AIDS at 30: Africa at the forefront of the war
Home to 22.5 million people with HIV -- nearly 70 percent of the world's total -- sub-Saharan Africa bears the brunt of the 30-year-old AIDS pandemic.
Millions of lives have been destroyed, yet the war now shows signs of progress: infection rates are stabilising or dropping in many countries as access to life-saving drugs widens.
But the challenges are huge.
From Kampala to Mbabane, the following are short reports on the key issues from five AFP bureaux.
ACCESS TO DRUGS
LAGOS - Microphone in hand, the receptionist calls over the public address system to the next person waiting to grasp a lifeline: the precious drugs that will keep the deadly AIDS virus at bay.
The Nigeria Institute of Medical Research, located in the working-class suburb of Yaba, is often overwhelmed by the numbers. Hundreds queue daily at the clinic, and hours can pass in the waiting room.
The drugs are free, as in many African countries, but just 360,000 people receive treatment -- about one third of the Nigerians who need it.
The health system struggles to expand treatment and ensure people take their pills in the face of sharp social stigma. Then there are simple practicalities for the poor, like paying for transport to fetch the drugs.
"You don't really think about it, but just coming here is a very great task. I have to wake up very early, like today I woke up at 4:00 am -- and I spend between five and six hours" at the clinic, said a 42-year-old woman, one of Nigeria's 3.1 million people with HIV.
She has been on treatment for nine years, since a time when such medicines were rare.
Even so, treatment has transformed the pandemic from a looming death sentence into a chronic manageable disease.
"Thank God the drugs work," she said.
KAMPALA - After six years of campaigning about safe sex in a Kampala suburb, Kenneth Mukwaya worries Ugandans are suffering from AIDS fatigue.
Uganda has been hailed as one of Africa's successes in the fight against AIDS, with infections slashed from 18 percent in 1992 to 6.1 percent in 2002.
But in recent years, the decline has stagnated, even rising slightly to around 6.5 percent.
"Before, we were focusing on the youth by going to schools, talking to young people and they really picked it up. Now we are trying to reach older people and married couples," said the 26-year-old.
"Although Uganda has had a lot of success against AIDS, the fight is still on and it's now the older groups that are being more affected."
Around 43 percent of new infections come from people in long-term relationships, with doctors pointing to a rise in risky behaviour among older people and married couples.
Now, a series of campaigns targets the older generations and urges couples to get tested together and to avoid extramarital affairs.
"With time people became complacent. The people started taking the information for granted and levels started rising again," said Tom Kabugu, manager of the AIDS Information Centre Kampala branch. "This is why we have to intensify the campaigns again."
WOMEN IN THE FRONT LINE
KINSHASA - The first question the raped women ask is: "Am I HIV positive?"
"For those who have been raped and infected with AIDS, it is catastrophic, it's very, very traumatic," said Nene Rukunghu, a doctor at the Panzi Hospital in the conflict-ridden eastern Democratic Republic of Congo.
"It's already very difficult for the victims of sexual violence to integrate into society. It's a disaster for those who are also affected by AIDS."
Sixty percent of people with HIV in Africa are women, compared with 50 percent elsewhere in the world. Many have contracted the disease through coercive sex.
In DR Congo, more than 1,100 women are raped every day according to one study, with marauding gangs of militia and soldiers sweeping through villages in cold-blooded mass attacks.
"When the female victims of sexual violence arrive at the hospital for treatment, except for the ones who are seriously hurt, the first question that they ask is if they are infected by the 'disease'," said Rukunghu.
Up to 30 percent of rape victims here catch HIV, according to the World Health Organisation (WHO). Panzi Hospital has treated 920 women living with HIV this year, including 16 rape victims.
"We had a case of one woman who was raped and then went home," said Rukunghu.
"Then, she was raped for a second time and was infected with HIV. After that, she refused to go home. 'I returned the first time, and then I got AIDS,' she said."
CAPE TOWN - The bold letters on the hand-written posters are stuck to a bedroom wall in Cape Town's shack-filled outskirts: "I am not just a number... I am strong".
They were penned by one of South Africa's nearly two million AIDS orphans, "Sandile", a skinny, HIV-positive 10-year-old whose mother died when he was just nine months old.
"I was young," is his simple observation of his arrival at the Khumbulani Children's Place of Safety in 2002.
Sub-Saharan Africa is home to one in nine of the world's 16.6 million children who have lost one or both parents to AIDS.
Some like Sandile are scooped into humble shelters where small bedrooms are shared with three other boys and the living room is full of baby cots.
But they have a foster mother to call "mama", someone who worries about food prices, ensures anti-AIDS drugs are taken, checks on school, and is a generous hugger.
Despite gains in slowing HIV's spread and expanded treatment, which has also cut infections from pregnant mothers to newborns, orphan numbers are rising.
The parentless children are a potential timebomb for Africa's already stretched systems: falling through cracks, absorbed into extended families to live off meagre welfare grants, and even forced to head households.
"It's huge. There's no question about it and it's scary -- it gives me sleepless nights actually," South African Health Minister Aaron Motsaoeledi told AFP.
MBABANE - Mfanzile Nxumalo averts his eyes and screws up his face while his foreskin is sliced off, but he declares his mettle as the nurse stitches him up. He's joining in a push by Swaziland to curb HIV infections with male circumcisions.
"I am the bravest man alive!" he declares from the hospital trolley. "I've tested negative -- that's what motivates me."
As a 29-year-old Swazi, Nxumalo has a nearly one in two chance of being infected with HIV in the small mountainous kingdom which has the world's highest prevalence rate and lowest life expectancy, 32 years.
After trials suggested circumcision could reduce HIV infection risk to men by up to two-thirds, Swaziland decided to revive a tradition that had been abandoned in the 19th century.
"Everybody seems to want to use a condom in the research we've done," said Derek von Wissel, who heads Swaziland's emergency response council on AIDS.
"But often they are too drunk to use a condom. Or round one they use a condom, round two they don't."
The ambitious, US-funded campaign hopes to reach one in eight Swazi men, but has had disappointing results so far.
The clinic performing Mfanzile's procedure is geared to see 80 patients a day. At best 15 trickle in -- fewer than even before the campaign began in February.
Adverts urging men to "circumcise and conquer" are everywhere but organisers now admit they may not reach their targets as quickly as hoped.
"Most of the time in Swaziland, men are the decision makers. Men must be in the forefront of this battle," said Health Minister Benedict Xaba. "It takes time for a Swazi person to accept something new; to accept change."
© 2011 AFP