A recent World AIDS Day video produced by UNAIDS, the Joint United Nations Program on HIV/AIDS, opens with a scene of a young Ugandan walking through his family's burial grounds. The boy points to one grave after another. He points to his mother. His father. His sisters. His brother. His uncle. AIDS has taken his whole family.
The fear, heartache and despair in the face of this frail 10-year-old is instantly recognizable to anyone who has lost someone to AIDS. But his eyes -- devoid of expression -- speak volumes about something harder for us to identify. It is the familiar suffering of AIDS, yes, but on a scale beyond our capacity to imagine.
The staggering statistics can only hint at the extent of the crisis. Since the epidemic started, an estimated 11.5 million Africans have died of the disease. Today more than 20 million, including millions of children, are living with HIV -- on a continent long plagued by war, drought, famine and grinding poverty.
It is no exaggeration to say that the virus has penetrated everywhere. One of the achievements of the postcolonial period had been to raise the average lifespan by 16 years, from 39 to 55. But from Cairo to Capetown, AIDS has reversed this trend. Now a person in Malawi, where one in every five is infected, can expect to die six months shy of a 30th birthday. The Southern Africa AIDS Dissemination Service estimates that over the next 20 years AIDS will reduce by a quarter the economies of sub-Saharan Africa, where the average annual income is only $500 a year. In Tanzania, where one in every 10 is infected, the labor force is likely to shrink by a fifth by the year 2010.
It's estimated that as many as 90 percent of those who have HIV are not even aware of their infection; many doctors typically choose not to inform HIV positive patients of their status because they have only the most minimal care to offer. Most governments do little beyond the omnipresent AIDS billboards, coping as they are with regional and ethnic conflicts, fragile economies and a host of other deadly diseases, including epidemic levels of malaria and tuberculosis. Fewer than one percent of PWAs can get antiretroviral therapy.
If resources are rare, stigma is rampant. A climate of AIDS prejudice prevails. Many people are hesitant even to be seen at an HIV testing center. Likewise, those who test positive are wary of seeking out treatment at clinics known to provide AIDS care. "To be recognized at such a clinic by a neighbor or relative would almost surely lead to reaction in the community," said Musa Njoki, an openly HIV positive woman in South Africa.
Fear and hatred of the disease explode all too often into violence. In South Africa, a man hacked his wife to death with a machete after finding condoms in her bag. A woman with AIDS was stoned to death by her fellow villagers after she came out publicly on World AIDS Day.
Yet not all the news is bleak. In the Ivory Coast, a private clinic operated by Marc Aguirre, MD, provides drugs for opportunistic infections at minimal cost and offers home care support to the capital's HIV positive population. Clinics like this are cropping up across Africa as alternatives to overburdened government health services. Forced to choose between shame and survival, more and more PWAs are taking their first brave steps to empowerment. And some of them -- such as Mercy Makhalemele, a leading advocate for AIDS awareness at South Africa's National Association of People with AIDS -- are making amazing leaps.
"What we need is ties with groups who have a broader voice that can echo our calls to action to a bigger and more influential audience," she says. Makhalemele travels around Africa and the world sharing her story of living with HIV and urging those who can to speak up, come out. "I do sometimes wonder whether the message about AIDS in Africa gets through to Americans," she says.
It's obvious that AIDS can't be addressed effectively as a single issue in Africa; it is just one of many afflictions. But the immensity and complexity of these problems haven't defeated Africans -- and are no reason for us to turn away, either. With more than 5,000 funerals every day, AIDS is filling up Africa's burial grounds with a fury. In the end, the continent's fate depends on the response -- and, above all, the humanity -- of others, especially those of us in the United States who know something about the suffering of AIDS.