AIDS, Aid, and Africa

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By Ernest W. Lefever

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In sub-saharan Africa an estimated 30 million people have the HIV-AIDS virus. Some 17 million have died so far, and the disease kills 5,000 adults and 1,000 children every day–a rate 20 times that of Western countries. The crisis is especially grievous because it adds millions of victims to those killed by tribal wars and genocide in postcolonial Africa.

To stem the tide of suffering and death, billions of dollars have been given or pledged by the U.S. Government, other wealthy countries, U.N. agencies, and American philanthropists. But the pandemic continues.

The causes of the AIDS-HIV plague in Africa are known, but efforts to prevent transmission, or slow it down, have run into complex problems.

World Bank President Paul Wolfowitz underscored the crisis in sub-Saharan Africa: “Between 1981 and 2002, the number of people living in poverty…nearly doubled, from more than 160 million to more than 300 million.”

Despite this dire picture, there is a gleam of hope. Ironically, it comes from Uganda, a country that had suffered terribly under its late president Aide Amin, who called himself “The Last King of Scotland” and slaughtered millions of his people.

IN 1986, there was some honest news about AIDS–a public acknowledgment that its chief cause in Africa was rampant promiscuity, especially by young males who prey on defenseless girls. Years later, in a Foreign Affairs article (Jan.-Feb. 2004) on “The Politics of AIDS,” Dr. Holly Burkhalter, an AIDS specialist with Physicians for Human Rights, cited evidence of increasing promiscuity in Africa. She quoted Dr. Karl Peltzer of Cape Town, who said the widespread pursuit of young women by older men “has led to a disproportionate number of girls becoming infected. Young girls–some under age 5–are often raped by men, purportedly because of a widespread myth that sex with a virgin can cure or prevent AIDS.” Such assaults have generated “millions of orphans and street children…who are especially vulnerable to rape and to being forced into the commercial sex industry.”

Dr. Burkhalter added: “The predators who sustain the forced-sex trade and child rape industry…should be punished severely,” but this “almost never occurs.” She calls for strategies to fight AIDS transmission by forced prostitution and “voluntary sex.”

During the worsening crisis in the mid-1980s, only one African leader seemed to have read the writing on the wall, President Yoweri Museveni of Uganda. Oddly, his awakening was inspired by a brief conversation about AIDS with Fidel Castro at a 1986 conference in Zimbabwe. Castro told Museveni bluntly: “Hey, brother, you have a problem.”

Back home, Museveni quickly huddled with his doctors to discuss the issue and consulted several Christian medical missionaries who had already addressed the problem. They agreed that the best way to control the HIV virus was to encourage abstinence. Zeroing in on the root cause, Museveni launched a vigorous three-part campaign promoting abstinence before marriage, fidelity in marriage, and, only then, the use of condoms. Museveni put it bluntly to young males: “No grazing!”

He was criticized by other African leaders and Westerners as naive and moralistic, but his campaign reduced the rate of new AIDS cases from 22 percent in 1992 to 7 percent in 2002, winning plaudits from the World Health Organization. In contrast, most African regimes were in denial about the cause of HIV-AIDS. And foreign donors, attentive to unpopular facts, were reluctant to press the issue and focused more on treatment than prevention.

Rock Star Bono urged America to give a $1 billion grant to combat the scourge in Africa. Since then, most money from wealthy countries has gone to easing the pain of those already infected with HIV or those with full-blown AIDS. This emphasis reflects the earlier American approach to dealing with AIDS, when it was politically incorrect to openly address the fundamental cause of the plague–promiscuity, exacerbated by forceable sex with young girls.

Today in Africa, under the pressure of financial aid and Hollywood hoopla, Uganda’s early success in curbing AIDS may be slowing, smothered by ignorance, an unresponsive bureaucracy, and a seemingly endless flow of experimental drugs.

This point is made in a carefully researched article by Craig Timberg of the Washington Post Foreign Service. He writes from Uganda: “Despite [this country's] success story, unmatched elsewhere on this AIDS-ridden continent, no country has entirely replicated Uganda’s approach. Most instead have followed the diffuse palette of other remedies pushed by Western doctors–condom promotion, abstinence training, HIV testing, drug treatment, and stigma reduction–while forgoing what research shows worked here: fear and a relentless focus on fidelity.”

– Ernest W. Lefever, a senior scholar at the Ethics and Public Policy Center in Washington, is author of America’s Imperial Burden.