A sixteen-year-old mother, one of many in this rural region of Zimbabwe, carried her malnourished baby like a limp rag in her arms into Howard Hospital. Mother and child were infected with AIDS, which killed 160,000 Zimbabweans in 1999, leaving more than 600,000 children orphaned. The young woman introduced her child as “Design,” not a particularly uncommon name in Zimbabwe. Danielle Harssema, the University of Toronto medical student who attended to them, recalls the irony of the child’s name. “Where is the design in all this?” she wonders. “These kids are dying of something so simple as eating the right food.”
Harssema remembers how she overcame the language barrier with her patients during the two summers she spent in Africa. “I found it hard to convey my sorrow and sympathy,” she says, “so I tended to cry. Tears don’t need any translation.”
Harssema’s emotional response is understandable in light of the situation she faced. According to the December, 2001 report by the Joint United Nations Programme on HIV/AIDS and the World Health Organization, AIDS killed 2.3 million African people in 2001. More than 8 per cent of all African adults are estimated to be living with the disease. Approximately 3.4 million new infections occurred in 2001, bringing the total number of people living with HIV/AIDS in this region to 28.1 million. In some of the most devastated areas of southern Africa, more than a third of pregnant women seeking prenatal care are infected.
Compare these statistics to those in North America. Here, the infection rate hovers around 0.6%. In Canada in 1999, about 400 people died of AIDS. They were likely treated with a powerful cocktail of AIDS drugs and died in a clean, modern hospital. In Zimbabwe, some people start walking at 3 a.m. to reach the hospital by noon. There is a bus available, but most cannot afford both the bus fare and the hospital fees, which, depending on services rendered, are a few dollars per day.
This is not to suggest that the problem of AIDS in Canada should be ignored. In fact, a team of U of T researchers, led by Professor Ted Meyers, will launch a study in January to investigate an increase in the rate of HIV diagnoses between 1996 and 1999 among gay men in Ontario.
The situation, however, is hard to compare. At the end of October, the United Nations Special Envoy for AIDS in Africa, Stephen Lewis, spoke at U of T at a panel discussion on AIDS in Africa. He said, “The pandemic is, in every sense, a modern apocalypse… You can stand in a number of parts of east and southern Africa and feel like you’re standing in a graveyard. You feel as though Dante’s “Inferno” has come real.”
Harssema faced a situation difficult to imagine. She travelled to Zimbabwe with a group from Ve’ahavta, a Canadian Jewish humanitarian organization. In Hebrew, “ve’ahavta” means “you shall love.” Once there, she worked at Howard Hospital, a non-profit private hospital supported by the Salvation Army servicing 200,000 people in the nearby area, about an hour outside the city of Harare.
Harssema estimated that about half of the people she saw in the hospital were HIV-positive, although many were asymptotic. She remarked, though, that “after a while you can start to pick out the ones with HIV—they look skinny and sick.” In a country already plagued by malnutrition, the effects of AIDS, a wasting disease, have been even more pronounced.
As most North Americans are aware, HIV can be spread by sharing needles or through sexual contact. Heterosexual sexual contact is the most common way the virus is spread in Africa. HIV is believed to have been first spread by truckers in Africa as they brought the disease from one prostitute to the next along their routes and then home to their wives. Also, polygamy is common to most of the continent, with men taking as many wives as they can afford. When one member of the family is infected, all members are likely to get the disease.
Once you’ve caught AIDS in Africa, there are few options available to you. Untreated, the disease is likely to cause death in about eight years. HIV disables the body’s immune system by attacking immune cells and forcing them to produce the virus. Its main targets are the helper T cells which organize the body’s immune response. After the immune system has been weakened, the body is open to all sorts of opportunistic infections. In Africa, where diseases like tuberculosis are still rampant, co-infection is very common. The UN estimates that almost half of HIV-positive people in sub-Saharan Africa will also develop active TB. These later infections, worsened by malnutrition, are what eventually lead to death.
Grim as these statistics are, there may still be cause for hope. Botswana, which has one of the highest infection rates in the world at around 35 per cent, has begun to combat the disease with a vigorous public health campaign combined with drug price reductions from pharmaceutical companies. A South African court has heard testimony from an activist group, Treatment Action Campaign, which is trying to force the government to offer nevirapine to pregnant women to prevent passage of AIDS from mother to child.
And students like Danielle Harssema continue to take an interest in global health causes. Asked how the experience in Zimbabwe has changed her, Harssema described the “special tug for me to get back there.” She says she learned that there’s “so much more than studying in Toronto and having a good job and being comfortable.”
Look for Part II of this series in the January 14th issue of the Varsity, which will explore the forces impeding treatment of AIDS in Africa.
