Newsday - December 26, 1988
Laurie Garrett. Newsday Staff Correspondent

But the five had more than just their symptoms in common - they were all upper-class Zaireans living temporarily in Belgium.

That spring Clumeck published a letter in a British medical journal saying, "this preliminary report suggests that Black Africans . . . may be another group predisposed to AIDS."

It was then that the world had proof that AIDS existed in Africa.

While scientists debated the importance of Clumeck's discovery, truck drivers in Zaire, Tanzania, Kenya and Uganda continued to visit brothels alongside major thoroughfares. Villagers, uprooted by war and social upheaval, flooded into cities. The largest, Kinshasa, Luanda, Bangui, Lusaka, Kampala, Nairobi, Mombasa and Kigali, became centers of a burgeoning youth culture that substituted discos, sex and travel for the traditional rural values. The rates of syphilis, gonorrhea and other sexually transmitted diseases climbed.

The number of urban AIDS cases in 1985 was still small when officials from Zaire, the Congo, Zambia, Uganda, Burundi, Kenya, Central African Republic and Tanzania gathered in Bangui to map strategies for containing the plague.

No one realized the virus was quietly taking a deadly toll in remote rural areas surrounding Lake Victoria. In towns like Entebbe, Mwanza and Bukoba, and villages such as Kanyigo and Minziro, people watched friends and relatives mysteriously die and urgently spoke of witchcraft.

Today, all but seven of Africa's 50 nations, with a combined population of 538 million people, have officially reported at least one case of AIDS. Cases of the disease have been found in nearly all of Africa's 3,000 ethnic groups or tribes, whether in the busiest metropolitan city or the most remote village.

World Health Organization scientists divide the globe into three AIDS groups, defined by the ways the virus appears to be transmitted. In the first group, countries in North and South America and Europe, AIDS is spread primarily among intravenous drug abusers and homosexual men. The second group of countries, all in Subsahara Africa, are experiencing a heterosexual epidemic. And the third group, nearly all in Asia and North Africa, has yet to experience a serious AIDS epidemic.

In the Lake Victoria region, which comprises parts of Tanzania, Kenya, Rwanda, Burundi and Zaire, more than half of all young adults are now infected with the primary AIDS virus, HIV-1, according to local surveys. Many scientists, who asked to remain unnamed for political reasons, said they believe the 1978 war between Uganda and Tanzania was key to spreading the epidemic. During that brutal 18-month war, villages on both sides of the border were occupied and re-occupied. Prostitution and rape were reportedly common.

In the predominantly Moslem Saharan region, countries officially acknowledge few cases of AIDS. Most have claimed fewer than 10; Egypt reports only six, Libya none. There has been speculation that some Islamic practices such as strict penalties for prostitution and drug use may be slowing the epidemic's spread, though little evidence has been offered. Most scientists argue that the AIDS epidemic has yet to reach the north from the epicenters a thousand miles to the south. "We must assume that is the case," said WHO's Daniel Tarantola, "and take steps now to prevent the disease from taking hold in these countries."

Some countries actively block the flow of AIDS information, fearing knowledge of the extent of the disease will jeopardize foreign investment and tourism.

According to the World Bank, AIDS is already severely taxing the beleaguered health care systems of several African countries, and threatens to slow economic growth in these, the world's most impoverished nations. Because the educated elites of several countries are among the prime groups hit by the virus, the World Bank is worried that the economies will further suffer as skilled personnel are infected by the epidemic.

There has also been political fallout from the first wave of western researchers who spread word of disease rates that rivaled those seen in Europe and the United States. Much of that initial research was seriously flawed, because the early blood tests for AIDS were unable to discriminate between infection from malaria and from the HIV virus, which causes AIDS. Because most Africans have a history of malarial infection, it was mistakenly reported that the continent was overrun by AIDS. Tests have since been improved.

The combination of early exaggerations and speculation that Africa was the origin of the epidemic deeply angered the continent's leaders, prompting some to ban all discussion of the disease and to close their doors to outside scientists and journalists.

But the biggest problem in determining the extent of the plague is the lack of infrastructure. The poorest continent, Africa has few paved roads, no reliable national telephone systems, modern medical facilities or computers to tabulate the death toll.

Dr. James Chin, of the World Health Organization, has pioneered mathematical and computer methods for estimating the size of epidemics when real numbers are lacking. Chin said in an interview that WHO, "has confidence that less than 10 percent of the real cases of AIDS are reported."

That estimate is based on studies where, under very limited circumstances, researchers have compared the reported number of AIDS cases to those they found in later in-depth surveys. In such a check, about nine additional unreported cases were found for each reported AIDS patient. Chin added that surveys of physicians in several African countries show that about nine out of 10 admit they either file no AIDS reports, or grossly underreport their cases.

Ideally, AIDS is diagnosed by a variety of standardized blood tests. In the United States, for example, AIDS cases are confirmed by a minimum of three separate blood examinations. But in much of Africa these simple tests are unavailable, and diagnosis is based on careful study of the patient. Doctors compare all the symptoms against an internationally accepted AIDS checklist. Comparisons with blood tests shows this method catches roughly 89 percent of all AIDS cases.

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Where the Danger Is

Incidence of AIDS virus (HIV-1 or HIV-2) infection in African countres, based on a Newsday compilation of informaltion from various sources. Data available for each country varies, and some of the population groups tested are high-risk groups such as prostitiutes or people who visit clinics for sexually transmitted diseases.

Key:

Negligible incidence of infection:

Tunisia, Morocco, Western Sahara, Mauritania, Mali, Algeria, Niger, Guinea, Sierra Leone, Liberia, Ghana, Nigeria, Libya, Egypt, Somalia, Madagascar, Djibouti, Lesotho

Insufficient information available:

Togo, Chad, Sudan, Mozambique, Namibia, South Africa, Zimbabwe, Gabon

Some population groups have a greater than 3 percent incidence of infection:

Guinea Bissau, Burkina Faso, Benin, Equatorial Guinea, Cameroon, Central African Republic, Ethiopia, Angola, Botswana

Some population groups have a greater than 30 percent incidence of infection:

Senegal, Ivory Coast, Congo, Rwanda, Uganda, Zaire, Kenya, Malawi, Zambia, Buhundi, Tanzania

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