Newsday - July 7, 2000
Laurie Garrett, Staff Correspondent

Shameful as the sight of a pregnant 18-year-old might be, it was a lie invented to hide what was considered an even greater horror, for the sister, Hasifa Nanfuka, was infected with HIV.

Hasifa was banished, left to survive on her own. And Lukio had barely celebrated her 12th birthday when Hasifa's old boyfriend, having also banned the teenager from his life once she was diagnosed, raped the little sister.

Today Hasifa is 27, battling not only HIV but also tuberculosis that has infected her lungs. And Lukio, a shy 19, has AIDS, which she said gives her sharp headaches and makes her tire easily.

Lukio and Hasifa share an uneasy sisterhood. Though both girls were virgins when they met the man, it is not he who has paid the price for their HIV infections, but they.

"I have no hope for marriage now," Lukio said, speaking softly in her native language, Luganda. "I'm not even interested. When boys come to me I send them out."

To survive, Lukio sews people's clothing, repairing tears and replacing buttons to earn the 6,000 shillings (about $4) a month that she needs for water and rent for a 6-foot-by-6-foot windowless cell that fills with water during the rains and smells of mold in the dry season. She has no toilet, bath or electricity.

Older sister Hasifa lives only slightly better thanks to her sales of macram pot hangers-her hut's roof doesn't leak. The mud walls are covered with quotes from the Koran and pictures of her female idols: Princess Diana and Monica Lewinsky. "She's beautiful," Hasifa said of Lewinsky.

All across sub-Saharan Africa, women are more vulnerable than men to HIV infection, both for biological and social reasons. No strategy to control HIV's explosive growth in Africa or Asia can succeed, experts say, without directly confronting stark gender inequalities. Few marriages here are genuinely monogamous, and women routinely tolerate treatment from their men that in the United States would be grounds for imprisonment. According to a World Health Organization report released last month, the root cause of women's subservience is poverty, since few women have jobs that earn cash. Women are the agricultural labor force in Africa, responsible for raising most of the food consumed by the continent's populace. But cassavas, bananas and mangos have little cash value, and few women have the land or tools necessary to produce significantly more than their families consume.

The report also explains that the lack of power to control their sexuality is the No. 1 reason women are becoming infected with HIV.

Biologically, it's clear that male-to-female transmission of HIV is far more efficient than the reverse, said Nancy Padian of the University of California in San Francisco, an expert on HIV transmission. And this is particularly true when the female is very young, a virgin or a victim of violent sex.

In many African communities, according to a survey by Dr. Angella Muchini of the University of Zimbabwe, men refuse to have sex with a "moist woman," insisting that they garner greater pleasure from women who have dried their vaginas with traditional herbs, commercial detergents or lemon with salt, even though that experience is abrasive, usually painful, for the female. That abrasion, scientists say, creates tears through which HIV readily enters the woman's bloodstream.

The social dynamic that puts women at special risk begins with an old Baganda adage, as recited by school teacher Jacob Batalingaya in the Ugandan village of Kimkundwa: "When a man has only one wife, actually he's more or less a bachelor. You must have more than one wife so that if one goes home to visit her parents the other remains to look after you."

Polygamy, whether tied by bonds of legal matrimony or as a matter of common law, is the norm.

Diseases associated with sex can even be viewed as male status symbols.

"The old people believed that VD, gonorrhea, make a man a real man," Batalingaya said. "You must have syphilis to be a real man, they said."

When a man takes on a wife-or wives-she moves onto whatever plot of land he or his parents own. And it is her duty to farm the land and bear him many children, especially boys.

"Ladies are supposed to be ready to give food and open their legs for a man at any time. That's the culture," said Jocelyne Hulera- Girard, who has for nearly a decade been running an AIDS treatment effort in Bukoba, Tanzania, for the Paris-based organization Doctors of the World. If a man takes multiple women, Hulera-Girard added, each must become even more compliant with his demands in order to ensure that her children get adequate shares of the food and school fees. When a man takes ill, this world falls apart.

In 1990, Mary Idrisa's husband fell ill with AIDS and languished in their tiny home in a village just outside the Lake Victoria seaport of Bukoba. In the preceding years, Idrisa's husband saw three prostitutes regularly and married a second wife. All of them died of AIDS. Idrisa nursed her husband for a year and, at the command of her in-laws, spent scarce resources on useless medicines and witch doctor incantations.

"When my husband was sick, my father-in-law planned to take all of our things to his house. My husband said, 'No! Let them [my wife and children] stay in my house,'" Idrisa recalled recently from her Bukoba General Hospital bed. "So my husband wrote a will to say...the house should belong to me."

That was a rare act-few widows in this East African region ever possess such papers. Nevertheless, "when my husband died his parents blamed me," Idrisa continued, her once form-fitting orange dress dangling like a huge tent from her skinny shoulders, and a crucifix swinging from her neck as she waved her hands about. "They say I killed their son with witchcraft. So relations are very bad. They even claim that the house will be taken by the clan and when I die I will not be allowed to be buried on the land."

Idrisa, 42, described her legal battle to ensure that when she dies of the HIV infection that has devastated her body, her children will inherit the land. As she speaks, the woman in the next hospital bed, 53-year-old Paulina Sebastian, listens and weeps. AIDS has already killed her husband and two of her children, Sebastian whispered between tubercular coughing fits. Her in-laws took their land and left her destitute and living on the floor of a Bukoba bar where her eldest daughter plies the only profession open to her- prostitution.

Idrisa, who has seven children including two daughters, prays that she can leave her young a legacy that will forestall the prostitution option for the girls. But already, she said, "all the fields are in bad shape," because for a year she has been too sick to farm them.

"The children are all in school. They do a little, but not in a good way," in the garden, Idrisa said. So there isn't enough food.

The results of such female sagas can be seen on the burgeoning malnutrition wards of East Africa, where babies like 3-year-old Renata, weighing just under 20 pounds, languish. Renata's mother is on the AIDS ward of Bukoba General Hospital, the nurse explained, while the severely malnourished girl, a little taller than three feet with half her hair falling out, lays so lethargically as to seem inert.

Row upon row of these stunted babies have overflowed the pediatric wards. They are warehoused two, sometimes three, to an infant-sized bed. The nurses say the numbers just keep mounting, although Tanzania has had ideal farming weather.

"It isn't drought starving these babies," a nurse said, "it's the plague."

These aren't HIV-positive children, but their lives are in peril just the same.

Mothers, desperate to feed their young, will do anything for money, even prostitute themselves-and thereby spread HIV.

In Zimbabwe, the Mtoko Highway bisects the nation, connecting the capital city of Harare to its eastern border with Mozambique. Because Zimbabwe is landlocked, traffic along this highway is usually heavy, with trucks bearing goods from Mozambique. And all those trucks pass through the seedy Zimbabwe border town of Nyamapanda.

Above the town circle chapungu vultures-spirits, locals say, that watch over the dead. And Nyamapanda's business district-all 100 yards of it-is lined with 18-wheeler trucks. On the stoops of every shop, and the stools of local bars, sit prostitutes from all over Africa. One said she's from Malawi, another from South Africa. A cluster of Portuguese-speaking women are from Mozambique. And some are from Zimbabwe.

Barmaids in the beer halls work behind steel cages, passing drinks to customers who, despite the barriers, still try to grab at the women. "It's rough here at night," chuckled barmaid Chipo. "There aren't enough women, so the men get drunk and fight over them."

A police sergeant who declined to give his name relaxed in a grocery store, draining three bottles of beer in less than 15 minutes.

"If you come here later [at night] you can see girls of 12 or 14 years of age here doing the business," the sergeant said with evident disgust. "It's a border station, and all the drivers need a woman at night. That's how it goes."

According to studies funded by the Zimbabwe Ministry of Health, some 80 percent of these Nyamapanda residents and transients are HIV- positive.

And so the epidemic grows, and the wives-infected through their husband's promiscuity-are often compelled to complete the circle themselves, becoming sources of infection for other women's husbands. Unless this cycle can be broken, scientists insist, the African AIDS epidemic cannot be slowed.

Dr. Mary Bassett, a New York City-born scientist who has worked on AIDS problems in Zimbabwe since 1986, thinks that cycle explains why HIV is far more prevalent in east and southern Africa than in the far western regions of the continent.

"In West Africa...many women have their own checkbooks, so to speak. Female entrepreneurialism is common and accepted there," Bassett, who has joint appointments at the University of Zimbabwe and Stanford University, explained. "But in southern Africa it is really unheard of. Women here think they're protected by having one partner. But the issue is the husband's multiple partners. From a public health point of view the best answer is to try to transform the social norm [among men] to, 'don't take it home with you.'"

Many men complain that the deteriorating economy and superstitions in village life practically force them into a promiscuous and dangerous lifestyle.

"It's difficult for most young men to marry," Tarirai Muchayabande, of Marimbindi village in Zimbabwe, said. "We are fortunate if we have two wives. But our fathers had three to six. Here when people have AIDS they rush out of town to the villages to sex with little girls," he continued with obvious anger. "Because they think sex with a virgin takes AIDS away."

Social analyst Michel Caral, who participated in a United Nations AIDS Programme study of sexual behavior and HIV transmission in six African nations, argues the focus has to be on changing male attitudes. It's too late for the post-adolescent generations to learn whole new ways of behavior, but at least discouraging men over the age of 20 from having sex with young girls could break the cycle on a generational basis.

Sadly, however, he also found that girls are losing their virginity at ever-younger ages, usually to men who are a decade or more their seniors.

"These older men," Caral explained, "believe these young girls aren't infected. And, of course, they never imagine that they are infected. And the probability of HIV transmission to these young girls is so high! It's after just one or two sexual acts.

"Changing these older men. The goal in the community is to make it socially unacceptable for these older men to have sex with younger women."

That could begin with strict enforcement of statutory rape laws- where they exist. But even that holds little hope in some areas because rape, much less statutory, has become a social norm. An Interpol survey of South Africa found that in 1996 a woman was raped in that country every 26 seconds, and reported rape rates were 35 times those seen in the United States. Last year in South Africa an estimated 1,872,000 women-or one out of every 15 women in the country- were raped.

There are rays of hope in this bleak picture, insisted attorney Sophia Mukasa-Monico, executive director of Uganda's private group The AIDS Support Organization. She moved out of her home, separating from her husband, "because he said, 'Sophia, I use a condom, but with my other women, not with you. You are my wife.'

"Now you can say no, but you must be ready to pack your bags," Mukasa-Monico continued. "And more women are ready to do that now, because it is a matter of saving their lives."

The AIDS Support Organization is also reaching out to young girls, hoping to transform Uganda's next generation into stronger, more assertive women. That's why Luboa Kavina is able to go to school-the organization pays her fees. Both of Luboa's parents died of AIDS when she was 8, and she and her five siblings and one cousin buried their dead in the family banana grove. Then the eldest, Luboa, became a mother to the rest.

Today Luboa is a pretty, open-faced 16-year-old whose womanly body is stretching the seams of her raggedy child's clothing. The neighbors taught her how to farm the garden, and The AIDS Support Organization built a modest concrete house to replace the one-room shack in which the orphans had lived.

"I wake up at 5 a.m.," Luboa quietly explained. "I take the kids to the garden and dig. Then we wash and go to school. When we come back we look for food from the garden and from neighbors and I cook dinner."

Finally, exhausted, Luboa lights a tiny paraffin lamp and does her homework. Her most recent report card from St. John's Progressive School ranks Luboa number four in a class of 53, and is dotted with "excellent" and "very good."

"I tell them [my siblings] that we have to be strong in the world. We don't have parents. We must stay together and work hard to survive," Luboa said. "And I study hard. I want to be a nurse in a hospital and help people."

Schoolteacher Batalingaya is Luboa's neighbor: a sort of surrogate parent for the band of orphans. He calls Luboa "the village miracle" of Kimkundwa. And in her, he sees Uganda's new future.

"People now feel we will last longer if we change," Batalingaya said. "Women now have had teachings of their rights. They should not be forced just because they are women...And men are changing. My father had six wives, but I am having one. He had 20 children, but I am having three. Going with men and women is all so dangerous that we have learned. And we have decided to stick to just one."

Perhaps change is coming in such villages, Dr. Nour Kiwanuka said, but it is painfully slow. Kiwanuka is a public health scientist with the Rakai Project in Kalisizo, Uganda.

"It's still an uphill battle," Kiwanuka said, shaking his head. "Because culturally most of the African systems are still patriarchal. And by the time girls grow up they have seen their mothers beaten. They have been indoctrinated and they accept the imbalance as a norm."

Yet, if girls like Luboa can face the incredible odds against orphans, finish school and get well-paying careers, Africa may begin to change, argues Awa Coll-Seck, a founding member of the Society for Women Against AIDS in Africa. It will be painfully slow, given the exploding AIDS epidemic, "But if we are empowering women everything will change, and it is best for all of society. At the end of the day I am looking at AIDS as an opportunity for Africa to change, for the better."

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