Black Death: AIDS in Africa

256 Pages·2003·1.01 MB·English

by  Susan Hunter

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Who
Cares?
AIDS in Africa
Susan S. Hunter
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WHOCARES?
© Susan S. Hunter, 2003.
All rights reserved. No part of this book may be used or reproduced in
any manner whatsoever without written permission except in the
case of brief quotations embodied in critical articles or reviews.
First published 2003 by
PALGRAVE MACMILLAN™
175 Fifth Avenue, New York, N.Y. 10010 and
Houndmills, Basingstoke, Hampshire, England RG21 6XS.
Companies and representatives throughout the world.
PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan
division of St. Martin’s Press, LLC and of Palgrave Macmillan Ltd. Macmillan® is a
registered trademark in the United States, United Kingdom and other countries.
Palgrave is a registered trademark in the European Union and other countries.
ISBN 1–4039–3615–3 paperback
Library of Congress Cataloging-in-Publication Data
Hunter, Susan S.
Who cares?: AIDS in Africa/by Susan Hunter.
p. cm.
Includes bibliographical references and index.
ISBN 1–4039–3615–3
AIDS (Disease)––Africa. I. Title.
RA643.86.A35H86 2003
362.1(cid:2)969792(cid:2)0096––dc22 2003055378
A catalogue record for this book is available from the British Library.
Design by Newgen Imaging systems (P) Ltd.
First edition: November 2003
10 9 8 7 6 5 4 3 2 1
Printed in the United States of America.
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Contents
Preface v
CHAPTER ONE
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
CHAPTER TWO
AIDS and the World . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
CHAPTER THREE
Africa’s Political and Economic Development . . . . . . . . . . . . . 49
CHAPTER FOUR
Epidemic Rules, Part I: Causes and Conditions . . . . . . . . . . . 77
CHAPTER FIVE
Epidemic Rules, Part II: Internal Dynamics of Epidemics . . . 107
CHAPTER SIX
SexuallyTransmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . 147
CHAPTER SEVEN
Disease and Evolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
CHAPTER EIGHT
Evolution and Epidemic Management . . . . . . . . . . . . . . . . . . 205
NOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
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Preface
Many of my preliminary readers have said that they couldn’t put this book
down, that it reads like a novel, and that they loved the stories of Darwin and
the courageous, unstoppable women in Africa who are committing small acts
of heroism and kindness every day. If this book has one success, the one I
wish for most is that it opens your heart to their struggle. It is for them that
I undertook to write this book. In the distance I will always see them, the liv-
ing heroes and the dead. In the fourteen years since I worked with the real
“Molly,” “Pauline,” and “Robina” in Uganda, I have had the privilege of
working with hundreds of other incredibly courageous people who are
fighting this epidemic in Africa, Asia, Europe, the Caribbean, and the
United States. Some are internationally known; hundreds more contribute to
their countries, regions, or villages. Big or little, I have seen them perform
miracles. Thank God for that.
My editor, Ella Pearce, is a bubbly, intense, articulate New York intellec-
tual in her mid-twenties, who seems to waste no breath or motion. On our
first meeting in the city, in February 2001, I got whiplash chasing her down
the stairs of the Flatiron Building and across the street to the café where she
informed me “all the editors take their writers.” I almost choked when she
said that, and I soon learned that Ella, flush with triumph after the publica-
tion of Peter Schwab’sAfrica: A Continent Self-Destructs,wanted me to write
a layperson’s book about HIV/AIDS in Africa. With her coaching,
I submitted a proposal and spent close to eight months pulling together
material on the book’s many themes. A busy consulting schedule kept me
from completing the first and very rough draft until January 2003. With
Ella’s help, the manuscript went through another four revisions. Talk about
learning how to write! Thanks, Ella! It is a mark of her love for her writers
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vi PREFACE
that I never felt hassled, hurried, or browbeaten, a miracle considering how
late I was with the initial manuscript.
The next person who deserves my undying gratitude is my friend, Gail
Stern, who took on the task of editing my first book, Reshaping Societies:
HIV/AIDS and Social Change,and as if that wasn’t enough, muscled through
the first and second versions of this book, giving me ideas and encourage-
ment. It takes a very brave person to read through a rough draft. Thanks,
Gail! The only other person brave enough to do that was Ella’s Mom.
Hopefully someday she’ll meet my mother, Blanche Sefton, who read
through a later version. The comments of my sisters, Margaret Bellucci and
Joyce Devine, who read and commented on the final edit, were invaluable.
The staff at Crandall library in Glens Falls, New York, were unflagging in
their good cheer as they responded to one request after another. Thanks! And
infinite thanks are due to Barbara Glaser, long-time friend and fellow board
member of the Foundation for Hospices in Sub-Saharan Africa, who has
stimulated my thinking, stood by my side, and pulled me out of a number
of jams over the past many years. However, the fortitude of my dearest friend
and husband Arlin Greene––whose specialty for more than twenty years has
been jam-removal––cannot be compared with that of any other living mortal.
Friends and colleagues who were kind enough to read the final draft
included Stephen Lewis, UN Secretary General Kofi Annan’s special envoy
on HIV/AIDS, who has been a sympathetic supporter since I first met him
in 1998; Peter Piot, head of UNAIDS, with whom I’ve shared several podi-
ums and whose encyclopedic knowledge and grasp of the danger of this dis-
ease always leave me stunned; Eric Sawyer, co-founder of ACT-UP and
brilliant conceptualizer of the AIDS film, A Closer Walk; and Paul Zeitz,
Executive Director of the Global AIDS Alliance and a tireless activist on the
global AIDS scene who has been crucial in moving the world forward on a
number of critical issues, including debt-for-AIDS relief.
Not everyone will agree with what I say. That is never possible. I only hope
this book will fill a gap in the knowledge base, and that it will provoke
controversy, study, counter arguments, and action. The Black Death that is
AIDS in Africa deserves nothing less.
Lake Luzerne, New York
August 4, 2003
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For my mother, Blanche Wronowski Sefton, whose Polish blood is my
romantic-democratic wellspring.
And for my father, John Richard Sefton (1917 to 1994),
who died while I was in Africa.
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CHAPTER ONE
Introduction
T
he early morning bustle of Kyotera town, in the heart of the Uganda’s
district of Rakai, had already begun. Radios blared, children cried, men called
out to one another on their way to work, but Molly’s warm brown eyes
didn’t snap open until daylight bounced off the rude stucco walls of her room
and hit her chubby face. She was still tired after a restless sleep, but Molly knew
she’d have to hurry this morning. The meeting with UK’s Save the Children
started at nine-thirty, and she had to remind Pauline to clean the reverend’s
shabby suit and make sure he wore his best dress collar before she ran over to
the church hall to check on the lunch. Calvary Women’s Group was cooking
fish and matooke,1rice, and offal for one hundred people, no small job in the
church’s outdoor kitchen. She’d given Pauline the money to buy fish and
banana yesterday, but they’d need plenty of firewood to get the rice boiled in
time. She smiled with satisfaction. Something was finally going to happen.2
Robina Nyeko, the district administrator, had called the district-wide
meeting so she could talk with Rakai’s chiefs and subchiefs about creating
volunteer village committees to look after the orphans, care for AIDS vic-
tims, and help stricken families as much as they could within their own small
means. Parents were too ill to work, families were destitute, and dying was
only a small part of their troubles. What she wouldn’t give, Molly thought,
for a little more help, as she watched these poor children grieve for their lost
parents, abandoned by destitute relatives overloaded by the deaths of too
many sons and daughters, helpless in a bad world. Yesterday she’d come upon
Mrs. Kategera’s five and seven year olds, who suffered through the long death
of their father just last month, crying so hard she thought her heart would
break. They’d worked all day on empty stomachs for the butcher,