyway.

" I know I am very sick, " she said, softly twisting her braids as she

breast-fed her baby. " I am feeling very tired. All I am thinking about is

how to prepare for my baby when I am not alive. "

To be HIV-positive in Africa is often a slow, hopeless struggle to stay

alive through better nutrition and good treatment for other infections.

Sometimes, for the lucky or the rich, there is access to the life-saving

drugs that are widely available and affordable in the West.

But to contract HIV during war in Africa is tantamount to a death sentence.

" We have big illness here. But we only have rubbing alcohol to treat it, "

said Bisimwa Gaspard, a nurse at a fetid military hospital in Bukavu, where

bullet-ridden metal tables served as beds. " We know it's spreading. To be

very honest, it's very much out of control now. "

A bucket of dirty water was being used to towel off the perspiring head of

a patient who might have been suffering from AIDS. Gaspard shrugged and

turned away. " What can we do? We don't even have AIDS tests, " he said. The

patient was too sick to be interviewed.

In eastern Congo, no residents had received the life-saving AIDS drugs

until Doctors Without Borders, a French medical aid group, began treating

10 patients in Bukavu last month. Without a functioning government in the

country, the organization was able to bring in low-cost generic drugs that

many African governments have rejected. The initiative is the first time

that an aid group has tried to give antiretroviral treatments in Congo,

where the fighting has not stopped.

" Africans know how to die with AIDS, " said Cordero, who is helping

to run the program in Bukavu. " But they don't know how to live with it.

This is a moment in history for eastern Congo. It's an incredible

opportunity. "

The group hopes to have 150 patients in treatment by January 2005. For the

treatments to work, however, patients must show up for medicine and

appointments. If there is fighting again, they should not flee, as many do

when shots are fired, Cordero said.

In that case, they will face a tough choice: run from war and possibly die

from AIDS, or stay and be treated and possibly die from war.

" It's a horrible choice, " said Francois Mutela, who works in Bukavu with

the Catholic Church in the program with Doctors Without Borders. " I think

that about sums up our dilemma. But, right now, it's the best choice we

have. "

_____________________________

M. Cohen

U.S. Director, Campaign for Access to Essential Medicines

Doctors Without Borders/Médecins Sans Frontières (MSF)

333 Seventh Avenue, 2nd Floor * New York, NY * 10001-5004 * USA

Tel: +1-212-655-3762

Mobile: +1-917-331-9077

Fax: +1-212-679-7016

E-mail: rachel.cohen@...

http://www.doctorswithoutborders.org/

http://www.accessmed-msf.org/