Aids and a lost generation: Children raising children

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The Independent Online

Ruth Nakabonge crouches on the ground clutching a handful of earth to fling over her father's coffin. She is too distressed to cry, her tiny body contorted by grief as a relative gently strokes her forehead.

Ruth was eight when her father Samuel died of Aids in their Ugandan village. She has not just lost a father, she has also been deprived of a childhood, like millions of other children across the continent.

Samuel Nakabonge is not just another Aids statistic. He is a symbol of how the Aids pandemic is still cutting down the breadwinners of Africa in their prime, leaving behind an army of orphans. Girls like his daughter Ruth suddenly find themselves thrust into the role of parent, responsible for the welfare of their siblings.

Samuel lost 10 members of his family to Aids before he succumbed to an opportunistic disease that took his own life, his body wasted from the virus that was once known as "the slims" in his country.

It is easy to see how Aids is responsible for creating a missing generation across Africa, devastating economies, and crippling health sectors as it strikes. Across the continent, 6,500 Africans are dying every day, the equivalent of a village being wiped from the map every 24 hours. A further 9,000 are infected each day by HIV/Aids, which is the leading cause of death in Africa.

In Uganda, 84 per cent of Aids victims contract the disease through heterosexual contacts. The men go first, followed by their wives. Fourteen per cent of children are infected by mother-to-child transmission. Up to 6.6 per cent of the adult population in Uganda is infected with HIV. If you are an adult male in Uganda suffering from Aids, you are unlikely to live beyond the age of 47.

In Zimbabwe, the population is already struggling to survive an economic crisis and an inflation of 1,000 per cent, brought about by the policies of their tyrannical leader President Robert Mugabe. Now, one in three children in Zimbabwe are Aids orphans, and the anti-retroviral drugs are running out.

In the continent's economic powerhouse, South Africa, 800-900 people every day are dying from Aids. The country holds the dubious record of having 5 million HIV/Aids sufferers: the highest number in the world, with 21.5 per cent of the population infected. "President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang have failed to provide unambiguous and clear leadership on Aids," says Mark Haywood of the Treatment Action Campaign, which successfully sued the South African government to roll out anti-retrovirals. "South Africa is getting it wrong at the very top."

"They [the leaders] still send out confusing signals doubting the efficacy of ARVs. Some people are now actually scared of treatment. It's a tragedy," Mr Haywood added.

Africa still lags lethally behind the West, which has taken great strides thanks to life-saving anti-retroviral drugs. Falling drugs prices and new sources of international funding are needed to help it catch up.

Aids treatment varies from country to country, but also can vary greatly from place to place within a single state, and even within a single city.

Botswana's biggest hospital, the Princess Marina in Gaborone, recorded eight people yesterday who died of HIV-related illnesses. Yet at the Botswana-Baylor Children's Clinical Centre of Excellence, which benefits from Western cooperation in a public-private sector partnership, the chief nurse, Liz Lowenthal, said that no deaths were recorded at her Gaborone clinic in the past 24 hours.

"We have about 1,400 children receiving highly active anti-retroviral therapy (HAART) through our site. Walking through the waiting room, you would not recognise most of these children as being ill in any way," she says.

"The areas where death rates are high due to Aids-related illnesses are those in which HAART is not readily available. In Botswana, when children are diagnosed early, they are entitled to free treatment and generally do as well as children in Western nations on the same excellent regimens," she said.

So even in Africa the picture is not entirely gloomy. Governments - including those of Uganda and Botswana that have put Aids at the heart of government policy - have notched up some successes.

But it is not just a lack of appropriate medicine that is preventing Africa from saving a generation. Other major obstacles are preventing the Aids pandemic from being conquered. One of these is ignorance of how the virus spreads.

In South Africa, whose urban blacks have had the benefit of education, a former deputy president of the country, on trial for allegedly raping a 31-year old HIV-positive woman revealed the depth of ignorance about how HIV/Aids is transmitted. Jacob Zuma told the court that he was safe from contracting the disease because he had taken a shower after having unprotected sex with the woman, an Aids activist and family friend. He said that it was his understanding that it was difficult for a man to contract HIV by having sex with a woman.

Mr Zuma was acquitted of the rape charges last week. Aids campaigners complained that his statement in court had thrown years of hard work in Aids awareness down the drain.

A second obstacle holding up progress is the issue of abstinence, with programmes in Africa promoted by the Christian right wing in America and advocated by such prominent politicians as Colin Powell, the former secretary of state.

Ugandans were once told that "the slims" could be kept at bay through the ABC strategy of "Abstain, Be faithful and wear Condoms" . But now, thanks to US-funded programmes which carry ideological conditions, the condoms are literally being thrown away, and HIV-Aids infections are on the rise again.

Ruth Nakabonge's father died five months ago. Since that time, according UN estimates, 31,950 Ugandans have perished from HIV/Aids - and almost one million Africans have died. How many more villages will fall silent before the global response catches up with the deadly pace of the pandemic?

A continent's misery

* Sub-saharan Africa is home to 10 per cent of the world's population and 60 per cent of the world's Aids population.

* Right now in Nigeria, there are 1.8 million Aids orphans. There are 12 million across the continent.

* In South Africa, 4,000 teachers will die of Aids this year.

* 37.5 per cent of South Africans would keep it secret if a family member was diagnosed with HIV.

* 66 per cent of South Africans think they will never contract HIV. 41 per cent of those use condoms.

* 6,500 people died from Aids on this day last year

* There is at least one HIV-positive child in every classroom in Botswana

* 9,000 people across Africa are infected daily

* More than 15 million people in Africa have died of Aids, more than the highest estimates of the Rwandan genocide (800,000), Khmer rouge regime (up to 2 million), Holocaust (11 million) and Iraq war (up to 38,000) combined.

Only 16 per cent of HIV positive people in Africa can hope to receive antiretroviral drugs.