DRESSED IN their finest, members of Zambia's young elite
strolled into the elegant Maykusu Nightclub for a Saturday
evening of dining and dancing to the hot rhumba rhythms of
Zaire's Lumbumbashi Stars. Mosi beer flowed liberally and the
dancers reveled into the morning hours.
But the joy peaked as musicians shimmied their shoulders to the
repeated chorus of Le Sida, French for AIDS.
It may seem strange to find joy and dancing in a song that
simply repeats over and over again the name of the deadly
epidemic that has gripped much of Africa, but that is but one
of the contradictions here.
Unlike the epidemic 1,000 miles away around Lake Victoria,
Zambia's AIDS problem is relatively new, though growing. AIDS
here is found in the two largest cities, Ndola and Lusaka, and
is spread among young urban adults by the new sexual freedom
that is also found in the other major centers of the
continent's epidemic: Kigali, Dar Es Salaam, Kinshasa, Kampala
DESPITE the best of intentions and an aggressive educational
campaign, the fight against AIDS is being fought here by an
overburdened health-care system that has difficulty coping with
more immediate medical problems, such as a new, extremely
deadly form of cerebral malaria, rampant malnutrition and a
variety of tropical diseases that demand the bulk of the
nation's health budget and attention. It also conflicts with
some long-standing cultural traditions.
Zambia's battle with its AIDS epidemic is, like most things in
the region, being waged against a background of continuing
tensions with the West and with the apartheid regime of South
Africa. Secrecy in the name of national security has shrouded
much of the information about AIDS infection rates.
In times of relative prosperity, Zambia, a leading copper
producer, has always concentrated its wealth in Lusaka, where
construction, from high-rise office buildings to sprawling
suburban housing, is once again booming. According to the UN's
Food and Agriculture Organization in Rome, Zambia's
agricultural problems have decreased markedly, and this year it
will harvest a record 1.6 million tons of maize. That, too,
fattens the coffers of urban banks and industries as increasing
agricultural profits are invested.
Prosperity has ushered in an urban lifestyle conducive to the
growth of AIDS. The nation's urban young adults find themselves
the first generation with a significant disposable income, and
are eager to enjoy the fruits of their nation's relative
Zambia has managed to educate an entire generation of young
male and female civil servants, professionals and business
executives. A handful have become wealthy; most are simply far
more prosperous than their parents. The baby-boomers, those now
in their late 20s and early 30s, strive to dress in hip western
fashions, and most speak excellent English in addition to their
According to Zambia's most recent surveys, these young adults
are the key target group for the AIDS virus: more than 10
percent, men and women equally, are infected with HIV-1. Men
aged 30 to 35 in Lusaka have an even higher rate of infection:
more than a third test positive for HIV. And the epidemic,
among all groups, is doubling in size every eight months,
nearly twice the rate of the United States.
"That's a key risk population, absolutely," said Dr. Subhash
Hira of University Teaching Hospital in Lusaka. "They are
people who have a lot of disposable income, they have moved
away from traditional homes and are single people looking for
employment or having easy money." Hira said Lusaka has very
little prostitution, particularly compared to other major
African cities. "What we really have here," said Hira, "is a
free sexual atmosphere."
ACCORDING to Dr. Sam Nyawa, chairman of the government's
Zambian National AIDS Surveillance Committee, 1,056 AIDS cases
had been reported to the government as of last June. Nyawa said
the figure is accurate because doctors are required by a 1986
law to report all cases.
"If you compare AIDS to other health problems we have here in
Zambia," Nyawa said of the reported cases, "AIDS won't even
appear on a scale. But we can't say, 'Let's wait until it does
appear, until villagers are wiped out.' It is an epidemic, and
we must fight it." That fight, said Nyawa, should focus on
Zambia's AIDS hotspots - the cities of Ndola and Lusaka.
Dr. Eric Von Praag is the official World Health Organization
AIDS representative in Lusaka, working closely with Nyawa. Von
Praag said he is less confident of the figures.
The World Health Organization, which does not comment on
specific countries, says in general that only 10 percent of all
AIDS cases are actually reported in a typical African country.
Von Praag said he believes the same ratio applies to Zambia,
meaning that the nation of 7.1 million people could have a
total of 10,000 AIDS cases. Nyawa said such an estimate for
Zambia was absurd, adding that it is very unlikely the nation
has experienced far more than about 1,000 cases of AIDS.
Von Praag said that part of the reason for what he believes is
under-reporting are telecommunications and transport problems.
In addition, there is a growing awareness in government circles
that AIDS in children is usually misdiagnosed as marasmus or
acute malnutrition. A recently completed study at University
Teaching Hospital found that 20 percent of the children
admitted to the malnutrition ward tested positive for HIV
In addition, recent government studies show there has been a 60
percent increase in tuberculosis cases in Zambia. TB is a
common opportunistic infection among people infected with the
AIDS virus, and the government suspects this may indicate a
higher incidence of the disease than statistics now show.
Nevertheless, said Nyawa, "Our situation is still quite
containable. Serosurveys - blood screening - show that
98.7 percent of primary school children are uninfected. That
means if we target young people we may be able to prevent the
spread of AIDS in this generation. AIDS is still very much in
the early stages in this country, but we aren't taking any
chances. We are taking it as a priority."
As part of that effort, Zambia is waging one of the world's
most aggressive educational campaigns against AIDS, surpassing
anything being done in the United States. Throughout the
country, posters exhort the nation's young adults to "Stick to
One Partner" to avoid the scourge of AIDS.
The government's AIDS education campaign starts in grammar
school, where children are given a brightly colored pamphlet
depicting Kalulu the Rabbit saying, "Learn about AIDS and keep
yourself safe! You cannot tell by looking at someone if they
are infected, so for safety stick to one rule: No sex before
Secondary school students receive a more detailed pamphlet that
describes the biology of AIDS and quizzes readers about their
knowledge and prejudices related to the disease. One page
depicts a prostitute who says, "Sex for sale? AIDS is the
price! I think I'll take up farming - it's safer!" The
pamphlet goes on to urge young people to have absolutely no sex
before marriage, and remain faithful to their marriage
partners. "Boys, have the strength not to ask!" it advises,
and, "Girls have the right to say no!"
A similar theme forms the basis of the government's adult AIDS
education campaign. Posters all over the country urge Zambians
to stick to one partner, and depict marriage as the umbrella
that fends off showering AIDS viruses. One prominent poster
states simply, "Sex thrills, but AIDS kills."
ZAMBIAN President Kenneth D. Kaunda, who acknowledged that his
30-year-old son, Maguzyo, died last year of AIDS, has been more
outspoken about AIDS than any other head of state. In an August
statement before the ruling party congress, Kaunda, a devout
Christian, said, "It is not enough for believers just to kneel
down and pray because there is no secret in this except to face
the situation as it is. Doctors are telling us to stick to one
sexual partner, male or female. If we cannot do that out of
strong, moral principle or religious beliefs, we will have to
do so as a matter of self-preservation because if we do not
behave well in this respect, AIDS will catch up with us - and
sooner rather than later."
In Zambia, where 70 percent of the people are Christian and
missions run by the Jehovah's Witnesses and Jimmy Swaggart are
prominent, all condom campaigns have generated strong
opposition. The groups oppose the use of condoms and argue that
such birth control also promotes promiscuity and adultery.
According to Von Praag, there are plenty of condoms in family
planning offices, but their use is not promoted because of
protests from the Christian community, and young adults are
generally unaware that condoms can help protect them from AIDS
infection. No condoms are distributed in the schools.
To date, no studies have determined what effect Zambia's
educational campaign is having. Young Zambians call AIDS "slow
puncture": like a slowly deflating tire because people with
AIDS waste away. The use of the "slow puncture" phrase lends a
certain comic element to discussion of the disease, apparently
making it easier to shrug off.
Health workers say that halting the epidemic requires a sharp
change in cultural patterns, some of which are deep-seated.
Last year University Teaching Hospital focused on the spouses
and sexual partners of people infected with the AIDS virus.
Couples were informed that condoms provided the only barrier to
the otherwise inevitable transmission of the virus between
them. Despite such aggressive counseling, less than 10 percent
of the couples opted to use condoms.
At Chinkankata Hospital some 60 miles to the south of Lusaka,
social worker Thebisa Hamukoma regularly confronts AIDS
patients, their lovers and relatives about their attitudes
toward AIDS. Last year, 183 out of 680 admissions to her
hospital were diagnosed as having AIDS, and it became obvious
drastic steps had to be taken to slow the spread. Most of the
people in the rural area are members of the Tanga tribe, which,
Hamukoma said, carried out an unusual practice that promoted
the spread of AIDS - "ritual cleansing."
"It is traditional among the Tanga people," said Hamukoma,
"that the bereaved spouse is supposed to be cleansed following
a death. If the cleansing does not take place, the surviving
spouse will be haunted by the dead one for life." Cleansing is
accomplished when the family selects a partner for the bereaved
spouse, and the pair must engage in a night of intercourse.
If the bereaved spouse is infected with the AIDS virus, which
is usually the case, it could be passed on during the ritual.
Hamukoma said she and her colleagues have devoted a lot of
effort to persuading families and spouses to forego the ritual,
or replace it with some other rite that might safely serve the
same purpose. "Half the spouses counseled had a negative
reponse to the idea," she said. "But in ninety percent of the
cases the families pushed the spouses and an alternative to
ritual cleansing was found."
HIRA said the practice is limited to two Zambian tribes, and
careful counseling seems to have dramatically reduced the rite.
Despite this success, the epidemic continues to expand in the
area through nonritual heterosexual intercourse.
"AIDS is not a problem in the villages, the way, for example,
syphilis is," Hira said. "HIV is a disease of the
better-educated, well-to-do, those who are single, the young
population, mostly in the cities. There is no doubt it is
heterosexually transmitted, and the entire risk is based on
Because the disease is transmitted heterosexually in Zambia,
foreign scientists have eagerly moved in for short-term
research projects. In general, the tremendous costs of AIDS
treatment and research have made Zambia's health officials
agreeable to such collaboration, though it has also brought
Early in the Zambian epidemic a group of American scientists
tested hospital patients for AIDS infection and then released
the information to western reporters before discussing it with
their Zambian collaborators. When the number of those infected
was reported to be large, several Zambian scientists
temporarily lost their jobs, and political tensions with the
"In the past people have exploited our situation," said Hira,
"blown it up, and in the process there was a political
backlash. And what happened was that the entire medical
research effort suffered, not just in Zambia, but everywhere.
Because it is the exchange of knowledge between researchers on
various continents that is so important. No medical problem has
ever been properly addressed by 'safari research.' We have
people come in for two weeks and they go back and tell you,
'Look, you have a problem in this area.' That is wrong. The
research should be done by local people, or people committed to
the region on a long-term basis."
All collaborative research projects on AIDS are now cleared
through the Ministry of Health's Ameristo Njelesani, who said
the real task for his office is to protect AIDS patients from
overzealous drug companies and foreign scientists.
OVERALL, there is concern in Africa that the continent's people
will be asked to serve as guinea pigs in the war on AIDS. At a
news conference two months ago, leading U.S. AIDS researcher
Robert Gallo, of the National Cancer Institute, suggested AIDS
vaccine trials might best be conducted in Tanzania and Uganda,
rather than the United States. Tanzanian officials bristled,
saying no drug or vaccine should be tried on Africans before it
has been tested on volunteers in the country in which it was
President Kaunda said in an interview that this represents an
alarming event. "I wish that some international regulations
could be formulated," he said, "which would place controls on
these matters. How could anybody think we should be guinea pigs
here? Human beings! I can't understand that. We are all one
human race, and for any part of it to be treated as guinea
pigs, because of their race or I don't know what, is wrong."
AIDS also has increased Zambian antipathy toward the western
press, which has charged that the government is covering up the
true extent of its epidemic, an accusation Njelesani vehemently
There is, however, no doubt that a certain amount of secrecy
shrouds Zambia's AIDS situation. A technician at University
Teaching Hospital said, "It is absolutely forbidden to give out
information about the prevalence of HIV infection. We cannot
tell you anything. It's because of them." The technician
pointed to two young soldiers sitting nearby. "The South
Africans ran news stories saying all our boys in the army were
infected, every single one of them. And people started saying
nasty things, like the Zambian army would be the first one in
history wiped out without firing a shot. And these chaps -
the soldiers - got quite upset."
Last year, the government conducted a survey of infection rates
among its soldiers, and officially denied the South African
reports. But the survey findings have never been made public,
and sources at WHO in Geneva say even the agency has not been
able to obtain the data.
ZAMBIAN reticence to release further information about AIDS
also comes at a time when the nation is locked in a battle with
the world's largest lending institution, the International
Monetary Fund. Since AIDS is hitting the educated elite of the
nation, Zambian officials are concerned about the long-term
economic impacts of the epidemic. The World Bank has made
financial forecasts of the AIDS epidemic, predicting dire
circumstances for many African nations. Zambia is struggling
hard to cut its losses, control the epidemic and limit its
effect on the economy. Zambian leaders fear that exaggerated
accounts of the impact of AIDS could cut off vital
Throughout the world, governments are having a difficult time
balancing present health priorities against the danger that is
acquired immune deficiency syndrome.
But for nations such as Zambia, whose economies are in constant
need of external support, any additional health spending is
made at some pain. This is particularly true when the nation is
in the grips of other epidemics. Young Zambian adults are
falling to a new, drug-resistant form of cerebral malaria.
Between January and August of this year, University Teaching
Hospital saw 26,524 cases of the new type of malaria, more than
9,000 of which required hospitalization.
Four months ago, a team of West German and Zambian researchers
released results of a nationwide survey on malnutrition,
finding that 55 percent of Zambia's children under 4 were
dangerously underweight, and malnutrition accounted for 48
percent of all child mortality.
In the face of such enormous usual medical problems, AIDS
becomes just another threat to an already tenuous existence.
The question facing Zambia, and other stricken African nations,
is whether the disease will prove to be one threat too many.
NEXT: The Monetary Cost
Dancing to the Beat of a Musical Battle Cry
The No. 1 song heard on radios and in record stores from Lusaka
to Kinshasa is "Attention Na SIDA," or "Beware of AIDS." It was
recorded more than a year ago by Zaire's most popular muscian,
Franco Luambo Makiadi, who bills himself as "The Grand Master
Franco," and his T.P.O.K. Jazz Band, and has remained on the
pop charts of Central Africa ever since. It is common to see
crowds roaring "SI-DA! SI-DA!" to the beat.
"Oh! Le SIDA! Une terrible maladies!" shouts Franco. Going back
and forth between French and Kilunda, Franco issues a veritable
battle cry against AIDS:
Oh! AIDS! What a terrible disease!
AIDS! A Disease that pardons no one.
AIDS! A disease that attacks all persons.
Oh, it's something to fear, this AIDS.
All medicines are impotent before it.
Keep your body, I keep mine.
Protect yours, I protect mine.
AIDS! It ravages all societies.
There is fear.
Europe and America accuse Africa of being the origin of AIDS.
All sections of society are victimized by AIDS.
Babies, children, youth, workers, bureaucrts, politicians,
women, men - it is the same for all.