Africa's HIV superhighway
I'VE BEEN REPORTING on AIDS in Africa for nearly 15 years, but on a 2005 visit to KwaZulu-Natal, the province with South Africa's highest HIV infection rate, the hush surrounding the epidemic was so spooky that it surprised even me.
The Catholic Church had been running an AIDS treatment program for more than a year at a local hospital there. Outreach teams set out each day to care for sick people and encourage them to be tested for HIV and, if necessary, join the treatment program. I spent a week following these caregivers on their rounds and, as we went from one homestead to another and sat with dying patients and their families, no one, not once, said the word "AIDS."
Patients told us they were suffering from "ulcers" or "tuberculosis" or "pneumonia." Orphans said their parents had been "bewitched" by a jealous neighbor. Many AIDS patients died in their houses, cared for with compassion but in silence, their condition shrouded in euphemisms.
Occasionally, I was told, those known to be HIV-positive have been thrown out of their houses, scorned by their relatives or quietly fired from their jobs when their status became known or even suspected.
The stigma surrounding AIDS is profound, as it has been since the early days of the epidemic. But, for several years, I have been wondering whether perhaps a misunderstanding of the epidemiology of HIV in Africa has not exacerbated it.
The AIDS epidemic in southern Africa is uniquely severe. About 50% of new infections occur in this region, home to less than 3% of the world's population. Unlike other regions of the world where the epidemic is largely confined to what epidemiologists call "high-risk groups" -- prostitutes, migrants, gay men with many sexual partners and injecting drug users -- in such countries as South Africa, Botswana and Lesotho, everyone is at risk: teachers, doctors, market traders, Cabinet ministers, everyone.
Why is that? Sexual cultures around the world vary, but the differences are not always obvious. For example, southern Africans do not seem to have more sexual partners over a lifetime than people in the U.S. However, what epidemiologists do know is that southern Africans are more likely than people elsewhere to have more than one -- perhaps two or three -- long-term sexual partnerships at a time, and they may overlap for months or years.
This pattern differs from the "serial monogamy" more common in the West, or the casual and commercial sexual encounters that occur everywhere.
