The New York Review Abroad (56 page)

4.

AIDS threatens African development because it kills and disables adults of working age and leaves children without parents. Societies lose teachers, doctors, bureaucrats, soldiers, businessmen, and other workers, and the rest of the world loses consumers. But AIDS is as much a symptom of social crises as it is a cause of them. Rural poverty, corruption, political mischief, human rights abuses, and a pointless war are reviving tensions that linger from Uganda’s brutal past and could contribute to further spread of HIV. There are already signs of increased insecurity. Kampala is still one of the safest cities in Africa, but there are reports that violent crime rates have risen in recent years, after a long decline since 1986, and I heard people talk casually about crime in a way they did not before. During the past few years, Kampala has been hit by a spate of bomb attacks and eight students at Makerere University have been murdered, but the killer has never been found. There are stories in the newspaper about
traditional healers kidnapping and sacrificing children, because chickens and goats no longer do the trick. There are also many accounts of domestic violence, which remains an endemic problem.

Recently the UN, a group of concerned Harvard academics, and other advocacy groups have been campaigning for an AIDS fund for developing countries that, they hope, will amount to up to $10 billion per year. There is considerable debate about how this money should be spent, if it actually materializes. Lack of AIDS treatment and inadequate funding for prevention programs in Africa are increasingly seen as grave injustices. However, injustice itself, and the many forms it takes in Africa, are a fundamental cause of the growth of the epidemic, and unless that changes, even the most well designed prevention programs may not make much headway.

In the meantime, thousands of Ugandans are dying every year from AIDS, and there is a desperate need for better treatment. But that is not all they need. In April I accompanied a nurse from the charity Hospice Uganda on a visit to a woman who was dying at home, in a village outside of Kampala. In the small, dark room, the patient’s skeletal outline was barely perceptible among the wrinkles in the bedcovers. Sun shone through holes in the iron roof, so that the patient got soaked when it rained. “We would fix it if we had the money,” the woman’s sister said. Family members gathered in the room and asked the nurse questions as she dispensed antibiotics and painkillers. Small children came and went, and one little girl, about four years old, with a bald head and tiny shoulders, stared at me. This was the patient’s daughter. Her uncle, a man of about twenty, leaned over and asked me a question: “The other children go to school, but not this one. She keeps getting sick. What do you think is the matter with her?” I did not have the courage to tell him what he already knew.

There is much explicit information in the newspapers and on the radio in Uganda about how to use a condom, and the feelings, manners, and techniques of romance and sex; but there is far less open discussion about what it is really like to live in a family affected by HIV. There is an odd silence surrounding these people, who now number in the millions, if you include those whose wives, husbands, parents, siblings, or children are HIV-positive.

The family I visited was relatively lucky. The nurse comes once a week. But Uganda needs much better salaries for more people like her, and also for better medications and health centers for the roughly 50 percent of its people who have no access to health care at all.

While I was in Uganda, I learned that these people also need not just health care, but protection from cruel and discriminatory treatment as well. I met a woman named Milly Katana, who runs an organization that monitors AIDS-related discrimination. She explained to me how, in the early days of the epidemic, people used to gossip whenever someone died. People didn’t want to sit next to someone whose children or husband was known to be sick, and schoolchildren would tease classmates whose parents had died. At funerals, rumors would go around: “If that one died, well, so-and-so is next.” But according to Katana, Ugandan communities soon realized that anyone could die from AIDS, and these cruel attitudes are slowly changing. Now, she says, a new form of discrimination is emerging, in businesses, the civil service, and other institutions. President Museveni has made a negative HIV test a requirement for promotion in the army, and the US embassy had a similar policy, but it ceased this month, after journalists accompanying Colin Powell on his recent African tour drew attention to it.

Being HIV-negative is also an unspoken criterion for employment in many businesses. During the past ten years, under Uganda’s World Bank–sponsored reform program, state-owned businesses have been
privatized and government jobs have been cut. As a result, many workers and civil servants have been laid off. According to Katana, workers whose wives, husbands, or children have died, and who are therefore suspected to be HIV-positive—what her HIV activist friends call “the so-called sick”—are usually the first to go.

People may live with HIV for years or even decades without AIDS symptoms, and human rights groups have long argued that HIV infection should be treated like any other “latent” affliction, such as diabetes or high blood pressure. Uganda has no laws against unfair hiring practices based on HIV status, but they are in clear violation of international guidelines established by the UN Commission on Human Rights.
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Before I met Katana, I attended a speech given by President Museveni on the subject of AIDS. Museveni is a large man, with a great bald head like polished brass, and a deep voice that carries very far, like the roar of a lion. In his speech, he told a rather strange story, tracing the origins of the AIDS epidemic in Uganda to the arrival of Europeans in the nineteenth century. Before that, Ugandan society had strict moral codes. For example, if an unmarried girl became pregnant, “the punishment then for the boy and girl was death; the girl would be tied in dry banana leaves, set on fire, and rolled down a cliff, and the boy speared. But when the Europeans and Christians came they said it was barbaric, and put a stop to it. So the tribal regime broke down into a permissive society.”

Press reports provide further insights into the President’s attitude toward people with HIV. For more than a decade, rebels based in
Sudan have launched attacks on villages and towns in northern Uganda. More recently they have been abducting Ugandan children and forcing them to join their armies, or in the case of girls, to work as slaves. The parents of 12,000 of these children have been complaining that the Ugandan government has not been doing enough to get their children back. Museveni has responded by saying that these children were by now HIV-positive anyway, so they were “no longer an issue.”
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Shortly before polling day in March 2001, Museveni told an American journalist that his main opponent, Kizza Besigye, had AIDS.
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Later he repeated his remarks to the Ugandan press. “State House is not a place for invalids,” Museveni said. In the court case challenging the election results, Besigye denied that he had AIDS, and claimed that Museveni was spreading false rumors to dissuade voters from supporting him. But Museveni’s lawyers argued that since Besigye’s first wife and child had died in the early 1990s, it was fair to assume that he had AIDS. AIDS support groups in Uganda have claimed that Museveni’s statements were an outrageous and cynical attempt to use the stigma surrounding HIV to further his campaign, and to promote discrimination against people whose lives have been affected by AIDS.

In Uganda, the loyalty and strength of Ugandan families and the perseverance of HIV prevention workers and AIDS treatment advocates are continually undermined by war, corruption, and injustice. HIV struck Europe and the US just as gay men were organizing to confront discrimination against them, and the struggle against AIDS became part of the greater struggle for gay rights. By and large, the
people of sub-Saharan Africa have yet to assume their rights. Until the status of women improves, something that is linked to the improvement of rights for all people, regardless of tribe, political connections, or HIV status, the most generous funding for AIDS in Africa will not go nearly far enough.

—July 5, 2001