by Robert Guest
All these encounters sadden me. When an African woman offers to sleep with me for money, I know I am talking to someone who will probably be dead in a few years. Most African prostitutes contract the human immuno-deficiency virus (HIV), which leads to AIDS. They die emaciated and ravaged by fungal infections, and they take many of their clients with them.
In rich countries, AIDS is no longer a death sentence. Costly drug cocktails can keep HIV-positive patients alive and healthy for a long time. After being bombarded with warnings in the 1980s, most Westerners know how the disease is transmitted and are fairly cautious about swapping body fluids. HIV prevalence is low throughout the developed world, and only a handful of people actually die of it.
In most African countries, by contrast, only tycoons and cabinet ministers can afford AIDS drugs. By 2002, about 17 million Africans had died of AIDS, and 29 million were HIV positive.1 Pause for a moment to ponder it: 46 million Africans either dead or doomed. It’s more than seven times the number of Jews, Gypsies, and homosexuals murdered by Hitler. It’s one and a half times the 30 million Chinese who died of starvation under Mao Zedong.2 It’s three quarters of the death toll during the whole of the Second World War, and by the time AIDS has claimed its last African victim, it may outnumber even that.
In several countries in southern and eastern Africa, a fifth or more of adults carry the virus. That does not mean that a fifth of the population of these countries will die of AIDS. It is worse than that. Almost all those who are now infected will die in the next ten years, but before they die they will infect others. In Botswana, the worst-hit nation, more than a third of adults carry the virus. The president of Botswana, Festus Mogae, lamented in 2001 that unless the epidemic was reversed, his country faced “blank extinction.”3 He was not exaggerating.
Nowhere has the AIDS epidemic run its course, so any predictions about its long-term effects are speculative. But even on the most optimistic assumptions, Africa faces an unprecedented catastrophe. Everywhere I travel south of the Sahara, I see signs of the silent havoc wrought by AIDS. I have visited hospitals where virtually every bed was occupied by an AIDS patient, some so thin that their skin sagged and their arms looked like broken broom handles. I have flipped through the obituary columns in dozens of African newspapers: all are filled with photos of young faces: thirty- and forty-year-olds who died “after a long illness.” I have visited schools that lack teachers because of AIDS and companies whose managers have started to limit the number of funerals employees may take time off to attend.
When my wife and I lived in South Africa, our housekeeper’s boyfriend, a long-distance taxi driver, grew thin and died. The doctor wrote “tuberculosis” on the death certificate, which was accurate enough, but probably only part of the story.
Why is this happening? Why has Africa suffered so much more than anywhere else from AIDS? What can be done to curb the epidemic? I’ve spent years pondering these questions. I still don’t know the answers, but I’ve found some clues. I’ve spoken to doctors, to charity workers, and to politicians. I’ve swapped stories with my wife, a former charity worker, who has written a book about AIDS orphans. While researching it, she used to come home from visits to orphanages with her clothes flecked with tears and spit where dozens of lonely children had clung to her.
In 1998, I went to Uganda, where a taxi driver inadvertently helped me frame the question. His name was Charles, and he drove me along the unlit road from Entebbe airport to Kampala, the capital, after dark. Long-horned cattle blundered onto the asphalt, but we could not see them until the headlights bounced off their eyes. Cars coming in the other direction sometimes had no lights at all. But Charles hit the gas pedal and swerved when necessary. He coaxed more speed out of an old Toyota than I would have thought possible. He overtook on blind corners. I looked the other way.
As we drove, he told me his life story. He had lost his mother, his father, two brothers, and their wives to AIDS. Everyone in his family knew how the virus was transmitted and that it was deadly. But they still failed to take precautions. And the thought struck me, as we sped and weaved through the dimly visible traffic. Anyone who wants to curb the devastation that AIDS is wreaking in Africa must answer this: how do you promote safer sex on a continent where no one wears a seat belt?
We Westerners have grown accustomed to caution. We wear crash helmets when we cycle, we expect our governments to ensure that every last molecule of any chemical that even sounds scary is removed from our tap water, and we buy bags of nuts with the words “Warning: contains nuts” on the packet. All this is quite recent. Our great-grandparents did not expect all their children to survive to adulthood. Premature death doubtless upset them as much as it upsets us, but it did not surprise or anger them so much. It was too common for that.
In this respect, Africa resembles Europe at the turn of the twentieth century. Poverty fosters a kind of fatalism. Life is hard when you are poor and death could come at any time. Malarial mosquitoes swarm at night, but you can’t afford mefloquine. You take the cheapest, most crowded minibus to work, which is cheap because it’s old and the brakes are dodgy.
You take things one day at a time and seize passing pleasures when you can.
How the virus spreads
Most scientists think that HIV originated in the rainforests of central Africa in the 1920s or 30s and then eventually spread around the world. Some Africans are insulted by the assertion that AIDS began in Africa and feel that they are somehow being blamed for the disease. They are not. A deadly virus evolved and jumped from apes to humans, perhaps when a woman with a cut on her finger prepared chimp meat for the pot. No one could have foreseen this, and no reasonable person could believe that it was anyone’s fault. The question of exactly when and how HIV first found its way into a human bloodstream is of great scientific interest. But of more immediate concern for anyone interested in keeping the death toll down is the question of how it spreads today.
Unlike in the West, HIV in Africa is contracted mainly through heterosexual sex. Men and women infect each other when they make love without condoms. The virus then travels from town to town along the old colonial highways, in crowded minibuses and lorries. Its staging posts are bus stations and truck stops, where travelers meet locals and the virus finds new hosts.
I visited a truck stop at Beitbridge, on the border between Zimbabwe and South Africa. It was hot and dusty, and there was not much to do. A little kiosk sold cold Cokes and beef jerky, but that was about it. Truck drivers waiting to cross the border parked their eighteen-wheelers on any vacant patch of dirt and opened cans of Castle beer. As dusk fell, they sat in their cabs, watching a parade of young women in tight tops saunter by. When they saw one they liked, they called out to her.
“Sister, come and cook for me,” was the most common come-on. It was meant literally. Cooking was part of the package. Every trucker had a pot, a stove, and a chicken or some fish in a plastic bag. For a few rand, a truck-stop prostitute would cook a tasty stew with whatever ingredients the trucker had on his dashboard. And then they drew the curtains across the windscreen.
“I fuck thirty bitches a month,” boasted John Masara, a twenty-nine-year-old trucker. He slammed his fist into the palm of his left hand to emphasize the point. He was wiry and strong, with a thin gauze of facial hair and enough beer in his bloodstream to loosen his tongue. Fucking was the only entertainment in Beitbridge, he explained. It could take a week to process the paperwork required to move a load over the border. Rumor had it that customs officials owned shares in local hotels. Most truckers shunned hotels, however. It was cheaper to sleep where they parked or to pay a prostitute for a share of her mattress.
Did Masara know about AIDS? Sure, he said, a colleague died of it two days before. He knew how the virus spread, too. “You get it from women.” He knew how to protect himself too, but did he use condoms? “Sometimes,” he said. His friends laughed: “When you’re not drunk.”
He ignored them and said that he “con
domized” with most women but not the most beautiful ones. A trucker’s life is dangerous, he explained. He’d been hijacked by men with guns. Any day, he said, he could fall asleep at the wheel and die in a ditch. But the job paid well by local standards, so he had some spare cash. He figured he might as well have some fun while he could.
His relaxed attitude to risk extended to his two wives, whom he said he saw about once a month. They didn’t ask him to use condoms, so he didn’t. “There’s nothing I can do about it.” He shrugged. “I’m a trucker.”
Masara’s wives probably didn’t know how much danger they were in. Most of the prostitutes he slept with, by contrast, understood the risks but carried on as if they didn’t.
Chipo Muchero, for example, who sold sex on the Zimbabwean side of the border at Beitbridge, insisted that “if a client won’t use a condom, then I refuse sex.” But she was lying.
Her black hair was bleached yellow at the front. Her denim dungarees were cut off above the knee, to expose bruised calves. She was suspicious of questions but had nothing better to do than answer them. Business was slow: there were too many women in the same line of work in the crowded slum where she lived and not enough clients to keep them busy.
Muchero hung out with half a dozen other women of varying ages outside a dark, one-roomed house with mud-brick walls. There was no sign outside to indicate that it was a makeshift brothel. It was no different from hundreds of neighboring homes: mostly mud and wood, occasionally reinforced or waterproofed with sheets of corrugated iron or black plastic. Dirty water ran past in an open ditch. Children dashed around playfully shrieking, while their mothers built fires or scrubbed clothes.
Muchero and her friends all did other kinds of work, too. They fetched water and firewood, sewed and cooked, and tended small patches of corn. But no one paid them for any of this. To earn cash, they brought men home. Inside the house, blankets hanging from the ceiling subdivided the room and created a bit of privacy.
After a while, Muchero admitted: “OK, I’ll have sex with any man – trucker, tourist, or local guy – with or without a condom. I need the money. I don’t have a job or education. I have no other option.”4
If she had a passport, she said, she would cross into South Africa and trade things other than her body. She knew others who had done this. South African shops are cheaper and better-stocked than those in Zimbabwe, so there is money to be made buying toasters and televisions on the South African side and bringing them home to sell. One store in Messina, the nearest sizeable South African town, had a big red sign outside proclaiming that “Zimbabweans and hawkers are welcome for one-stop shopping.”
But Muchero could not afford a passport. To get by, she entertained about four clients a week. The price was fixed by haggling; she usually made between one and two dollars per trick. Eventually, her job was bound to kill her. But in the short term she could think of no other way to support herself.
How AIDS keeps Africa poor
After the Black Death wiped out a third of the population of medieval Europe, many of the survivors were better off. Because so many died there was a sudden labor shortage, and landowners were forced to pay their workers better.
Africans who survive AIDS will not be so lucky. AIDS takes longer to kill than the plague did, so the cost of caring for the sick will be much greater. Modern governments, unlike medieval ones, tax the healthy to help look after the ailing, so the burden of AIDS will fall on everyone. And because AIDS is sexually transmitted, it tends to hit people in their most productive years.
AIDS is making Africans poorer. But since the epidemic has not yet run its course anywhere, any prediction as to how much poorer it will make them involves a lot of guesswork. For what it’s worth, researchers at ING Baring, a bank, forecast that the South African economy will be 17 percent smaller in 2010 than it would have been without the virus. They could be wrong. But there is no doubt that AIDS will make a lot of things worse.
Africa’s already painful skills shortage will grow more acute. Skilled workers who die will be hard to replace, not least because so many teachers are dying too. Zambia is suffering power shortages because so many engineers have succumbed. Farmers in Zimbabwe are finding it hard to irrigate their fields because the brass fittings on their water pipes have been stolen for coffin handles. All over Africa, AIDS is making employees sicker and therefore more expensive and less productive. Costly and unproductive employees tend to get sacked.
At a national level, the effect of AIDS is felt gradually. But at a household level, the impact is sudden and catastrophic. When a breadwinner falls ill, his (or her) family is impoverished twice over. Their main source of income vanishes, and they must somehow find extra money for medicine. Daughters drop out of school to help nurse their ailing fathers. Because husbands infect wives and wives infect babies, AIDS often strikes several times in the same family.
A study in urban Côte d’Ivoire found that households afflicted by AIDS subsequently spent only half as much on education. Family members ate two-fifths less and were forced to spend four times as much on health care. Another survey in Tanzania found that a woman whose husband was sick with AIDS spent 60 percent less time growing food than before. And in Zimbabwe the disease so weakened peasant farmers that the ones tilling communal land produced half as much in 1998 as they had five years previously.
Orphans of the virus
I went to Ndola, in the copper-mining region of northern Zambia, where I had heard that the virus was wreaking particular havoc. The local cemeteries bore grim witness to the truth of this rumor. It wasn’t just that they were so huge or that so many of the headstones were new. What struck me was how unkempt the places were. There was a shortage of survivors, I was told, with the energy to tend the graves. Those whom the virus missed were often too busy battling hunger to waste time and burn calories hacking back the long grass that had swallowed their relatives’ tombs. Many graves were lost in the undergrowth. And some had been dug up: local thieves were so desperate, a local charity worker told me, that they stripped fresh corpses of the smart suits in which they were buried.
AIDS is wiping out whole families: the Zambian health ministry estimated that half of Zambia’s population would eventually die of it. Those who die are mostly breadwinners or mothers. Estimates of the proportion of Zambian children who have lost one or both parents (usually, but not always, from AIDS) range from 13 percent to 50 percent.5 If the difference between these two numbers seems absurdly large, remember that accurate statistics are rare in countries as poor as Zambia. Personally, I don’t believe that the higher figure can be true. But even at the lowest estimate Zambian children are a dozen times more likely to be orphaned than children in rich countries.
It is not only children who are hit. Elderly Africans usually expect their adult children to look after them in their twilight years. But because AIDS is causing many middle-aged people to die before their parents, the elderly are being “orphaned” at an alarming rate. Not only do they lose their main means of support, but they suddenly find themselves caring for their orphaned grandchildren as well.
I met one such elderly orphan in a “compound” (shanty town) near Ndola. Faides Zulu, a small and slender grandmother with gentle eyes, was old enough to have no idea when she was born. We spoke, through an interpreter, sitting on a rush mat on a concrete floor in a schoolhouse, where she came about once a month to receive a bag of corn from a local Catholic charity. Both her daughter and her daughter’s husband died in the same year “after being sick for a long time,” leaving her to look after five small children.
Faides Zulu’s “second motherhood” was not easy, she said. She grew vegetables in her backyard and then walked several miles on frail legs to sell them. One child was often ill, with bloody diarrhea, fever, and headaches. She preferred not to talk about the likelihood that this child had contracted HIV from his mother, either during birth or while breastfeeding.
Zulu fretted about the future. “I am old,” s
he said. “In ten years’ time I will not be able to work in my garden. What will happen to my children then?” Probably, she guessed, her eldest granddaughter would land the responsibility of looking after her younger siblings.
In 2002, there were an estimated 11 million AIDS orphans living in Africa. Extended families have adapted heroically to the crisis. In Zambia, one study, conducted in the parts of the country worst hit by AIDS, found that 72 percent of households had taken in one or more orphans.6 The national average is probably lower than this, but there is no doubt that such generosity is common.
Throughout Africa, families have opened their arms and homes to orphaned siblings and nephews. No matter how poor they are, they have welcomed them without hesitation, fuss, or a hint of resentment. There are millions of Faides Zulus, most of whom show a warm selflessness that leaves me stunned with admiration.
AIDS has put these families under a huge strain, of course. Extra mouths mean less food to go around, so many fostered children are made to work for their keep. The unluckiest can slip through the family safety net entirely. For example, if a mother dies of AIDS, her relatives sometimes wrongly assume that her baby too is doomed and so don’t waste scarce food delaying the inevitable.7 For the most part, however, Africans have lavished their orphaned kin with love and pumpkin-leaf stew. Not even AIDS can break the African extended family.
