[Congressional Record Volume 145, Number 96 (Thursday, July 1, 1999)]
[Extensions of Remarks]
[Pages E1500-E1502]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               AIDS EPIDEMIC IS CRISIS IN SOUTHERN AFRICA

                                 ______
                                 

                          HON. ROSA L. DeLAURO

                             of connecticut

                    in the house of representatives

                         Thursday, July 1, 1999

  Ms. DeLAURO. Mr. Speaker, I want to draw the attention of my 
colleagues to the AIDS epidemic which sub-Saharan Africa faces today. 
In all, 11.5 million people have died in sub-Saharan Africa since the 
disease emerged in the 1980's, and 22.5 million people now living with 
the HIV virus are expected to die in the next ten years. By the end of 
1997, at least 7.8 million children in this area of Africa alone were 
left orphans by the age of 14 due to AIDS.
  I am submitting for the Record these articles from the May 29th issue 
of the USA Today, which detail the problem.

                   [From the USA Today, May 24, 1999]

 Time Bomb South of Sahara--U.S. Urged to Confront Reality: 20% Could 
                                  Die

                          (By Steve Sternberg)

       Soweto, South Africa.--When the AIDS virus detonates in 
     this black township of 3 million in a decade or so, the 
     disease will wipe out about 600,000 souls--almost six times 
     as many people as the atomic bombs killed in Hiroshima and 
     Nagasaki.
       But unlike a nuclear blast or world war, the AIDS crisis is 
     an explosion in slow motion, a creeping chain reaction with 
     no end in sight. There is no sound, no searing heat, no 
     mushroom cloud, no buildings reduced to rubble. Just one mute 
     death after another.
       Sandra Thurman has come here--to the country where AIDS is 
     spreading faster than in any other on Earth--to break that 
     silence.
       Director of President Clinton's Office of National AIDS 
     Policy, Thurman hopes to bring home to the American people 
     and to Clinton the immensity of the crisis in South Africa 
     and the other countries south of the Sahara that form the 
     epicenter of AIDS.
       To this end, Thurman and a small team of U.S. officials 
     recently traveled through South Africa and three other 
     countries at the heart of Africa's AIDS epidemic: Zambia, 
     Zimbabwe and Uganda. A USA TODAY reporter and photographer 
     accompanied them to document the ravages of what is now the 
     No. 1 cause of death in Africa.
       In all, 11.5 million people have died in sub-Saharan Africa 
     since the epidemic emerged in the early 1980s, and 
     22.5 million now living with the virus are expected to die 
     in the next 10 years, according to UNAIDS, the United 
     Nations' AIDS agency.
       Staggering as the numbers are, Thurman believes that the 
     sub-Saharan epidemic has been met with indifference by 
     Americans and, to some extent, by their government, which 
     spends $74 million a year on AIDS programs in the region. In 
     contrast, Congress this month voted to spend $1.1 billion to 
     assist roughly 750,000 Kosovo refugees.
       ``When you're looking at whole generations of adults and 
     children in jeopardy--we ought to be able to hold hands and 
     sing Kumbaya around that,'' Thurman says. ``We can't do 
     anything if we can't do this.''
       To gauge the social and political costs of AIDS here, 
     Thurman visited cities and shantytowns, orphanages and 
     hospitals, taking in scenes from an epidemic.
       One of Thurman's first stops was at the Javabu clinic, 
     headquarters of the Soweto Project--an effort to unite 
     medical care, social support and AIDS prevention.
       The project is the brainchild of Mark Ottenweller, 10 years 
     ago a prosperous internist in a leafy suburb of Atlanta. 
     Today, at 47, he works in Johannesburg as a medical director 
     of Hope Worldwide, the relief arm of the International Church 
     of Christ.
       The clinic is housed in a small cluster of brick buildings 
     on a broad lawn, bordered by the brilliant splashes of 
     jacaranda and bougainvillea. To its beneficiaries, it's a 
     lifeline.
       Mary Mudzingwa, 35, mother of Chipo, 9, and Gift, 5, 
     credits the Soweto Project for helping her adapt to life with 
     HIV.
       ``I lost may job. I lost a place to stay. Now I stay with 
     friends, but there's no toilet, no water. Maybe that's why my 
     9-year-old is always sick.''
       She says that one of the most difficult things about having 
     the virus is the way it changes how people respond to you.
       ``Some people, I told them I am HIV-positive. They were 
     afraid. I said, `Don't be afraid. We look like other people.' 
     ''
       Many of the people Mudzingwa was preaching to probably are 
     infected themselves, though they don't know it.
       Ninety-five percent of HIV carriers in sub-Saharan Africa 
     have not been tested because tests are in short supply and 
     many people deny they are at risk.
       Consider the men Ottenweller comes across a few days later, 
     on an AIDS-prevention foray into the shantytown of Klipstown, 
     near Soweto. They grow silent as Ottenweller approaches.
       ``I'm Dr. Mark,'' he says, half in Zulu, half in English. 
     ``How many of you guys wear condoms?''
       Quizzical smiles bloom on embarrassed faces. Half the men 
     raise their hands; half seem indifferent. ``I never use a 
     condom,'' one man says defiantly. ``I stick to one partner.''
       ``But does she stick to you?'' the doctor asks. ``Come see 
     me at the clinic when you get sick.''
       ``Ten years from now, one-fifth of these people will be 
     dead,'' Ottenweller says later. ``HIV is going to hit this 
     place like an atom bomb.''
       Tests of women in prenatal clinics, a group believed to 
     reflect the infection rate in the general population, show 
     that at least one of every five people in South Africa, 
     Zimbabwe, Zambia and Botswana is infected with the AIDS 
     virus.
       That means those nations stand to lose at least one-fifth 
     of their populations, a death toll that rivals the Black 
     Plague in Medieval Europe.
       In some places, the infection rates are much higher.
       In South Africa, between 1991 and 1997, the infection rate 
     on average soared from 2% to almost 18%. And in South 
     Africa's most populous province, KwaZulu-Natal, the rate has 
     reached 37%.
       Alan Paton, in the classic 1948 novel Cry, the Beloved 
     Country, described the province's rolling green hills as 
     ``lovely beyond any singing of it.'' Those lovely jade hills 
     outside Pietermaritzburg are still there.
       But there also stands a massive brick building that is 
     overflowing with human misery beyond any lamenting of it.
       The building is a hospital known as Edendale.
       During apartheid, it was for blacks only. That soon will 
     change, as part of a massive South African health reform 
     program under way.
       For now, the battered wooden benches lined up in corridors 
     and the large anterooms in the hospital's wards are packed 
     with black people. Some are waiting to deliver babies--8,000 
     are born here each year, although there is just one 
     obstetrician on the staff.
       On average, 20 children are admitted to Edendale each day. 
     More than 60% are infected with the AIDS virus, says 
     pediatrician Johnny Ahrens, and they often are brought in by 
     their grandmothers or aunts because their mothers have died.
       The nurses in the pediatric HIV ward, once accustomed to 
     returning children to health, now are so over-whelmed with 
     dying infants that they are on the brink of cynicism.
       Many nurses, Ahrens says, are beginning to think: ``If 
     there's nothing you can do to help, why bother? It's just one 
     more dying child.''
       Ahrens himself is furious because he thinks the government 
     should have done something, anything to stop HIV before it 
     took hold.
       ``We all knew that HIV was going to hit South Africa. It 
     was coming down through Africa like a red tide. People were 
     trying to warn us. But nothing ever happened.
                                  ____


              Zambia: The Cradle of Africa's Orphan Crisis

       Lusaka, Zambia.--Fountain of Hope resembles nothing so much 
     as a refugee camp for children. And it is nearly that for 
     1,500 of the 128,000 orphans who live on the streets of this 
     lush capital, with its broad boulevards and spreading trees.
       This informal day school in a shabby recreation center 
     downtown was the first stop outside South Africa for Sandra 
     Thurman, the White House's top AIDS official, on a recent 
     fact-finding mission to see the AID's crisis in Africa.
       Each morning, the youngest victims of AIDS, ranging in age 
     from 3 to 15, straggle in from the streets. They don't come 
     for the books or the playground or the toys. There aren't 
     any. And there's nothing distinctive about the rec center, 
     built of unadorned concrete.

[[Page E1501]]

       They come because it's better to be here than in the lonely 
     streets, where food is scarce and companionship often 
     involves sex with an older child. Here volunteers teach 
     reading, arithmetic and music. And there's food--though only 
     every other day.
       Zambia once was one of he richest countries in sub-Saharan 
     Africa. It supplied copper for the bullets the United States 
     used during the Vietnam War.
       Now this country of 11.5 million is one of the poorest--and 
     bears the distinction of having one of Africa's largest 
     orphan populations. In 1990, Zambia had roughly 20,000 
     orphans. By next year, says UNAIDS, the United Nations' AIDS 
     organization, there will be 500,000.
       ``The numbers of orphans are increasing by the day,`` 
     Zambian President Frederick Chiluba tells Thurman. ``Street 
     kids are everywhere, and we don't have the funding to care 
     for them.''
       And they're not just concentrated in the cities. For 
     example, the shantytowns called St. Anthony's and Mulenga's 
     compounds, in Kitwe near the Congolese border 150 miles from 
     Lusaka, have huge numbers of orphans--about 20% of each 
     town's 10,000 residents.
       Eventually, many orphans find their way here to Lusaka.
       In 1996, when the Fountain of Hope school started, there 
     were 50 children, outreach coordinator Goodson Mamutende 
     says. Just three years later, 30 times that many attend 
     classes in two shifts. Fountain of Hope staffers estimate 
     that half the children have been abandoned; the other half 
     have lost parents to HIV.
       And with 700 HIV-related deaths each week in Lusaka along--
     a number so large it has caused weekend traffic jams and day-
     long waits in the cemeteries--the number of orphans and 
     abandoned children continues to multiply.
       Dirty-faced, wearing the cast-off clothes that are their 
     only possessions, the children eagerly cluster around a 
     makeshift blackboard to learn arithmetic and the alphabet. 
     They learn to sing in unison, acting out the songs 
     enthusiastically. ``Fight child labor with an AK 47,'' 
     they shout, thrusting their arms as if they were firing 
     guns.
       Nicholas Mwila, 23, who has written the words for many of 
     their songs, is the art director.
       ``I take them as they are, the way I find them,'' he says. 
     ``I want them to dress as they do on the street. I don't 
     encourage them to take a bath.''
       These ``gutter kids,'' Mwila says, project a message to 
     Thurman and the visiting foreigners: ``The problem is real.''
       After school, when they return to the streets, the children 
     beg, steal and, in many cases, sell sexual favors for food. 
     At night, they sleep in culverts along a thoroughfare called 
     Cairo Road.
       Most prized, especially in winter, are the culverts across 
     from a gas station. On cold nights, volunteers say, the 
     children fight the chill by getting high on gasoline fumes or 
     on methane inhaled from bottled, fermented excrement.
       Jack Phiri, 14, traveled 150 miles to Lusaka from Ndola, in 
     the copper belt, where statistics show that 46% of young 
     pregnant women are infected with HIV.
       Jack says his mother died in 1996 of tuberculosis--the 
     leading killer of people with AIDS in Africa. He says he 
     doesn't know what killed his father; staffers at Fountain of 
     Hope are convinced the culprit was HIV.
       Fiddling with the ragged edges of his cut-off jeans, Jack 
     says he has lived on the streets since 1997. His brother has 
     been taken in by relatives and has vanished from Jack's life. 
     The ``auntie'' who took Jack refused to feed him and made him 
     sleep outside her hut. So he stowed away aboard a train and 
     ended up here.
       The other kids in the street told him about Fountain of 
     Hope.
       ``I like being here because I can go to the school,'' he 
     says. ``And they give you food.''
       Asked whether he remembers what it's like to have a family, 
     Jack's eyes flood with tears. ``He cries very easily,'' 
     Fountain of Hope staffer Rogers Mwewa says. ``He hasn't 
     developed the survival skills of most of the other kids.''
       When he grows up, will he have a big family?
       ``I don't know if I'll live that long,'' Jack says.
       Jack spends most of his nights sleeping near fast-food 
     restaurants on Cairo Road. After dark, children clog the 
     sidewalks, chasing anyone who might be persuaded to part with 
     money for food.
       One night recently, staffers from Fountain of Hope and an 
     official from the Dutch Embassy dug into their pockets for 
     money to feed 78 starving children.
       Buoyed by the prospect of a meal, the children waited 
     patiently on the sidewalk while an older child counted them. 
     Tomorrow night, they knew, they might not be so lucky.
                                  ____


The Epicenter of AIDS--Uganda: Deadly Traditions Persist Amid Progress, 
                              Vaccine Test

                          (By Steve Sternberg)

       Kampala, Uganda.--Tom Kityo, the tall, animated manager of 
     the AIDS Service Organization, stands before a map of his 
     country, gesturing to one area after another, railing about 
     the traditions that spread HIV.
       ``Here,'' Kityo says, ``The groom's father can have sex 
     with the bride, and that's accepted. Here, other clan members 
     may have sex with someone's wife, and no one says anything.''
       Kityo blames these and other cultural practices for much of 
     Uganda's AIDS problem. It's a situation that, while showing 
     great improvement, still is marking this country with tragic 
     consequences.
       A year ago, U.S. officials estimated that 10% of Uganda's 
     20 million people are HIV-positive--with 67,000 of those 
     infected younger than 15.
       Nearly 2 million people have died nationwide since what 
     some call ``slim disease'' emerged here in 1982, leaving 
     thousands of orphans. Government statistics suggest that 
     600,000 children have lost one parent--and that 250,000 have 
     lost both parents--to AIDS.
       ``We are fighting a lot of complex problems,'' Kityo says. 
     ``There are wars, cultural beliefs, a gender imbalance--these 
     are very difficult things to change.''
       But change is under way in Uganda, which has done more than 
     almost any other country in the world to slow the spread of 
     HIV.
       The evidence lies no farther away than a palm-shaded 
     hilltop above the crush of populous Kampala, inside a 
     sprawling white stucco compound enclosed by a tall white 
     wall.
       Once it was part of the palace of the Bagandan king, now a 
     largely ceremonial figure whose domain straddles the equator 
     and borders the legendary source of the Nile.
       Today it serves a vastly different purpose.
       Known as the Joint Clinical Research Center, it is the site 
     of the first HIV vaccine trial in Africa.
       On Feb. 8, a nurse guided the first hypodermic into a 
     volunteer's arm--the first of 40 in the trial. The man, whose 
     name was withheld to protect his privacy, isn't just anybody.
       He is a medical orderly on the staff of Ugandan President 
     Yoweri Museveni, the most outspoken of the world's leaders on 
     the threat posed by HIV.
       Museveni's AIDS awakening came in 1986. Some after he 
     seized power from dictator Milton Obote, Museveni get a call 
     from Cuban military authorities who were training Ugandan 
     troops. They told him that 25% of the men had HIV.
       For Museveni, fresh from a civil war, the news was 
     alarming. An army hobbled by disease can't fight, and 
     Museveni had yet to consolidate his power. By the end of 
     1986, he had established the nation's first AIDS Control 
     Program.
       Museveni also issued an international call for help from 
     AIDS researchers and public health organizations. And he 
     declared his intention that Uganda play a key role in any 
     African AIDS vaccine trials.
       Five years ago, Museveni's prevention efforts began to pay 
     off. Behavior surveys showed that Ugandans were reporting 
     fewer casual sex partners, more frequent condom use and 
     longer delays before young people became sexually active.
       More recent studies of pregnant women demonstrate that 
     infection rates have begun to drop. In Kampala, the infection 
     rate among 15- to 19-year-old women fell to 8% in 1997 from 
     26% in 1992.
       But traditional practices still exact a steep toll. Indeed, 
     they cost Justine Namuli her life. Today, in a small family 
     graveyard in a village two hours from Kampala, she will be 
     laid to rest.
       Hillary Rodham Clinton met Namuli, then 25, two years ago 
     while visiting Uganda.
       During the visit, Clinton planted a tree to commemorate the 
     opening of the AIDS Information Center's headquarters. There, 
     Elizabeth Marum, a former director of the information and HIV 
     testing center, introduced Namuli to Clinton and Ugandan 
     first lady Janet Museveni. ``Justine was so beautiful,'' 
     Marum says. ``And so excited to meet Mrs. Clinton.''
       Clinton and Museveni listened as Namuli told her life 
     story.
       In Bagandan tradition, Namuli said, she was ``heir to her 
     aunt,'' meaning she was to take her aunt's place if anything 
     happened to her.
       When her aunt died of tuberculosis, Namuli was forced to 
     drop out of school, marry her uncle and care for his 
     children. She was 16.
       At the time, she didn't know that her aunt was infected 
     with HIV or that her uncle was infected, too. Eventually, 
     Namuli's husband died, but not before he infected her. She, 
     in turn, unwittingly infected one of her two sons.
       Namuli quickly sought an HIV test at the information 
     center. Learning that she was infected, she joined the Post-
     Test Club, a support group that emphasizes safe sex, good 
     nutrition and ``living positively.'' And she joined the 
     Philly Lutaya Initiative, an AIDS education and prevention 
     program named for a local rock star who acknowledged publicly 
     he was HIV-positive--the Magic Johnson of Uganda. Like others 
     in the group, Namuli spoke out about HIV and how to guard 
     against infection.
       ``Imagine what this girl has gone through,'' Marum says. 
     ``Her mother died of AIDS. Her aunt died of AIDS. Her husband 
     died of AIDS, and for 10 years she lived with the knowledge 
     that she was HIV-positive.''
       About a dozen information center staffers and volunteers 
     pile into two four-wheel-drive vehicles for the two-hour 
     drive to Namuli's funeral.
       The little caravan drives down the truck route, the 
     TransAfrica Highway, connecting Mombasa, Kenya, and Kinshasa, 
     in the Democratic Republic of the Congo.
       The highway, which runs across southern Uganda, has spread 
     AIDS here, too: The

[[Page E1502]]

     truckers carried HIV from one end of the road to the other, 
     stopping regularly for paid sex with women who needed the 
     money to feed themselves or their families. The women 
     infected their boyfriends and husbands, who infected their 
     wives and girlfriends.
       Today, the villages along this road are outposts in an AIDS 
     wasteland, peopled almost entirely by grandparents and 
     children. The middle generation lies in village graveyards.
       One grandmother, Benedete Nakayima, 70, says she has lost 
     11 of her 12 children to HIV--six daughters and five sons. 
     She now cares for 35 grandchildren with the help of her 
     surviving daughter.
       At the Namuli funeral, Marum reads a letter from the U.S. 
     first lady, wishing Namuli a speedy recovery.
       Sandra Thurman, the Clinton administration's top AIDS 
     official, who is visiting here in her last stop in a tour of 
     four sub-Saharan countries assaulted by AIDS, was to have 
     delivered the letter to Namuli's bedside at Mulago Hospital 
     on Feb. 7.
       She was too late.
       Namuli died of pneumonia two days earlier--because Mulago 
     Hospital lacked a working oxygen compressor that might have 
     helped her through her respiratory crisis.
       Her two sons, Moses, 5, and Isaac, 7, have joined the ranks 
     of Uganda's orphans.
       ``We are going to sing a song of thanks that she died in 
     Christ,'' says the preacher, wearing a black suit in bold 
     defiance of the searing midday sun. He consults a hymnal that 
     has been translated into Lugandan, the Bagandans' native 
     tongue. He leads almost 100 men, women and children in Jesus, 
     I'm Coming.
       Soon, it is Lucy Mugoda's turn to speak.
       Mugoda, one of Namuli's co-workers at the information 
     center, wastes no time on platitudes or prayers. She has a 
     message: HIV holds no respect for tradition; it seeks simply 
     to perpetuate itself through any means possible.
       Namuli died, Mugoda says, not because she was promiscuous 
     or willfully engaged in risky behavior, but because she 
     accepted her traditional obligations as ``heir to an 
     auntie.''
       ``Let her death serve as an example that not all the old 
     traditions are good,'' Mugoda says.
       ``This tradition is death.''

       

                          ____________________