An African Solution
Stephanie Nolen's book shows how AIDS is affecting Africans in their everyday lives, and gives us some idea of the form Epstein's social movement might take. Nolen presents brief profiles of twenty-eight people, a number she chose because 28 million Africans are estimated to be living with HIV. A South Africa-based correspondent for the Toronto Globe and Mail, Nolen has traveled widely around the continent, interviewing everyone from Nelson Mandela to shantytown prostitutes. She is an evocative and empathetic writer, and her journalism doesn't succumb to the affliction of so much other writing about Africa, the tendency to reduce people to categories that fit the reader's, and the author's, preconceptions: corrupt or honest, victim or killer, sinner or saint. When Nolen rides shotgun with an HIV-positive long-haul trucker who claims to have bedded 100,000 women, she doesn't condemn him to her readers; she just lets him tell his tale.
The people introduced here give one a sense of the breadth of the epidemic. They're not exactly representative, though; a more descriptive title for Nolen's book might have been The Exceptions. All of the people she interviews meet two conditions: First, they're alive, and second, they're willing to talk frankly about AIDS, which in Africa is unusual. "Stigma is one of the most used words in the AIDS pandemic, a two-syllable shorthand for the shame and fear that cling to this disease," Nolen writes. There is "a particular distaste saved for those diseases where the sick are viewed as the authors of their own misfortune, and a particular shame that comes with a disease most often transmitted by sex."
Consequently, Nolen's profile subjects are largely a self-selected group. Many are HIV-positive people who have started advocacy groups, or who work for Western nongovernmental organizations. You get the feeling you might run into a couple of them crossing the lobby of the Nairobi Hilton the next time the UN holds an AIDS conference there. But Nolen is such a gifted writer that her book transcends its limitations. To read the stories of Malawi's Alice Kadzanja, a nurse who contracted HIV from her husband, a philandering college administrator; or Zimbabwe's Prisca Mhlolo, who lost her husband and her daughter and was shunned by her family because AIDS "was a disease for prostitutes"; or Uganda's Gideon Byamugisha, an Anglican priest who admits he "did some good things...and failed in some" in relating how he passed HIV on to his late wife, is to see Helen Epstein's thesis about concurrency brought to life. The book's finest moments, however, are the ones that take Nolen by surprise: An AIDS counselor she knows in Zambia tests positive; a little girl she met in Johannesburg dies. When her dreadlocked artist friend Thokozani, who's told her he always uses condoms, finds out he has the virus, she reflects:
At first I used to marvel at it--at why people have gone on making such choices in defiance of what might seem like the most basic survival instinct. But in talking to [Thokozani], I realized that it's not, in the end, so hard to understand. Infection rates are much higher here than in, say, Canada and France, but the variables that go into decisions about love and sex and intimacy, those are no different here. People have sex without condoms because it feels good to say you trust someone that much--or because there is a particular pleasure that comes in taking risks. Or, my friend points out, just because it feels nice. We all do things we know we shouldn't--especially when we're in love, or filled with lust, or lonely.
As it happens, Epstein believes that recognizing human nature was the key to Uganda's early success in bringing the HIV infection rate under control. She contrasts contemporary South Africa, with its culture of denial that extends up to the president, with Uganda in the early 1990s. Back then, every Ugandan was talking about AIDS: the president, newspaper columnists, taxicab drivers. People started support organizations, and churches got involved. The most successful program, Epstein argues, was a local initiative called Zero Grazing (Ugandans favor cattle metaphors). "Zero Grazing was a compromise," she writes, "and its real message was this: 'Try to stick to one partner, but if you have to keep your long-term mistresses, concubines and extra wives, at least avoid short-term casual encounters with bar girls and prostitutes.'"
At the same time, the AIDS crisis also galvanized Uganda's women's rights movement. In Africa, many women are stuck in "transactional" relationships with men, relying on their money and lacking power to demand faithfulness. In the early 1990s, "women were being urged to keep their daughters in school, start small businesses, and challenge laws and practices that discriminated against women," Epstein writes. The activists also used the Zero Grazing campaign as ammunition to confront men about their behavior: "In bars and discos that were once mobbed with men and single women, men now sat drinking among themselves." The number of people reporting casual sexual partners dropped. This "partner reduction" strategy worked, Epstein says, because such casual encounters served as "on-ramps" through which HIV entered concurrent-relationship networks.
If Zero Grazing was as successful as Epstein says, you'd think international organizations would have paid to reproduce the campaign all over the continent. But they didn't--for reasons that are once again more about our preconceptions than Africa's needs. On the one hand, Western conservatives couldn't stomach a program that countenanced polygamy. On the other--and Epstein doesn't explicitly make this connection--the early 1990s coincided with a huge homegrown evangelical revival in Uganda, and many of the loudest women's rights activists were also born-again Christians. This association made many Western liberals--the type who work for organizations like the UN--quite uncomfortable. "There was a sense that promoting fidelity must be totally wrong if it was a message favored by the Christian Right," the former head of one humanitarian group told Epstein.
Near the end of her book, Epstein notes with some sadness that Zero Grazing is now a museum piece. These days, Uganda's approach to AIDS is ruled by pieties--both religious and secular. The locally devised programs of fifteen years ago have been replaced by a bland package of somewhat conflicting strategies known by the acronym ABC: abstain, be faithful, use a condom. The Bush Administration and the evangelicals push A, the public health community stresses C and no one pays much attention to B, because there's no money in nuance. Meanwhile, on the strength of its "miracle," Uganda has become an AIDS pilgrimage spot. "The big hotels in the capital play host to a perpetual round of AIDS-related conferences and workshops, and the streets are jammed with the vehicles of AIDS NGOs," Epstein writes.
The influx of money has brought profiteers, both white and black. A recent investigation revealed massive corruption in the Ugandan Health Ministry's administration of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. That's just the beginning of the graft. And yet for all the many millions flowing in, HIV prevalence rates have not fallen much since the year 2000. Men aren't sitting alone at bars anymore, and statistics suggest that casual sex may once again be on the rise. For a fleeting moment, in a time of unimaginable tragedy, Ugandans found it within themselves to fight this epidemic. But AIDS has a way outlasting vigilance. It's a disease of human fallibility, and for that there is no cure.