Apocalypse: The Truth About Aids
edited by Ursula Owen
Index on Censorship £9.50, pp224
If Aids is about anything, it is about growing up too soon. Whenever I see the word, a vivid image flashes into my mind of an orphanage trust which I visited last year in Botswana. The Dula Sentle day centre in Otse cares for 50 children whose parents, aunts uncles and grandparents have died from the virus, and who otherwise would have little hope. It stands under a brilliant sky, offering them a good meal and extra education. The Belgian who runs it knows how to persuade the pharmaceutical companies and Western donors to give generously.
Music is a big part of their lives and they entertain visitors with a song acted out between boys and girls, the girls gently pushing away the boys who want to hug and kiss them. These children are learning to say no, because polite refusal may be the only skill which saves them once they move to a big city. It is done with humour, but the message is deadly serious.
In the vast hinterland of Aids-awareness, the relationship between men and women, boys and girls, is often overlooked and yet, in the end, it is only equality which will defeat the virus. If the disease is ever to be prevented on a meaningful scale, it must be about women saying no. Aids affects more women than men - in sub-Saharan Africa, 67 per cent of the 8.6 million young people with the disease are women and girls. They have no rights, no power to say no to sex, no way of leaving a brutal husband. It is the women who have to find the money for schooling and food, but who are mostly likely to die before the children have grown up.
In this illuminating book of essays on the subject, gender comes to the fore again and again. So much of our agony over the disease has focused on anti-retroviral drugs, yet behavioural change is the only long-term solution. Behaviour is the toughest issue to deal with, and human beings are remarkably resistant to the idea of doing things differently to help themselves. In Africa, there are enormous forces working against use of condoms. As Alex de Waal points out in his excellent essay: 'Knowledge counts for nothing when women have no power in sexual encounters, and when sex with a condom commands a significantly lower price than sex without.'
For miners in a South African township, the dangers of unprotected sex appear remote compared with the hazards of going down a mine every day: 'The risk-taking may even be part of what constitutes their masculine identity.' These are difficult issues for Europeans and Americans to deal with; they challenge our view of sufferers as victims who would no longer be victims if they could simply get their hands on the drugs. The cultural challenge this presents is enormous, not least to Islamic societies which for years have denied the existence of Aids. Attitudes may be changing, but many fundamentalists see it as the result of a Western lifestyle linked to promiscuity, alcohol and drugs.
As the writer Salil Tripathi puts it: 'The really difficult question is this: is the emphasis on providing affordable treatment to Aids patients taking health dollars away from preventive mechanisms or investment in research towards a vaccine?'
The logic is obviously towards preventing infection, but as this book forcefully points out, prevention can only be based on wholesale behavioural change, not merely about condom use, important though it is. It has to emerge, above all, in the attitude of men to women.
The survivors pay a heavy price - survivors such as Kiiza Ngonzi, the well-educated daughter of well-educated parents who succumbed to the virus. She has lost five siblings who themselves have left behind 12 orphans. The orphans are divided between the remaining four girls, who are financially responsible for the children, without homes or assets to provide for them properly. For her, the anguish lies not only in watching her mother die. 'It is about the children, the next generation, who are moved from relative to relative, usually separated. It is about their upbringing amid chaos and neglect; about equipping them with survival skills; it is about growing up before time.'
