San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Tuesday November 20, 1990 Edition: FINAL Section: BRIEFING Page: 2/Z1 Word Count: 1,566
Ed hooper

Ed Hooper is a British journalist and author specializing in AIDS coverage. His book, "Slim: A Reporter's Own Story of AIDS in Africa," was recently published in Great Britain by Bodley Head

TEXT:

In 1988, Zimbabwe became the first country in the world actually to downgrade from 380 to 119 its total of AIDS cases -- as officially reported to the World Health Organization -- because only the latter number had been subjected to three separate confirmatory tests for the causative virus, HIV.

In itself the incident was trivial, but it typified the atmosphere of denial which has characterized Zimbabwe's public response to HIV and AIDS during the two years when an army brigadier was serving as health minister.

During the last 10 months, however, Zimbabwe seems to have embraced a far more candid approach.

First came the decision to allow doctors to inform patients about their HIV status; then came official permission for the word "AIDS" to be entered on death certificates.

In April, in his Independence Day speech, President Robert Mugabe called AIDS one of Zimbabwe's five major problems, and appointed Dr. Timothy Stamps as health minister. Stamps is known to be a champion of safer sexual practices.

At the start of May, the ministry announced that Zimbabwe now had 2,357 confirmed AIDS cases, or three times the official total of nine months previous.

(WHO estimates that in sub-Saharan Africa, one of every 40 adult men and women is infected with the HIV virus; as of mid-1990, about 65,000 AIDS cases had been reported from the African continent, although WHO adds that closer to 500,000 adult AIDS cases probably exist -- more than half the estimated global total.

(The organization says, conservatively, that 5 million Africans may be HIV carriers and if the trend continues, millions of African infants will be born with the deadly disease.)

A CONFUSION OF INFORMATION

The new atmosphere in Zimbabwe has allowed much more material about AIDS to appear in the press, but not all of it has been constructive.

An example is the advertisement placed by the ruling political party, ZANU-PF, during the recent election campaign, which baldly equated the major opposition party, ZUM, with AIDS.

Elsewhere, long articles appeared quoting terrifying, but inadequately sourced, HIV-prevalence figures.

In one report it was claimed that between 1 and 2 million of Zimbabwe's 9 million people could be HIV-positive; in another that "at least 60 percent of Zimbabwe's uniformed forces" were infected with the virus.

Such unsubstantiated data tend only to encourage official reticence. There are, however, some hard statistics available which suggest that Zimbabwe does indeed have a serious problem.

Three years ago, an unpublished survey of 300 bar girls living along the two main arterial routes between Zambia and Zimbabwe found that some 70 percent were HIV carriers -- a percentage that echoes those for groups of prostitutes and bar girls tested in Uganda, Rwanda and Kenya at around the same period, between 67 percent and 88 percent of whom were found to have the virus.

Even more alarming are the figures for Zimbabwe's first-time blood donors, some 7 percent of whom tested HIV-positive during the first months of 1990.

However, more than half the donors were teenage high school students, hardly any of whom were infected.

Among the rest, the first-time donor adults (mostly factory workers), about 15 percent were carriers. The fact that each donor is first examined by a nurse, counseled, and then made to sign a form that seeks to discourage donations from those who have had many sexual partners, suggests that HIV-prevalence, at least among urban adults, may exceed 15 percent.

Other statistics from around the region are just as alarming. A source in Zimbabwe's health service says that recent tests on adults in Lusaka, the Zambian capital, found 32 percent to be infected.

Extrapolations made by a consultant epidemiologist from Malawian survey data indicate that 17 percent of sexually active adults in the country's rural areas and 19 percent of those in towns have HIV.

The war against the right-wing Mozambique National Resistance (Renamo) has prevented widespread data collection in Mozambique, but last year 10 percent of adults sampled at random in the Beira corridor, and 24 percent of a small group of newly returned refugees, were found to be carrying the virus.

Such figures are ominously similar to those in Uganda, where a national serosurvey carried out in late 1987 and early 1988 found that nearly 800,000 people (including 12 percent of the rural adults in one region and 29 percent of the urban adults in another) were HIV-positive.

Last year the Ugandan government estimated that 1 million people, or 6 percent of the total population, were infected.

ROADS TO CONTAMINATION

The similarity ends, however, when one compares numbers of confirmed AIDS cases. Uganda currently reports 12,444 such cases -- or nearly three times as many as Zimbabwe on a per capita basis.

All this would suggest that in Uganda HIV began to infect people in large numbers some years before it did in Zimbabwe, but that the latter country has now effectively "caught up."

Many epidemiologists believe that the reason for HIV's faster spread in southern Africa -- both from country to country and town to countryside -- is that the transport network is better developed than in east Africa, allowing both human beings and human immunodeficiency virus to move about more easily.

In many ways, Zimbabwe has already made an energetic response to the threat posed by AIDS. A well-developed health service, and an excellent Blood Transfusion Service (the third in the world to screen blood for HIV on a national basis), ensure that very few are infected through unsterilized needles or contaminated transfusions.

Meanwhile, the national AIDS Control Program (with a 1990 budget of $6 million) does its best to reduce sexual transmission by mounting health education campaigns in the media, distributing pamphlets written in Zimbabwe's three lingua francas, and undertaking peer education programs among groups such as prostitutes and truckers.

The ACP expects to distribute 26 million condoms this year alone.

Individuals are also helping. Peter Fraser Mackenzie, a white farmer from rural Mutoroshanga, is so exercised by the threat of HIV that he hands out condoms with his workers' pay packets, and keeps the local library and post office supplied with AIDS manuals.

ACT, the AIDS Counseling Trust, just over a year old, not only provides counseling for people with HIV and AIDS, but mounts a "Body Positive" self-help group, runs training workshops for teachers, doctors and nurses and produces a wide range of health education materials, including an excellent AIDS comic book.

But it takes only a brief tour around the country's hotels, bars and discotheques to confirm that the average Zimbabwean is not yet taking the threat of AIDS seriously.

SEXUAL MERRY-GO-ROUND

The overall impression is one of a hectic sexual merry-go-round. All groups, from school children to farm workers, would seem to be in need of more forthright information about the risks of unprotected sex.

This opinion is confirmed by "Charles Mahuni," a 27-year-old health worker who, in late 1988, recognized that his persistent symptoms were indicative of immune suppression, and volunteered himself for an HIV test.

He was found to be seropositive, as was his wife. Their first child died a few days after birth, although their second has thus far tested HIV-negative.

Charles is angry with the health ministry for its former lack of candor about the epidemic.

"They were actually frightening people rather than informing them. There was a poster saying 'AIDS Kills,' but there was no real information about what happens -- not enough about what the virus does, and how it is caught.

"The (health education) campaign was only emphasizing that women can pass the virus: nothing was said about men giving it to women."

Charles believes that the government needs to be more frank if people are to be persuaded to change their sexual lifestyles. He himself acknowledges having had "at least eight girlfriends who were a bit steady" and having slept with another 20 to 25 prostitutes.

He adds that: "it was, and it presently is, the 'in thing' with young guys to go out with a lot of partners . . . We have a Shona proverb: 'A strong bull is seen by scars.' Even if you got a sexually transmitted disease, it just showed your virility."

Stamps, the newly appointed minister of health, echoes these sentiments when he says that he is far from satisfied with the level of awareness about HIV and AIDS in the country.

"The amount of work that needs to be done is pretty immense. Sexual attitudes are not really changing . . . We have to establish mutually faithful life-long marriage as the norm.

"Unless we can (do that), any other (advice), like 'Choose your partner carefully' or 'Put a condom on,' is not going to reduce the tremendous number of people (added to) the HIV-infection lists."

CAPTION: PHOTO (3)

(1-3) A doctor from the Makerere University Department of Health, above, tested a man in a Ugandan village while Sister Nellie Carvalho, below right, analyzed blood samples at a hospital there as part of the effort to halt the spread of AIDS to victims such as the woman pictured at left/PHOTOS BY ED HOOPER

Always watch for outdated information. This article first appeared in 1990. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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