The Plague Years

In 1991, a visitor to rural Uganda could peer through the portals of hell and glimpse the holocaust to come. It took a little work then. You had to hire a Jeep and drive from the capital of Kampala to the Rakai district in the south of the country, then the epicenter for a burgeoning AIDS epidemic. There you'd enter a world of private horrors. A skeletal man with festering abscesses on his skin, hidden away in a shack only slightly larger than an outhouse that reeked of sickness. A spindly grandmother who had lost all of her four sons and four daughters-in-law to "slim disease" and was caring for 20 grandchildren in a house without electricity or running water. An HIV-infected child, in the lap of his dying mother, antidiarrheal medicine mixing with tears on a small face that had no power to grasp the scale of the tragedy building around and within him.

The warnings were as clear as the terror in that 3-year-old's eyes. A UNICEF-sponsored study at the time predicted that in 10 hard-hit countries of sub-Saharan Africa, up to 5.5 million children under 15 would lose their mothers to AIDS during the 1990s. Rakai, the experts warned, would become a perverse model for communities across Africa. Millions would perish in a plague of medieval proportions. Now that the decade is over, it seems the warnings were somewhat mistaken. A full-blown crisis is upon us, and it's worse than expected.

The global death toll from AIDS was 2.6 million last year alone. Roughly 85 percent of those deaths occurred in Africa. Even as the corpses were buried, some 5.6 million more people--mostly African--became infected with HIV during 1999. Although AIDS is viewed as a tragedy that people often bring on themselves, many of the victims of the pandemic have done nothing more harmful than enter the world. By the end of this year an astonishing 10.4 million African children under 15 will have lost their mothers or both parents to AIDS--90 percent of the global total of AIDS orphans.

In a continent already ravaged by wars and mired in poverty, AIDS is wiping out much of a generation. Families are being destroyed, skilled workers cut down. The disease began in Africa and spread, in part, because of social instability--via migrant workers, refugees and women who had few other means to support themselves than prostitution. Cultural factors also played a role: superstitions spread in some areas that the best cure for an HIV-infected man was to sleep with a virgin. Now the disease sows further instability that, in turn, ensures the kind of desperate conditions where AIDS flourishes.

For the rest of the world, this may seem to be a purely humanitarian tragedy. But as AIDS wrecks Africa's already crippled political and social institutions, instability on the continent may demand more intervention from the outside than medicines and educational programs. "The spread of this disease could not be contained in Africa, and the destruction of Africa from AIDS will not be limited to the continent," says U.N. Ambassador Richard Holbrooke. "If we don't work with the Africans themselves to address these problems... we will have to deal with them later when they will get more dangerous and more expensive."

Today we argue over past atrocities, hoping to draw lessons. Could Roosevelt or others have done more to save 6 million Jews from extermination during World War II by absorbing European refugees or bombing the railways to Auschwitz? Yet we face a new holocaust now--of a very different character, yes, but on an even larger scale of human destruction. While, for example, life expectancy in the United States jumped by 30 years over the last century, in southern Africa, life expectancy at birth is projected to plunge. A recent U.N. report forecasts that expected life spans in the region will drop from 59 years in the early 1990s to just 45 by 2010. Yet precious little is being done to stop the disease.

That may be about to change. There is new urgency: this week, with the United States taking its turn to chair the United Nations Security Council, the first topic on the agenda is AIDS in Africa. Beyond putting the issue on the world's radar screen, new government money will be pledged to combat the disease. Bill Gates's philanthropic foundation has committed $28 million--a small amount compared with the billions that experts say is needed, but a help--to vaccine development and AIDS prevention. In recent months The Boston Globe and Village Voice have published searing, multipart accounts of the tragedy. And in Boston, an outspoken preacher named Eugene Rivers is challenging American blacks to do more and speak out forcefully in this election year.

Why the upswell of interest after more than a decade of relative apathy? First, dire warnings have become hard reality. It's axiomatic that predictions of humanitarian tragedy--like forecasts of famines--rarely compel the world toward mass action. It's only when catastrophe hits that people get energized. Scenes on the ground in much of Africa these days are more graphic than any charts or tables could suggest: lines outside cemeteries as families wait to bury their dead; morgues that operate 24 hours a day, seven days a week. "The number of people who have gone into the coffin-making business--that is something you can see without being an epidemiologist," says Godfrey Sikipa, a program-development officer for Geneva-based UNAIDS, the lead U.N. agency dealing with the epidemic.

Some prominent visitors to Africa have returned to the United States with an overwhelming sense of mission. Rivers's epiphany occurred in December 1998, when he was in Zimbabwe to lecture the World Council of Churches on youth outreach and crime prevention in the United States. A Roman Catholic activist named Michael Auret took Rivers aside during the meeting. "I am appealing to you as a Christian, in an appeal rooted in faith," Auret told Rivers. The message: alert Americans to the destruction of a continent. "The mandate was to plead the cause of the widow and the orphan," Rivers recalls, quoting the prophet Isaiah's exhortation to "defend the cause of the fatherless."

Rivers--relentless and media-savvy--soon launched a minicrusade. He lobbied newspaper editors and approached black leaders in Washington and Boston about the crisis. To his surprise, many were unaware of its scope. Rivers believes that even some of those in the black elite who do grasp the situation may worry that highlighting AIDS in Africa reinforces negative stereotypes. "As I talked to folks around the country," Rivers says, "there was a sense that we can't handle another story about blacks as basket cases." He and other activists later issued an open letter to U.S. black religious, intellectual and political leaders castigating them for doing too little: "What verdict will our descendants render upon their ancestors who stood by silently as a generation of African children were reduced to a biological underclass by this sexual holocaust?" the letter asked.

Ambassador Holbrooke had a revelation of his own during a visit to Africa last month. He had been well briefed on the African AIDS crisis, but, Holbrooke says, "the trip gave it the reality of faces, lives, people lying there dying, orphans who had no place at night to go except on the street, people who were scared to death to be tested." He traveled with his wife, the journalist Kati Marton, who says both she and her husband "got religion" on the issue during meetings with AIDS sufferers. Shortly after Holbrooke returned, he put African AIDS at the top of his agenda for the Security Council session he'd chair in January--despite the fact that the Council had never before dealt with a health issue. The ambassador also invited Vice President Al Gore to open the session--the highest-level politician ever to do so--and asked a host of other big names, including World Bank president James Wolfensohn, to help attract attention to the cause.

NEWSWEEK has learned that the administration's new Africa aid proposal was originally planned as part of Clinton's Jan. 27 State of the Union speech. But the president has made Gore's election a priority and is keenly aware of the veep's need for black and gay support. At Holbrooke's suggestion, Clinton decided that Gore should take up the issue himself at the United Nations "on the grounds it would get more attention," says a senior administration official.

In this election year, political pressure has also been building on the U.S. government and pharmaceutical companies to ensure greater African access to AIDS treatments. Governments in the rich world have long supported the drug companies' claim that they have the exclusive right to license their drugs. But Clinton signaled a policy shift at the recent World Trade Organization summit in Seattle, announcing that the United States would now exercise "flexibility" on the issue. Now, NEWSWEEK has learned, activists in South Africa plan to test Washington by importing pirated drugs from Thailand.

Drug treatments, however, will not solve this crisis. That's particularly true in Africa, where the health-care infrastructure is so feeble. Africans say they need more substantial help--particularly relief from crippling debt that drains health and education budgets. But no program will be successful unless African leaders get their own priorities right. Not one head of state showed up at the 11th International Conference on AIDS and Sexually Transmitted Diseases held in Lusaka, Zambia, last September. AIDS activists charge that a "conspiracy of silence" has encouraged a climate in which AIDS victims are severely stigmatized. In a much-publicized case in South Africa on World AIDS Day last year, a woman who admitted on television that she was HIV-infected was beaten to death by neighbors in her township.

Some African leaders are finally getting religion themselves. Others have long had it. Nelson Mandela has been very outspoken on the AIDS threat; his successor, Thabo Mbeki, plans to announce this week a new Five Year Plan to combat the epidemic. Ugandan President Yoweri Museveni was a global pioneer on the issue: early on in the pandemic, he waged a prolonged campaign of public education, condom distribution, voluntary testing, counseling and support services. The policy has paid off: HIV infection has dropped from 15 percent of the population to 9.7 percent.

Yet Uganda also has the highest number of AIDS orphans in the world--1.1 million in all. The danger now is that with so many desperate kids, the good that has been done might actually be undone. Destitute girls may turn to prostitution to survive, unconnected young boys could turn violent. In the Rakai district--where the cycle of death and destruction all began--32 percent of children 15 and under are orphaned: 75,000 kids in all. The signs, of course, were there a decade ago. But now, more than ever, nobody has an excuse for apathy.

The Plague Years | News