|AIDS in Africa (UNAIDS, 1999, 11 p.)|
For all the palpable effects of AIDS, a silence born of shame and blame continues to shroud the epidemic in many of even the hardest-hit countries.
A recent study of voluntary counselling and testing offered to pregnant women in developing countries found that in many places with extremely high HIV prevalence, women refused testing or did not return for their test results. This was the case even when interventions that might help them give birth to a healthy baby were being offered to those who tested HIV-positive. In CdIvoire, for instance, fewer than half of more than 13 000 pregnant women in two study sites accepted to be tested and then came back for their results. More worrying still, in a majority of sites it was the HIV-positive women who were less likely to return. This correlation was seen in South Africas Soweto, too, where almost all pregnant women in the study agreed to be tested, four-fifths overall came back for their test results, but only half of those who were HIV-positive sought out their results. These systematic differences suggest that women who may be aware that they have been exposed to infection, or who have taken risks, shrink from learning their HIV status.
There is evidence that the fear and denial provoked by AIDS extends even to people working in the health sector. One study in southern Africa sought to record the number of needlestick injuries in primary health care clinics. Researchers found almost none-an unlikely scenario in overworked clinics with poor facilities. Senior staff then explained that, under clinic policy, anyone who reported a needlestick injury had to undergo HIV testing to measure the danger of sero-conversion through exposure to infected needles. Nurses did not report needlestick injuries because they did not want to be tested.
Silence can continue to reign even when people with HIV are ill and dying. Because AIDS is just the name for a cluster of diseases that immunodeficient people develop, patients and their carers can choose to view the illness as just tuberculosis, or diarrhoea, or pneumonia. An example from southern Africa is telling. In one study of home-based care schemes, fewer than 1 in 10 people who were caring for an HIV-infected patient at home acknowledged that their relative was suffering from AIDS. Patients themselves were only slightly more likely to acknowledge their status.
For too long we have closed our eyes as a nation, hoping the truth was not so real, South African Deputy President Thabo Mbeki told South Africans in October. At times we did not know that we were burying people who had died from AIDS. At other times we knew, but chose to remain silent.
With this major speech, South Africas leadership joined those who have spoken out loudly and clearly about AIDS, have sought to demystify it, and have encouraged discussion about safe sex everywhere from the classroom to the boardroom. It is in such countries-of which Uganda is probably the best known example in the developing world-that most progress has been made not just in putting a brake on new infections but in ensuring the wellbeing of those people who are already living with the virus.