March/April 2002

AIDS in Africa
The Eve of Destruction

by Elizabeth Farrell

It's 10:00 in the morning, and Mary already has a beer in her hand. Just 18 years old, Mary got the beer as payment from a client at her workplace in Mirerani, Tanzania -- a dingy brothel dubbed "the Mortuary" because of the number of clients and workers who die of AIDS-related diseases.

Living in extreme poverty, Mary has only her body as an "asset," and she sells it to men for a plate of rice, a bottle of beer and a chance to sleep for a while on a bed in the brothel. Mary is not alone; her fellow workers are girls as young as seven.

The town of Mirerani has grown rapidly since 1964, when a shepherd found a shiny stone that birthed the international tanzanite mining industry. Today, thousands of young men from all over Tanzania and neighboring countries come to Mirerani to find fortune, working days at a time underground.

"It is hard work, and dangerous, but there is no other employment for us," says one worker. "We had no money for education back home, so we decided to come here. I had to stop school after primary level because [my] mother and father died when I was 15, and I could not afford to go on with school."

He and thousands of other men come to the mines in the hope of finding enough violet-blue stones to make them rich enough to go home.

They can also become sick enough to die. Medical experts call Mirerani and the surrounding area a "high-transmission area" for HIV, meaning it contains an explosive mixture of social factors that give AIDS a fertile environment in which to spread. The combination of profound poverty, sudden wealth, alcohol abuse, drugs and prostitution is a recipe for disaster -- in this case -- AIDS. Yet most locals are completely unaware of the disease or how it is spread.

HIV/AIDS is now classified as a worldwide "pandemic" -- meaning an epidemic of international proportions. The United Nations uses words such as "devastating," "catastrophic" and "state of emergency."

The international AIDS crisis is so overwhelming that most Christians simply shake their heads when they hear stories about Africans like Mary and move on to more "manageable" disasters (such as nuclear war, stem-cell research or the crisis in the Middle East).

Nail-biting Numbers

It's no wonder that North Americans feel overwhelmed by the AIDS crisis. The numbers are cause for serious nail-biting. Take Africa, for example:

· 25 million Africans have HIV/AIDS (70 percent of the world's cases).

· 12 million Africans have already died of AIDS (one of every five deaths).

· 10 million African children are now orphans because both parents have died of AIDS.

· In some African countries, up to 35 percent of the population is infected with HIV/AIDS.

· In eight African countries, AIDS will claim the lives of a third of today's 15-year-olds.

Until recently, the combined Christian response to this international catastrophe has been far from Christ-like. Does the word "ostrich" paint a picture? How about "judgmental?"

Many Christians in the U.S. would say that AIDS is God's punishment for sin -- homosexuality. But, "AIDS is not just a disease of homosexuals," says Dr. Hector Jalipa, Africa HIV/AIDS advisor for World Vision, a Christian relief and development agency. "AIDS does not discriminate. It's a disease that affects everybody -- children, men and women. Across Africa, more than 8,000 daily die of AIDS."

Sub-Saharan adult HIV infection rate in 1999
country	population	% rate
Eq. Guinea	486,060	.5
Rwanda	7,312,756	1
Angola	10,366,03	3
Gabon	1,221,175	4
D. R. of Congo	53,624,718	5
Congo	2,894,336	6
Cameroon	15,803,220	8
Tanzania	36,232,074	8
Uganda	23,985,712	8
Burundi	6,223,897	11
Mozambique	19,371,057	13
C. A. Republic	3,576,884	14
Malawi	10,548,250	16
Namibia	1,797,677	20
Zambia	9,770,199	20
South Africa	46,586,094	22*
Lesotho	2,177,062	24
Swaziland	1,104,343	25
Zimbabwe	11,365,366	25
Botswana	1,586,119	36

*2000 estimate / Sources: UNAIDS, www.CIA.GOV/cia/publications/factbook/index.html

In fact, Jalipa says, AIDS has now hit the "inner-most core of the church." Christians in Africa initially buried their heads in the sand, he says, "but when they saw their pastors and elders dying of AIDS, they [realized] they couldn't afford to be judgmental."

World Vision was one of the first non-government organizations to respond to the AIDS crisis in Africa more than a decade ago by working with AIDS orphans and their foster families in Uganda. Today, more than half the 1,500 churches in Africa with whom World Vision partners to fight AIDS are "preaching AIDS from the pulpit," Jalipa says, and have opened their eyes, arms and funding to AIDS. Yet, he says, other congregations are still "judgmental and resistant" to the disease.

"Even in Africa, there is still a problem with people thinking that [infected] people get what is coming to them," adds Debbie Dortzbach, AIDS/HIV program specialist for another Christian organization working in Africa -- World Relief, the international assistance arm of the National Association of Evangelicals. "There is still an element of self-righteousness. At the foot of the cross, we may not all have AIDS, but we all have something. Just because my sin doesn't have the consequences that yours does, it doesn't make me more righteous."

Church in Action

Jalipa believes that AIDS is drawing "from the radical left to the conservatives because we have a common enemy. It's a very positive movement. Christians have a basic mandate to spread the word, and the social responsibility to be compassionate."

Dr. Owen Kaluwa, program manager of Malawi's National AIDS Control Programme, agrees. "The church plays an important role in the fight against AIDS in motivating the behavior of people," he says.

Even the United Nations -- not exactly known for its ringing endorsement of faith-based initiatives -- has acknowledged the role of religious organizations in the fight against AIDS. Last June, the U.N. held a special session on HIV/AIDS. Among the findings, the session "emphasiz[ed] the important role of ethical and religious factors[and] faith-based organizations" (United Nations Declaration of Commitment on HIV/AIDS, "Global Crisis -- Global Action," June 27, 2001).

At the U.N. special session, some experts testified that knowledge and information alone are not the answer. Richard Wilkins cited a study by J.D. Caldwell on AIDS in Africa. "Cultural beliefs about sexual practices are so pervasive that behavioral approaches, such as the encouragement of condom use, have not been successful," Wilkins said. "Unless knowledge and information are linked to beliefs and values, providing knowledge and information alone is a very weak intervention tool."

Wilkins also said that organizations that battle AIDS must start programs that promote sexual chastity in unmarried young people and sexual fidelity in married couples.

Jalipa agrees. "Only a change of heart will change their behavior, not the information we give them. Until information is tied with beliefs and cultures and behaviors, it won't be effective."

Many Christian organizations partner with local churches and with international ministries that are working locally. Senegal and Uganda, for example, involved religious leaders early on in planning and implementing national AIDS strategies -- resulting in dramatic changes in the course of the epidemic.

In South Africa, the South African Council of Churches has banded together to offer a biblical perspective on fighting the pandemic. World Relief has developed a church-based program called Mobilizing for Life; which emphasizes God's plan for sexual abstinence and faithfulness.

Window of Hope

As ministries work to change hearts as well as behavior in the fight against AIDS, they focus particularly on youth. Dr. Owen Kaluwa believes that his country's priority should be "HIV prevention before age 15. They are the unburned firewood about to be thrown into the fire."

This is the "window of hope" -- youth and children who are still AIDS-free and can remain that way through proper faith-based education.

Jos Holtzhausen, director of Youth For Christ (YFC) in Namibia, says that focusing on this "window of hope" is essential. Experts estimate that half of Namibia's 1.6 million people will die of AIDS in the next 10 years. About 98 percent of youth over age 15 in Namibia are already sexually active, and most are already HIV positive, Holtzhausen says. Most children under six years old are also HIV positive because their mothers were infected when they gave birth to them. So YFC targets those youth in the middle -- ages six to 15. Holtzhausen's reasons are sobering: "In ten years they'll be the ones leading the country because everyone else will be dead," he says.

There is complete freedom of religion in Namibia, so YFC has developed a "Worth Waiting For" school campaign to teach students abstinence, a Religious and Moral Education Christian-based curriculum taught in public schools by YFC staffers and missionaries and one-on-one Christian counseling with children about the dangers of premarital sex and AIDS.

A 3,000-kilometer AIDS Cycle Relay bike race organized by World Vision also focused on youth. Cyclists raced through Malawi, Zambia, South Africa, Swaziland and Mozambique spreading the message that people must "listen, hear about AIDS and discuss it openly." The event, which attracted an estimated 2,000 children and adults, began at Malawi's picturesque Monkey Bay, where infection rates are as high as 50 percent. World Vision operates an HIV/AIDS education, prevention and care program in the area and has reached approximately 40,000 people in more than 48 villages.

Good News?

The United Nations believes there are signs that devastating AIDS numbers are stabilizing -- at least in some parts of the world.

· New infections in Africa in 2000 totaled an estimated 3.8 million, compared with 4 million in 1999.

· In Zambia, the percent of pregnant girls age 15-19 infected with HIV in the capital city of Lusaka dropped by almost half in the last six years. The percentage of unmarried women who were sexually active fell from 52 percent to 35 percent between 1990 and 1996.

· In Tanzania, prevention efforts have resulted in changed sexual behavior, a reduction in frequency of premarital sex and casual sex, and increased male sexual abstinence. Remember Mary, the 18-year-old we introduced at the beginning of our article? She lives in a culture dominated by the Masai tribe that teaches having many sexual partners is commendable, and that a bride must not be a virgin when she marries. This is typical of the uphill battle Christian relief organizations fight as they combat AIDS.

· In Uganda the HIV prevalence rate dropped to around eight percent in 1999 from a peak of 14 percent in the early 1990s. HIV prevalence among girls 13-19 fell significantly over an eight-year period.

These numbers are particularly noteworthy because they occur in countries where Christian organizations have worked with the government and AIDS service organizations to fight the pandemic. In Uganda, for example, a church leader has led the country's National AIDS Commission since 1995, and launched a program partnering with World Vision. "Since that started a few years ago," says Jalipa, "we have seen the life span of the AIDS patient lengthen. They are now surviving over 5 years. In the past, when they got full-blown AIDS they died earlier. These are good indicators."

Although numbers are stabilizing in some countries, AIDS is mushrooming in others, and experts stress that we cannot let up in the war against the disease. "The real problem of the future is going to be India," says Rich Stearns, World Vision president who recently returned from a tour of AIDS outreaches there. AIDS in India is of enormous magnitude now, and the potential for the future is devastating.

Whether fighting AIDS in India, Africa or Asia, Christian churches and ministries stress that the key to success is not just information, but church-based programs that change hearts and behaviors.

"This epidemic has really brought the church together," adds World Vision's Jalipa. "We are now facing a common enemy where we can rise above church politics. It's a unique opportunity for the universal church to come together and pray and work together. We can't afford to be judgmental. We must have the spirit of compassion and love towards these people." 

Elizabeth Farrell writes frequently on international topics. Her work has appeared in Christianity Today, World, Charisma, SpiritLed Woman, and many other publications. She is the co-author of China: The Hidden Miracle.

The Twin Towers of the AIDS Crisis by Richard E. Stearns The September 11 terrorist attacks on the United States proved the mettle of the American people. We are strong. We are brave. We are a people of faith. And we are generous and compassionate. Few of us will be called upon to prove our strength by rushing into a burning building. Fewer still to prove our bravery by commandeering a hijacked airplane. But all of us can demonstrate our compassion by helping widows and orphans in need. Seven out of 10 Americans have given to help families of the people killed in the attacks on the Pentagon and World Trade Center's twin towers. But there's another "twin tower" disaster that has been all but ignored by the American people -- Africa's AIDS crisis. December 1, World AIDS Day, should not have passed us by without even a brief recognition of those impacted by this devastating disease. A few months ago, I received a list of children who had lost one or both parents to AIDS in just nine villages of the southern African country of Zambia. The list of 3,613 names, 10 to a page, was 3 inches thick. I calculated that a list of all of the African children who have lost parents to AIDS -- at least 12 million -- would be more than 90 stories high. Next to that, put a similar list of 28 million Africans now infected with HIV, the virus that causes AIDS; that list would reach 194 floors -- 84 stories taller than the World Trade Center. Many of the names would be of widows, infected by their husbands with the disease, wishing for nothing more than to stay alive long enough to raise their children. Unlike New York's twin towers which collapsed before the eyes of the world, these towers have been building slowly, inch by inch, for the past two decades -- not on global television, but in anonymous slums and villages. That's not to say that Americans are unaware of the toll AIDS is taking on Africa. We just choose to look away. A poll conducted in 2001 by the Barna Research Group found that about three-quarters of the American public are aware that many countries have a large population afflicted by AIDS. Nearly a third said they were "very familiar" with the AIDS crisis. The same survey found that more than half of the public is unlikely to help children who have lost parents to AIDS. Almost two-thirds said they are unlikely to help overseas AIDS prevention and education programs -- efforts that can protect wives from being infected by their husbands and young people from experiencing the same fate as their parents. Only 8 percent said they would definitely support these causes. Regrettably, evangelical Christians were significantly less likely than non-Christians to support AIDS education and prevention. And, although they are usually twice as likely as adults overall to support disadvantaged children overseas, they were less likely to support children orphaned by AIDS. Why would fewer than one in 10 Americans be willing to help widows and orphans of AIDS, while seven out of 10 were moved to help those who lost mothers, fathers, wives and husbands in the September 11 attacks? September 11 saw the first direct attack on the United States in nearly 60 years. The deaths of thousands of our countrymen in three short hours were also unprecedented. More compelling than the terrible ways in which they died was the ordinariness of their lives as they started the day. They commuted to work. They got on airplanes. They sat at their computers, coffee cup to the right, pictures of their kids to the left -- just like us. In short, we can all relate to the people who died on September 11. We feel compelled to care for their families like they were our own. As we should. Africa's AIDS crisis, by contrast, has been slowly building over the years. Those affected live in villages, even countries, we cannot locate on a map -- or even pronounce. Most are poor. Their cultures are different. The way men and women relate to one another is different. And so we turn away from what we do not understand. But while we turn away, the "twin towers" of those affected by HIV/AIDS continue to grow. By the end of this decade, Africa alone could have 40 million children who have lost parents to AIDS. That list would stack up high enough to make three of the New York twin towers. September 11 proved it is impossible for the United States to ignore the world's problems. Our television screens now have stories datelined Kandahar, Tashkent and Islamabad. We have been outraged by the oppression of women under the Taliban, and even moved by abuse and neglect of animals at the Kabul Zoo. We are more aware of world events than we have been in decades. We are a different country than we were six months ago -- stronger, kinder, more internationally savvy. Our new awareness of the world should lead us -- Christians and people of all faiths -- to extend the same respect and compassion to the widows and orphans of Africa's AIDS epidemic as we have to survivors of America's greatest tragedy. © 2001 Religion News Service Richard E. Stearns is president of World Vision.

Twenty Years of HIV/AIDS 1981 The first cases of unusual immune system failures are identified among gay men in the United States. 1982 Acquired Immunodeficiency Syndrome (AIDS) is defined for the first time. In the course of the year, the three modes of transmission are identified: blood transfusion, mother-to-child and sexual intercourse. 1983 The Human Immunodeficiency Virus (HIV) is identified as the cause of AIDS. In Africa, a heterosexual AIDS epidemic is revealed. 1985 The scope of the growing epidemic becomes manifest. At least one case of HIV/AIDS has been reported in each region of the world. Film star Rock Hudson becomes the first international icon to disclose he has AIDS. The U.S. Food and Drug Administration (FDA) approves the first HIV antibody test and HIV screening of blood donations begins. 1987 Africa's first community-based response to AIDS (The AIDS Support Organization or TASO) is formed in Uganda. It becomes a role model for similar activities around the world. The International Council of AIDS Service Organizations (ICASO) and the Global Network of People living with HIV/AIDS are founded. The World Health Organization (WHO) establishes the Special Programme on AIDS, later to become the Global Programme on AIDS. The first therapy for AIDS -- azidothymidine (AZT) -- is approved for use in the United States. 1988 In London, health ministers from around the world meet for the first time to discuss the growing HIV/AIDS epidemic. 1991-1993 HIV prevalence in young pregnant women in Uganda begins to decrease -- the first significant downturn in a developing country. The success is attributed to countrywide mobilization against the epidemic. 1994 Scientists develop the first treatment regimen to reduce mother-to-child transmission. 1995 An HIV outbreak in Eastern Europe is detected among injecting drug users. 1996 The Joint United Nations Programme on HIV/AIDS (UNAIDS) is created. Evidence of the efficacy of Highly Active Antiretroviral Therapy (HAART) is presented for the first time. 1997 Brazil becomes the first developing country to provide antiretroviral therapy through its public health system. 1998 The first short-course regimen to prevent mother-to-child transmission is announced. 1999 The first efficacy trial of a potential HIV vaccine in a developing country starts in Thailand. 2000 The U.N. Security Council discusses HIV/AIDS for the first time. 2001 U.N. Secretary-General Kofi Annan launches his call to action, including the creation of a global fund on AIDS and health. The U.N. General Assembly's special session on AIDS meets in New York. Source: UNAIDS

Rachel's Story by James Henderson We all learn from each other. Sometimes, as a minister, I feel I learn more from those who seek my help than I give to them. This is one such story "Hello. Can I help you?" "This is Rachel. I am downtown and have nowhere to stay. I haven't any food or money. My baby needs food and medicine. She won't stop crying. Please, please help me." I first met Rachel a few months previously. It was a sparkling, clear African morning, and everything seemed right with the world. When I arrived, feeling cheerful and good, at my office, Rachel was there. "Good morning. What can I do for you?" "Minister, I know God can help me, and you are from him. You can help me." She told me her story. She had had a good education, and was from a well-off background. She was 18. When she was 16 she found herself pregnant by a man from a different tribe. Her parents did not want to know. "Give the child to the father and then come back" was how they saw it. Rachel, however, wanted to keep the child. And, in any case, the father didn't care. What no one knew was that Rachel had been infected with HIV -- as had the baby. When I saw her that day, she had full-blown AIDS, and the baby -- a little girl -- was in the beginning stages. Rachel had sex only once. It had been without commitment and unprotected. It seemed a textbook case -- now she had a child out of wedlock, no money and was dying from AIDS. Was I hearing her correctly? Was it true? Was she trying to deceive? It had happened before. In the church, you hear many sob stories that are peppered with lies. As she spoke, she wept from time to time. She was dressed well, and the baby had clean clothes. I noticed blackish spots on her neck and legs. Kaposi's sarcoma? Some of the spots on her legs were open sores. She wanted food and money for ointment. We gave her those, and then she left, disappearing into the teeming Nairobi crowds. Some time later, Rachel returned. She was obviously thinner and ill, and the baby looked frail. "I was hoping to send my baby to my sister in the United States. But now she is too sick and won't survive the journey." "What can I do?" "I want you to give me some words of encouragement from God. I feel spiritually low." What do you say? I wanted to wave a magic wand and heal them instantly. Christ could have stretched out his hands and touched them, saying "Be healed." We prayed. I prayed that God would relieve their suffering and bring them comfort. I prayed about the hope of the dead and the resurrection, and asked God to fill Rachel with the certainty of that hope. My voice was trembling with emotion, and I was beginning to lose it. I despaired at my inability to change anything for her. When I looked up Rachel was smiling her big, wonderful smile. "Thank you. I feel better. I know there is a God in heaven, and that he cares. Jesus will look after us. Nothing will move my faith." How could she say that? This young girl and her baby were dying -- how was Jesus looking after them? I felt ashamed. My faith wanes with much lesser hardships. I envied Rachel her faith and the tranquility it brought her. I never saw her again. Sometimes I would watch for her in the streets. Later one of our church members heard that Rachel and the baby had died. Another victim, and yet, from Rachel's viewpoint, in death, another victory. James R. Henderson is a pastor in the Worldwide Church of God, residing in South Africa, while ministering throughout Sub-Saharan Africa.

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