Death Stalks A Continent

(5 of 14)
Jabulani Syabusi would use his real name, but he needs to protect his brother. He teaches school in a red, dusty district of KwaZulu-Natal. People here know the disease is all around them, but no one speaks of it. He eyes the scattered huts that make up his little settlement on an arid bluff. "We can count 20 who died just here as far as we can see. I personally don't remember any family that told it was AIDS," he says. "They hide it if they do know."

Syabusi's own family is no different. His younger brother is also a teacher who has just come home from Durban too sick to work anymore. He says he has tuberculosis, but after six months the tablets he is taking have done nothing to cure him. Syabusi's wife Nomsange, a nurse, is concerned that her 36-year-old brother-in-law may have something worse. Syabusi finally asked the doctor tending his brother what is wrong. The doctor said the information is confidential and will not tell him. Neither will his brother. "My brother is not brave enough to tell me," says Syabusi, as he stares sadly toward the house next door, where his only sibling lies ill. "And I am not brave enough to ask him."

Kennedy Fugewane, a cheerful, elderly volunteer counselor, sits in an empty U.S.-funded clinic that offers fast, pinprick blood tests in Francistown, Botswana, pondering how to break through the silence. This city suffers one of the world's highest infection rates, but people deny the disease because HIV is linked with sex. "We don't reveal anything," he says. "But people are so stigmatized even if they walk in the door." Africans feel they must keep private anything to do with sex. "If a man comes here, people will say he is running around," says Fugewane, though he acknowledges that men never do come. "If a woman comes, people will say she is loose. If anyone says they got HIV, they will be despised."

Pretoria University's Mary Crewe says, "It is presumed if you get AIDS, you have done something wrong." HIV labels you as living an immoral life. Embarrassment about sexuality looms more important than future health risks. "We have no language to talk candidly about sex," she says, "so we have no civil language to talk about AIDS." Volunteers like Fugewane try to reach out with flyers, workshops, youth meetings and free condoms, but they are frustrated by a culture that values its dignity over saving lives. "People here don't have the courage to come forward and say, 'Let me know my HIV status,'" he sighs, much less the courage to do something about it. "Maybe one day..."

Doctors bow to social pressure and legal strictures not to record AIDS on death certificates. "I write TB or meningitis or diarrhea but never AIDS," says South Africa's Dr. Moll. "It's a public document, and families would hate it if anyone knew." Several years ago, doctors were barred even from recording compromised immunity or HIV status on a medical file; now they can record the results of blood tests for AIDS on patient charts to protect other health workers. Doctors like Moll have long agitated to apply the same openness to death certificates.

THE TRUCK DRIVER