The New York Times

Tuesday, April 11, 2000

Africa's Plague, and Everyone's

By NADINE GORDIMER

JOHANNESBURG -- Sixty-nine percent of the world's victims of H.I.V. and AIDS are in sub-Saharan Africa. This figure is not easy to take in. AIDS seems to have come upon everyone while we were looking the other way: it happened to some sex or color other than our own; it was endemic to some other country.

In South Africa it was quite some time before the realization that the disease was not the unfortunate problem of our poorer neighboring countries, but was our own. Now, out of South Africa's 43 million people, about 4 million have been infected by H.I.V. and a further 1,700 are infected daily. Recently, in a Johannesburg home caring for orphaned or abandoned babies born with AIDS, there was a service in memory of 40 who had died there not long before. While South Africa is the most highly developed country on the African continent, we are faced with this kind of future for the generations to come.

But every community, every affected country has to decide how to approach what is no longer a problem but a catastrophe. There is prevention, and there is cure. The ideal is to seek both at once, but this is beyond the capacity of most countries where the disease is rampant.

Cure, and prevention by inoculation, are not within the capacity of lay people; these are in the hands of medical science, which implies money to be provided to advance research. Immediate prevention is in the hands and initiative of each population itself.

I believe we cannot emphasize bluntly enough that the cure and vaccine development depend on money. And until recently, the country that has the money, the United States, perhaps inevitably has concentrated on a vaccine for a subtype of AIDS prevalent in the Northern Hemisphere. It was only at the World Economic Forum's meeting this year that President Clinton announced that large-scale aid for vaccine development would be forthcoming from the United States. Only now has the International AIDS Vaccine Initiative announced a third international development project, based on those subtypes of the virus most prevalent in the direly affected regions of Southern and East Africa, the subtypes C and A.

It is encouraging that the project is being pursued in wide collaboration among researchers of the United States, South Africa, Kenya and Oxford University, and that the philosophy of the initiative is that of "social venture capital," meaning that in return for financing, it has secured rights to ensure that a successful vaccine, when it is achieved, will be distributed in developing countries "at a reasonable price." The formation of an International Partnership Against HIV/AIDS in Africa is to be welcomed as extremely important in the same context.

The question of money -- price -- is vital in terms of the palliatives available to arrest the disease and alleviate symptoms. It is another piercing example of the gulf between the world's rich and the world's poor that the suffering from AIDS may be alleviated, and even the lives prolonged, of those victims who can afford expensive treatment. The same principle applies to prevention. Everywhere in Africa moral and humanitarian decisions are a common dilemma, with money the deciding factor.

At the level of international -- global -- responsibility, the total sum needed annually for AIDS prevention in Africa is on the order of $2.3 billion. Africa currently receives only $165 million a year in official assistance from the world community.

Other questions that rest with the world community become relevant: debt relief for developing countries, for example. The director-general of the World Health Organization said last year that debt relief should be reviewed in light of the resources that governments with large debts need to confront H.I.V.

The role of governments in financing is another example. Where does the defense budget not far exceed the public health budget to combat AIDS? Nevertheless, what H.I.V. and AIDS mean to the capability to govern, ultimately, was revealed in South Africa by the minister of public service and administration in February. The public service is the largest employer in the country and the fundamental government structure. In 1999, one in eight South Africans was H.I.V.-positive. It is estimated that 270,000 out of 1.1 million public servants could be infected by 2004. This looming crisis in governance exists almost everywhere on the African continent. If, in developing countries, defense budgets continue to leave H.I.V. budgets relegated to a footnote, all we shall have left to defend in the end is a graveyard.

AIDS is not only a health catastrophe, a challenge to medical science. It is socially enmeshed in the conditions of life that obtain while it spreads, just as the medieval plague was in its time. Although AIDS is no respecter of class or caste, slum conditions, ignorance and superstition (it is a white man's disease; it is a black man's disease) make the poor its greatest source of victims.

In working to prevent the spread of the virus, we must accept the idea that promiscuity is difficult to condemn when sex is the cheapest or only available satisfaction for people society leaves to live on the street. On another socioeconomic level, casual sex thrives among young people who are materially privileged yet whom society has failed to endow with the real values of human sexuality, the knowledge that fulfillment involves contact with the other's personality, that the sexual act is not some mere bodily function like evacuation -- which is what some campaigners seem to reduce it to.

There are subtleties, important ones, connected with any campaign against H.I.V. and AIDS, if it is to succeed in changing attitudes toward sexual mores. For there will be a cure discovered, there will be a vaccine -- and after that? How shall we restore the quality of human relations that have been debased, shamed, reduced to the source of a fatal disease? The free condom dispenser is not the panacea. Neither, alone, is sex education restricted to anatomical diagrams and dire warnings in schools. The entire meaningfulness of personal sexual relations will need to be restored. That is what social health means, along with inoculation and survival.

Self-interest cannot be discounted. So, to the developed world, a pragmatic word from the stricken African continent: Call not to ask for whom the stock exchange bell tolls and the figures on the computer sound the alarm -- the toll is for Europe, for the United States, even for those countries where H.I.V. and AIDS victims are few. For if the markets and vast potential markets for the developed world's goods fail -- if decimated populations mean there is no one left economically active with money to spend -- that bell tolls for thee, globally.

H.I.V./AIDS is everyone's disaster. It has, finally, something to do with our whole manner of existence. It confronts us with questions that must be answered historically: What have we done with the world, politically? What are we doing with the world? What do we mean by development? Some Ugandans who had been in the audience of an AIDS information play were asked what message it had brought them. One said, "Don't go out with bar girls." Another said, "Stick to one partner." Then an older woman said: "AIDS has come to haunt a world that thought it was incomplete. Some wanted children, some wanted money, some wanted property, and all we ended up with is AIDS."

Maybe she spoke for Africa.

Nadine Gordimer, who was awarded the Nobel Prize for Literature in 1991, is a goodwill ambassador for the Race Against Poverty project of the United Nations Development Program.