Juniata College
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|Written by Paula Bock | |[pic] | | |
|Photographed by Betty Udesen | | | | |
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| | | | |The parents are dying. |
| | | | |The teenagers are next. |
| | | | |In the Africa of AIDS, is there |
| | | | |time to save the children? |
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(Visit the website at . This page includes maps, pictures, facts, figures, and a story from the reporter’s first-person perspective. )
LISTEN TO RUTH'S MOTHER CRY, and you'll never think of the number 2.3 million in the same distant way.
That's how many people died of AIDS in sub-Saharan Africa last year. It's also the population of King and Snohomish counties. Seattle, Bellevue, Redmond, Renton, Everett — every soul from Federal Way to Stanwood, Vashon Island to Snoqualmie Pass.
Two million three hundred thousand. A number too big to get your arms around, an amount easier to calculate than to comprehend.
The distance between Seattle and Ruth's house in Harare, Zimbabwe, is 9,889 miles, 10 time zones, 31 hours on three planes. Downtown Harare to Ruth's street is a half-hour ride in a creaky green taxi, past the factories ringing the city, along a veld of tall grass. Turn left at a billboard for Protector Plus Condoms: Strong, Sensitive — A Friend for Life. You're in Mabvuku, a dusty township once known best for its fertile red earth. These days, it's indistinguishable from too many other African communities wracked by AIDS.
Until you hear Ruth's mother cry. If you've ever wondered whether 2.3 million deaths makes any single death less painful, listen. Imagine wind moaning, tires screeching, goats being strangled.
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Ruth's mother is crumpled in the corner of her cinderblock home, wailing. She doubles over, forehead scraping the woven mat. Her tears leave a fan of dark stains. "My daughter! My daughter!"
Women crowd close for comfort. They've been there. Everyone here has lost someone to AIDS.
One of them starts humming, then another, and soon the house resonates with harmony, glorious song, the throb of a blue plastic drum. The music gives way to more wailing, which gives way again to song to ease the family's loss and help Ruth's spirit travel well.
For two days and two nights, while the men tend the fire outside, the women inside will clap and leap and cry, their grief amplified by the acoustics of a corrugated metal roof and the sorrow of so many mothers who've lost so many daughters so far.
|More not-so-faraway numbers: |
|In five years, at current rates, AIDS cases in Africa could double, |
|meaning 60 million infected people — 7.3 percent of the population — by |
|2007. |
|In the next 20 years, if current levels of prevention and treatment don't|
|change, 68 million people are expected to die of AIDS worldwide. |
WHEN WE FIRST MEET Ruth Njawara Chimuonenji, it is late on a Saturday afternoon and the sun has long ago starched the morning laundry dry.
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|BETTY UDESEN / THE SEATTLE TIMES |i|
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|Ruth Njawara Chimuonenji married an older man who was unfaithful and refused to use condoms. When|]|
|he died, she brought their children, Tafadzwa and Martha, home to her parents’ tiny, crowded | |
|bungalow and peddled small items at the bazaar to help buy food. Then, just 24, she fell ill with| |
|AIDS. "Who will take care of my children?" she asked visitors the day before she died. | |
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She is in bed, under scruffy blankets, in a tiny room of makeshift walls. For two weeks, she's been sick. Stomach running at both ends. Cough. Horrible headache yesterday that today is thankfully gone. She is 24 and gaunt, with hollow cheeks and exhausted eyes. Yet her skin is lovely and supple, her lips young and full. You can tell if she weren't feeling so lousy, she'd greet you with a beautiful smile.
As it is, she weakly presses your hand. Her fingers are cool, as if they've absorbed the dampness of the little cinderblock house.
Ruth moved home to Mabvuku township two years ago, back into the weary bungalow where her parents make room for 10 of their 12 children and several grandchildren. Ruth's husband, a truck driver, had died of tuberculosis in tandem with AIDS. Her in-laws blamed their son's death on shu-shu, witchcraft; they accused Ruth of killing him with evil herbs and magic to get his property. After his funeral, they took everything and left Ruth to raise the two children.
Martha will soon be 6 and loves flowered dresses. Tafadzwa is almost 4 and has eyes that promise mischief, but right now he looks scared. Strangers stare and ask questions. His mother is shrunken and ill. She squeaks like a baby mouse when he bumps against her. She can't gather enough air in her lungs to push out much sound.
"Who will take care of my children?" Ruth whispers.
Her mother and sisters have promised they will, so her question reaches beyond: What will happen to her children if the mealy-meal runs out (a distinct possibility given the current food shortage), if Zimbabwe's government collapses (also possible), if something should befall her mother, if her sisters get AIDS?
Most of all, Ruth worries about Martha. Who will protect her quiet daughter as she becomes a woman? If there is no food, no school, no jobs, what might Martha be forced to do to survive? What if she falls for the wrong man? Who will teach Martha about love?
"I wish my daughter would grow up to be a big girl, get a proper education and get married to a husband who will take care of her," Ruth says, her voice a wisp. "Not like what happened to me."
|The life expectancy of a child born today in Zimbabwe is 38 years; |
|without AIDS, it would be 70. |
IN SUB-SAHARAN AFRICA, 28.5 million people are infected with the AIDS — more than three times the population of New York City plus all the people in greater Seattle from Everett to Olympia. The world's highest AIDS infection rate is in southern Africa, in the nations of Zimbabwe and Botswana.
In Europe and the Americas, AIDS has most often been passed on through high-risk gay sex and needle-using drug addicts. But in Africa, the disease is largely spread through sex between men and women. In Zimbabwe, as many as a third of adults are infected with HIV.
Most are women.
The culture of sex in southern Africa would appear to put men at greater risk. They typically have more sex partners, before and outside of marriage.
And men do suffer. In the sub-Sahara, 12 million live with HIV.
But men, if they choose, can use condoms to spare themselves infection. Women have no way to protect themselves and no say. About sex. About condoms. About boyfriends and husbands who spread the virus by sleeping around, passing it from girlfriend to lover to wife.
Women account for 58 percent of all new HIV infections. The younger they are, the worse the statistics: Two out of three people infected in their late teens to early 20s are female; adolescent girls are five to six times more likely than boys to contract HIV.
Blame anatomy (women's tissue abrades more easily during intercourse, leaving wounds for the virus to enter); economics (food is scarce, children hungry, commercial sex work one of few options open to many women); deep history (polygamy was practiced in tribal villages); recent history (men had to leave their families to find work during segregated colonial rule); tradition (young girls tend to couple with older men who, having longer sexual histories, are more likely to carry and transmit the disease).
Indeed, the risk is so disproportionate, the cultural barriers so great, that global health workers no longer rely on male condoms or abstinence to slow the pandemic.
Instead they focus on women, who carry the threat of the disease in their blood and the burden of caring for the sick on their backs. Half a world away, in resource-rich Seattle, work is being done to improve female condoms, diaphragms, virus-killing gels — anything to help women protect themselves during sex.
And while it grows too late for Ruth's generation, they look to the future, to little girls like Martha.
The race to save them is a race against the virus, against hormones, against politics, against custom, against the clock.
AIDS, left unchecked in the developing world, threatens to rival the Bubonic Plague, which swept out of Asia in the 1300s and, by the 1400s, had ravaged a third of the population in China and Europe. Virtually unknown two decades ago, AIDS now is the leading infectious cause of death worldwide. In Africa alone, it has taken more lives than all the soldiers killed in both world wars. It has crossed public-health borders, undermining economies and destabilizing nations.
"Clearly, in this more globalized world, having healthy societies, which are the cornerstone for stability and economic growth, is going to make the whole world better," says Dr. Helene Gayle, director of the Bill and Melinda Gates Foundation's HIV/AIDS and Tuberculosis program. "And, as a human, it's very difficult to think that just because of an accident of birth, somebody in Africa or Asia does not have access to a reasonable quality of health care. And someone who happened to be born in Seattle or Buffalo or Shreveport can have a reasonable expectation of a long, healthy life."
Numerically, malaria and tuberculosis together killed as many people as AIDS last year.
But AIDS has a crueler, more tragic quality. Other diseases spread in anonymous swaths through dirty water, tiny parasites, mosquitoes, droplets in the air. HIV infection is intimate. One-on-one. You get it from someone you know — likely from someone you love.
How do women live with love that leads to death? How do they negotiate safe sex in a society where they have little power? How do they protect their daughters?
Women in Ruth's world, no surprise, do what women everywhere do in hard times — they share what they know with each other. They take us into their confidence, their bedrooms, their kitchens and once, in a funeral lorry, into their laps. They talk women's talk in women's places — around the cooking fire, in a hair salon, in a circle of young brides learning from a feisty neighborhood grandmother how to please their husbands during sex and, perhaps, keep them faithful.
The surprise is the stigma AIDS still carries, even though every person has friends and relatives dead or dying, even though roadside billboards promote condoms more often than cellphones.
In Africa, the shame transcends worries of being shunned by neighbors or bosses. Some young women fear prospective in-laws will discover their HIV status and revoke the lobola, or bride price, traditionally paid at marriage. Others, with brothers and sisters already gone, fear another death would destroy their parents.
It's OK for the world to know, they say over and over. Just don't tell my mother.
RUTH'S MOTHER already knows.
She sits at the foot of her daughter's bed, legs tucked beneath her long skirt, hands resting lightly on the blanket, head bowed. A red kerchief binds her hair.
Consolota Njawara Chimuonenji has borne and raised seven daughters and five sons. The youngest is 11-year-old Ireen; Catherine, at 33, is the oldest. In Zimbabwe, women are known as the mother of their first child, so we call Ruth's mother Amai Caty.
Later, we'd see Amai Caty's vigor and humor. But the afternoon we meet, she looks worn as a dishrag and decades older than 58. Shadows obscure her face. The dim room feels like midnight. Even the lightbulb seems tired.
None of her children have been sick like this before. Not with malaria or dysentery or dengue fever. She's always taken good care of them. Vaccinations at the local clinic. Dishes rubbed clean with dirt and water. Fourteen-year-old Elliott lost strength in his muscles a few years back and can't walk; doctors never said what was wrong. But Amai Caty makes sure the boy is part of family life, dragging him close so he can hear conversations, straightening his spine and frayed collar.
Now Ruth.
She is Amai Caty's sixth child, the helpful one. After moving home, Ruth traded small items so the family could afford more food. She'd buy used clothes cheap at the Mbare bazaar, peddle them at markup in the rural areas and return with tomatoes, onions and cabbages to hawk at a local market stand. She planned to save enough for a passport so she could expand her business to Zambia, Malawi and South Africa. She promised to buy everyone in the family a new pair of shoes.
Amai Caty knew her daughter was infected with the same virus that killed her son-in-law, but she'd hoped Ruth wouldn't get sick. Then Ruth's cough turned to vomiting and diarrhea. For days now, she's been too weak to walk. She soils her blankets.
Each time, Amai Caty cleans up. She wipes her daughter's bottom with warm rags. She scrubs the bedding with hot water and rocks.
At church, Ruth's mother says, she learned about home-based care for "this disease that has come among us." Use bleach and detergent and gloves, they told her.
She can't afford those things.
She repeats: I don't have any gloves.
|Multiply one mother's plea by 40 million. Globally, that's how many |
|people are infected with HIV. Seventy percent of them live in sub-Saharan|
|Africa. |
This, in a few understated words, is her plea for help.
FACED WITH such a massive problem, what do you do?
In the July issue of the Journal of the American Medical Association, doctors from the Centers for Disease Control and Prevention called the world's response to AIDS "the moral challenge of this era." In their commentary, An Unequal Epidemic in An Unequal World, they write:
"The situation in Africa is different in scale and scope with a devastating, generalized HIV/AIDS epidemic superimposed on an eroding health infrastructure burdened by other health threats. A fundamental question is to what extent public health strategies can reverse Africa's current adverse health trends without long-term economic development or an HIV vaccine."
There is no vaccine and none near. The Global Fund to Fight AIDS, Tuberculosis and Malaria, created last year by the United Nations, estimates it needs $7 billion to $10 billion a year to slow the tide of AIDS in developing countries by 2005. To date, governments have committed less than $3 billion, including a U.S. contribution of $500 million.
The Bill and Melinda Gates Foundation, headquartered in Seattle, has become a world leader in the battle against AIDS, its efforts trumping those of most governments. The foundation has committed $100 million to the Global Fund, $126 million toward finding a vaccine and more than $425 million to other groups for HIV/AIDS research, prevention and education. Last month, the Gates Foundation announced an unprecedented initiative in India, committing $100 million to slow the spread of the virus on the subcontinent.
A significant slice of the Gates' money is aimed at helping women and girls defend themselves against infection. Projects include: $28 million to the Women's Global Health Imperative to test whether diaphragms can help prevent transmission of HIV; $5 million to the Seattle-based Program for Appropriate Technology in Health (PATH) to continue development of female-controlled prevention methods; more than $45 million to the Population Council in New York and Contraceptive Research And Development (CONRAD) in Washington D.C. to develop a microbicide, a kind of vaginal gel or suppository a woman could use covertly.
Why invest so much to invent products for women when latex condoms are readily available, cheap and a proven block against HIV?
"People have been trying that," says Dr. Christopher Elias, president of PATH and longtime advocate of microbicides.
What's been learned from the condom campaigns: Men will use protection with prostitutes, but not reliably with wives and steady girlfriends.
Yet even if something is found to arm women, it's hard to know if they'll use it, if it will be approved by governments or allowed by husbands, if it will be available or affordable.
If, if, if.
In places like Africa and India, AIDS is more than a disease. It is social stigma, sexual lust, poverty, politics, gender inequality and love, all tangled with a virus that mutates so rapidly, it has outfoxed all efforts to disarm it.
What's one pair of rubber gloves?
Nothing.
Everything.
MARTHA.
On the brink of 6, she likes dressing up, playing pebble games, drinking tea with sugar if there's sugar to be had, splashing her dishes clean at the outdoor sink, circling through endless rounds of ring-around-the-rosie until she's so dizzy she collapses on the ground. She giggles. She pretends to be a bunny, hop, hop; a chicken, flap, flap; a warthog, snort, snort.
She is at that enchanted age when anything seems possible.
And that's just the problem.
In 10 years, when Martha is Sweet 16, strolling home from school in a swishy pleated skirt, men will certainly notice, and if one fellow in particular says Hello, how are you, and the next day says Hello again and that leads to the next thing and the next—what then?
Who will take care of Martha?
What's to stop her from following in her mother's footsteps?
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FACED WITH a global epidemic, what do you do?
Faced with a plea for one pair of rubber gloves, what do you do?
In impoverished Africa, people want and need to be paid for whatever they do, including sharing their time and their lives. But if we pay for information, a source might exaggerate or lie. Neighbors or relatives might grow jealous. If we buy gloves for one mother, why not bleach for another, drugs for a third? Where do you start? Where does it end?
Instead we tell a story, because that's what we do.
In journalism, that's ethics.
In the heart, it rings hollow.
In the room where Ruth lies dying, it makes the afternoon hang heavy, the air unbearably clammy.
Ruth is tired from our talk. Her eyelids droop shut. She shudders, winces, looks up at the sooty metal roof.
What does she dream?
"I always dream if I was strong as ever I would be doing A, and B, and C ... selling things," she says. "But now those dreams are nothing "
She struggles for breath.
"Now ... I ...don't ...think ...I'll ...do ...those ...things."
Smoke drifts in from the dirt courtyard where cornmeal mush simmers in a black pot. Little Martha plays with her fingers, walking them along the stripes that edge her mother's thin blanket. Outside, a cranky car engine revs. Chickens scrabble and coo.
How the living live.
And the dead?
"Maybe they stay around awhile," Ruth says, her words barely there. "Like a spirit you hear in your sleep as if a voice is talking to you."
She looks to her mother, questioning. Amai Caty raises her head. In the weak yellow light, you can see the sweet sweep of her cheekbones, the luster of her skin. You realize where Ruth gets her glow, and for a strange moment, the bedside tableau looks beautiful, a gauzy vintage ad for Ivory soap. But this is real life, real time, Zimbabwe in the age of AIDS.
"When you die, you die," the older woman tells the younger. "That's it. You don't come back."
Tafadzwa wets his pants and cries, curling up like a potato bug and snuffling into his shirt. Martha tries to comfort him. Warm urine and cold sweat soak the blankets. Ruth and her mother have a long night ahead.
We say goodbye and promise to return Monday.
We will find a way to bring gloves.
|In America, the lifetime cost to treat one person with HIV averages |
|$155,000. In Africa, fewer than one in a thousand infected people receive|
|any medical treatment. |
HOW CAN HERE AND THERE exist at the same time on the same planet?
There, in homes without medicine or even gloves, thousands of young mothers are dying, leaving thousands more daughters alone and at risk.
Here, in a boxy barn-red building at the base of Seattle's Ballard Bridge, global health workers are searching for solutions. Here, in a high-tech tinkerer's workshop in the basement, we chat with Lisa Tam, a thoughtful thermoplastics whiz.
Her quest: to build a better female condom.
"We hear all these horror stories about women whose husbands refuse to wear male condoms but go out and use prostitutes and it makes you go, ‘Oh boy, we really gotta do something.' "
Lisa is 28, with four silver hoops in each ear, a dragon stippled on her back, a degree in manufacturing engineering technology and the delicate hand skills of the jewelry maker and taxidermist she once was. She works at PATH, the Program for Appropriate Technology in Health.
For 27 years, the Seattle-based nonprofit has been devising ways to improve the health of women and children in developing countries. Among PATH initiatives: a defanger to remove needles from syringes; rapid tests for malaria, syphilis and HIV; a temperature sensor for vaccines; a solar-powered vacuum-insulated freezer; a pre-filled one-use syringe; massive efforts to vaccinate against Hepatitis B and meningitis; vitamin-enhanced rice, and ways to get vaccines to children in the world's 74 poorest countries.
Since 1995, PATH's work has been turbocharged with more than $285 million from the Gates Foundation, including $5 million to continue work on the female condom, a one-size-fits-most silicone diaphragm and a microbicidal gel.
Sparing Martha's generation from AIDS will require a liaison between science and business.
Commercial companies usually shy away from such research because there is too little economic incentive, too much upfront risk. So while Big Pharma chases easy money to be made from a second-generation Claritin or Viagra, nonprofits like PATH step in, funded by governments, gifts and grants. PATH tries to kick-start the market structure by developing a first-generation product and eventually partnering with the private sector to manufacture and distribute it.
Lisa came to the female condom project after stints stuffing dead animals and fabricating fiberglass sports-car chassis. The daughter of two scientists, she grew up in Seattle's Ravenna neighborhood and studied biology and engineering at Western Washington University. She wanted "to do more than making a company a lot of money."
"I'd always wanted to invent something that would help people," she says. "Not anything earthshaking, but something."
In PATH's basement workshop, Lisa works at a simple wooden table with simple tools: soldering irons, wire brushes, screwdrivers, PVC tubing, X-ACTO knives, dremmel drills, wooden mallets, a hand torch, calipers, spray bottles, a yellow 1/2-inch tape measure from Ace Hardware. Radiohead and Kaito crank on the CD. There's a laminar air-flow hood and several long-limbed machines wired to computers, including one that simulates intercourse with a pneumatic cylinder.
Lisa takes 57 seconds to construct a basic female condom. She cuts a sheet of transparent urethane from what looks like a giant roll of Saran Wrap. The urethane is one one-thousandth of an inch thick, silkier and thinner than the latex of male condoms and less vulnerable to hot climates. She folds the urethane, tops it with a Teflon template about the shape and size of a baby bottle and traces the form with a heated knife, simultaneously cutting and welding the plastic sheet into a pouch. She slides the pouch into a PVC cylinder about the size of a tennis-ball can, welds a plastic ring to the top and files away rough edges with a tiny drill. Voila!
Team coordinator Joanie Robertson, a diehard bicycle commuter, will pedal the condoms to Harborview Medical Center to be sterilized before they are sent around the world to be tested by volunteers.
Feedback has been enthusiastic and, at times, startling. In some countries, women wanted to wear the condoms while walking around during the day — in case of rape.
HAUDYE SWEET ne pepa raro. A popular Shona-language saying among men in Zimbabwe roughly translated: Having sex with a condom on is like eating a candy stuck in its wrapper.
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A CONDOM that's 98 percent effective doesn't work at all if it sits unused on a shelf.
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|Women have little control over sexual politics in the sub-Sahara, where |]|
|men pay a lobola, or bride price, to marry them, and then set the rules. | |
|The traditional male condom has proved a weak weapon in the fight against| |
|AIDS, so global health workers promote women-controlled devices, such as | |
|the female condom touted on this billboard. | |
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PATH's design process relies on feedback from real people, using the products in real situations. On the back pages of a Seattle alternative weekly, the Stranger, alongside blurbs for amazing psychic astrologers, singles getaways and "Smoke Pot—Get Paid," a PATH ad reads: "Are you interested in women's health? Are you interested in developing the female condom?"
Couples in Seattle and around the world test prototypes, evaluating whether they are awkward to insert, uncomfortable, messy, puzzling, ugly, noisy or just right. A device is changed and sent out for more testing. The one-size-fits-most silicone diaphragm, now in clinical trials, went through 250 iterations.
Sexual practices can differ greatly from culture to culture. And internal anatomy can vary as much in size as a grapefruit and a kiwi depending on a woman's body mass, bone structure and how many times she's given birth.
In Mexico, women are "non-touchers," often unfamiliar with handling their genitals. In southern Africa, women regularly cleanse themselves with their fingers and sometimes use herbs and astringents to dry and tighten their vaginas. In Thailand, women suggested enhancing the appeal of condoms with feminine colors, flowers and perfume. "This product should be like Thai food," they told researchers. "Spicy, salty, hot and sweet."
PATH's design team, led by Glenn Austin, translates feedback into improvements.
We want the product softer.
"Well, what does that mean?" Glenn says. "Is it too sharp? Should it be squishier? Bendier? Looser? Softer in the hand? To the man? Between the man and the woman?"
He sketches ideas in his black design notebook. On pages 13 and 14, he tackles the question: How to stuff the condom pouch into an inserter so it will neatly unfurl? IT'S INSERTION, STUPID! he writes in block letters. Pages of functional analysis follow, stuffing patterns that look like trumpets, pleats, Maypoles laced with ribbons. By page 17, the sketches resemble hibiscus blossoms.
"This is an ugly product, cost-driven and clinical," he says. "But it's also part of an intimate experience. So how can we make it beautiful? It's not going to be Chihuly, but can we make it neat, tidy, sexy, soft, easy to grab? How does nature achieve those shapes?"
Glenn is an avid gardener who once designed garden furniture and Gnu snowboard boots. That was fun, he says, but his work at PATH has meaning: "It's the ultimate to build something that you know is going to save lives."
Before going to Zimbabwe, before meeting Ruth, we ask Glenn if he imagines the lives he is trying to save. He says he doesn't envision couples making love in tropical heat or young wives managing the size of their families. Instead, he sees a landscape of orphans and old people: "Parents bedridden and dying, grandparents trying to care for them and for young kids, a wave of adolescents about to become sexually active."
Which brings us back to Zimbabwe.
WE STUMBLE from Ruth's house into blinking brightness, through the smoky courtyard, under laundry that drapes, no clothespins, over the line, back into the creaky green taxi that brought us here.
Our driver is Jesca Machingura, one of 10 female cabbies in the capital city of Harare. We'd met Jesca through Marvelous Muchenje, a manager at the Centre, a nonprofit agency that provides counseling and home-based training to families living with HIV and AIDS.
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|AIDS remains so stigmatized in Zimbabwe that many don’t seek treatment. | |
|At The Centre, a nonprofit HIV health and support agency in Harare, a | |
|shelf sags under the growing toll of AIDS reports. Clients are listed | |
|under "Worried Well" and Deceased. | |
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The Centre provides 2,000 patients with zinc, selenium, vitamins A and E. The Centre's garden grows aloe for herpes simplex, wormwood for diarrhea, fennel for appetite, rosemary for body warming, pennyroyal for thrush. There are only enough antiretroviral drugs for 35 people; patients number in the thousands. Inside, four shelves of patient records sag with thick binders. One is labeled "Worried Well." Eight are labeled DECEASED.
If we give money to the Centre, Marvelous says, she'll get gloves and bleach to Amai Caty.
We heard about the Centre, and thus Marvelous, through Lori Heise, who directs the Global Campaign for Microbicides, a worldwide advocacy effort headquartered at PATH's offices in Washington, D.C. Marvelous introduced us to Jesca the cab driver and to Prisca Nyakutombwa Mhlolo, a pushy community activist who coordinates women's support groups in Mabvuku township and who is, herself, HIV-positive. Prisca lives a few streets from Ruth's family and knows everybody's business. She introduced us to Ruth.
That's four degrees of separation. It feels like fewer as we settle into crocheted pillows in Prisca's living room.
We are women, so naturally the talk turns to food, family, money and love. We are women, so naturally no one agrees.
Jesca glances around Prisca's small but comfortable home. "This AIDS. If you're someone who has money, you can last longer."
Marvelous: "But I think you need love. You can have the money and the drugs, but if everyone is shunning you and no one cares for you, no one cooks for you, you won't have food to eat and you'll die."
Jesca: "Is that what the people around Ruth are doing? I don't think so. They love her and she's sick anyway! The problem is that that family doesn't have nutrition! Not enough meat! Not enough mealy-meal! What!what!what! No medicine! What if you've got love but there's no soup?!"
It's long past supper when we leave. We navigate the night, past empty vegetable stalls and glowing hooch stands, flickering grills where women hawk roasted meat and other favors, the lighted billiard hall where silhouetted men swig yeasty millet beer from fat plastic tubs. Music splashes from the bars: marimbas, mbira, the pulsing, socially aware lyrics of world-famous Oliver "Tuku" Mtukudzi. Tuku's brother died of AIDS.
We drive back into Harare along a modern highway lined with malls and an office complex for Nokia. In the era of cellphones, a Medieval plague.
Jesca talks nonstop while she drives. Her boyfriend of many years is a decent man, a schoolteacher, but he won't marry her. He puts her on his health insurance, calls her his wife, but what!what!what! he's never proposed. Never paid lobola! And why? Because he wants a woman who's humble and won't speak her mind, who only wears dresses and only wants to please him.
"I want to be free!" Jesca says. "Let me put on jeans and trousers and admire the person who I am. Most of the women who don't want to be oppressed have no husbands."
She shifts to the crux. She is HIV-positive, perhaps from an earlier marriage, perhaps from her boyfriend. He wants her to keep her status secret.
"If I don't disclose, how will other people know there's really AIDS? We must warn them. I'm not his wife! How can he tell me what to do?"
But she loves him. And he loves her. He brings her tasty fish from Lake Kariba. So why won't he marry her? Should she leave him while she's still strong and find someone more loyal?
"I wonder," she says, "when I'm sick as Ruth, would he run away from me?"
We are glad to finally reach our hotel. It's late, we haven't eaten since breakfast, we're anxious to call it a day. G'night Jesca! How easy to slam the taxi door on someone else's tangled life.
Only then do we remember: We forgot to give Marvelous money for the gloves.
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WHAT IF you can help, but don't?
What if Ruth soils the sheets tonight?
What if Amai Caty has cuts on her hands?
Tomorrow. We will give Marvelous the glove money tomorrow.
"EVERY LITTLE BIT, if you make any difference at all, is going to help. I think you're morally obliged to look at anything and everything that has any potential."
Dr. Nancy Padian is the director of the Women's Global Health Imperative, based at the University of California, San Francisco. With $28 million in Gates money, her group will study whether diaphragms can slow transmission of HIV in Zimbabwe and South Africa. On a more fundamental level, her group is trying to give women a few tools — and a chance.
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|BETTY UDESEN / THE SEATTLE TIMES |i|
| |c|
|Desperate to put protection into the hands of women, researchers are studying whether the |]|
|diaphragm can block AIDS as it does other sexually transmitted diseases. Nurse Mavis Kamba helped| |
|direct a study to determine whether women in Zimbabwe would use the device. "Ooooh, yes, they | |
|liked it." | |
| | |
|[pic] |
"It's hard to put yourself in the place of Zimbabwean woman where there's a 25 or 30 percent chance of their husband being infected. Think about this in context: Just being married can be a really significant risk because you're having repeat contact with someone who has a high risk of being infected."
The diaphragm has been shown to protect against other sexually transmitted diseases such as chlamydia. It's unknown if it can block HIV, but it protects the fragile surface of the cervix, a "hot spot" for infection.
But would women use it? The Women's Global Health Imperative teamed with University of Zimbabwe to survey 405 women whose husbands refused to use male condoms. Of those, 18 percent used a diaphragm every time they had sex over six months; more than half used a diaphragm most of the time.
Everyone liked the device, many because their husbands didn't have to know they were using it. One had a husband who agreed to let her use the diaphragm, then reneged. Before they had sex, he checked the wardrobe to make sure the diaphragm was there. What he didn't know was that she had gotten a second from the clinic. Another woman bragged so enthusiastically about her diaphragm, a relative stole it to use herself.
Diaphragms aren't available in most of sub-Saharan Africa. Even in big cities, most clinics and pharmacies don't stock the devices, which come in more than a dozen sizes, must be fitted by clinicians and are relatively expensive to buy.
One woman came 200 miles from Mutare in search of a doctor who would fit her with a diaphragm. She was married to a businessman who had many lovers and refused to use condoms.
"It's scandalous we are not providing this method when we are well aware women cannot negotiate use of the condom," says Dr. Tsungai Chipato, an obstetrician/gynecologist in Harare and the lead investigator of the Women's Global Health Zimbabwe studies.
The doctor saw his first AIDS case 20 years ago when he was an intern in Bristol, England. The patient, a gay film producer from Paris, had pneumonia and tuberculosis and claimed more than 200 sex partners.
"At that time, we thought it was a European disease of homosexuals," he says. "We didn’t think it would come to Africa."
Today, a third of his patients are HIV-positive. All of them are women.
WHEN A FEMALE CONDOM called the Care Contraceptive Shield was introduced in Zimbabwe in 1997, sales were forecast at 4,000 a month. In the first four months, more than 95,000 were sold.
Sales subsequently dropped, but a recent survey shows female condoms have found a niche among women in their mid- to late-20s who are relatively well-educated, well-off and the primary wage-earners in their households.
The user profile does not fit Ruth.
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ON SUNDAY, a message is slipped under the hotel room door.
Marvelous telephoned. Please call back. Ruth has passed away.
|Throughout sub-Saharan Africa, some 11 million children have been |
|orphaned by AIDS. |
|By 2010, the number will be 40 million. |
· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·
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|BETTY UDESEN / THE SEATTLE TIMES |i|
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|Throughout sub-Saharan Africa, some 11 million children have been orphaned by AIDS. Linda |]|
|Chitima, 14, is one of five siblings who lost both their parents to the virus. She carries a | |
|basin to a neighboring house for water to finish the laundry before church begins. Her dream is | |
|to be an "air hostess" when she grows up. | |
| | |
|[pic] |
EVEN IN THE DEEP PIT of human suffering, there is a hierarchy.
Ruth's children have grandparents and aunts to love and care for them. The five AIDS orphans of Mufakose have only themselves.
Each township — known here as a "high-density area" — is famous for something. Mabvuku, where Ruth lives, is noted for its fertile red earth. Mbare is the oldest township, known for its bazaar, soccer players and world-class musician Thomas Mapfumo. Epworth boasts politicians and the balancing rocks depicted on Zimbabwe's bank notes. Chitungwiza is praised for its sculptors.
Mufakose, where the orphans live, loosely translates as "suffering from all sides," a name that likely evolved decades ago during the war for liberation. It still seems apt today.
The five siblings live in a plank shack with a dirt floor and no running water. No electricity. No hinges on a door that hangs, lopsided, from wire loops. A white plastic bucket holds their only food — a few handfuls of grain called mealy-meal.
Still, their Sunday clothes are washed and wrinkle-free in time for church. This is especially amazing when you consider that in Zimbabwe, where dress is formal and appearance important, those who don't own irons press their garments under mattresses. The orphans don't have a mattress.
They sleep, shoulder to shoulder, on a scrap of carpet laid over pitted earth, girls on one side, boys on the other, baby brother King in the middle. It's good the ground is uneven, they say, because when rain floods the shack, the water drains away from their bodies.
King Chitima is 6 years old and likes to play with rocks.
Grace is 12 and wants to be a nurse so she can care for sick people, feeding them porridge as she once fed her mother.
Linda, 14, dreams of serving passengers as an air hostess even though she has never flown.
Leonard, 17, wants to be president of Zimbabwe so he can learn foreign languages, make friends in other countries and help his people.
Lovemore is 21. In an ideal world, he'd be a pastor because he loves to worship and do the work of God. In a merely normal world, he would be an engineer, but he failed his exams after he left school to care for his sick mother. If life was only mildly bad, he'd look for work as a mechanic, since he's earned a certificate in that field.
In reality, the five orphans are clinging to the lower rungs of the Ladder of Unluck, so Lovemore does whatever he can to scrounge a living in a place suffering from all sides. There is little work to be had. The government's corrupt and ill-conceived plan to redistribute farmland means not much maize was planted or harvested this year. Store shelves are empty, so food vouchers from a welfare agency are of no use. A few commodities are sold at exorbitant prices on the black market. Five kilos of mealy-meal cost 1200 Zimbabwean dollars (less than $5 U.S.) — double the price of three months ago.
Sometimes Lovemore earns money digging neighbors' gardens. Sometimes friends share their food. Most often, the children go hungry.
How often?
"Always."
The girls are especially thin, and in the warped Western aesthetic that celebrates starved supermodels, Grace and Linda look ethereally beautiful.
This is worrisome because orphan girls are easy targets for rape. Fortunately, Lovemore is known as being strict and strong, a neighbor says, so men don't tangle with his sisters. Fortunately, local tastes are for fleshy beauties with ample buttocks and breasts.
|In many sub-Saharan countries, |
|the probability that a teenager living today will die of AIDS is greater |
|than 50 percent. |
RUTH LIKED to sew and knit baby clothes, read the Bible and hold her children on her lap to watch the television before it was sold. She attended three years of secondary school and wrote every day in a private diary that disappeared before she died.
In a photo of her and Richard, he cocks his head and grins, best side toward the camera, shirt splayed open disco-style. Ruth smiles primly, her blouse buttoned to the very top. It's her favorite, a gift from Richard, white with red roses embroidered on the collar.
Her best friend claims Ruth was happy and that the couple never fought.
Her younger sister Mercy says there were fights, but Richard always brought gifts — clothes and cookware — afterward. Ruth wore one of the forgive-me blouses the day we met, a maroon polyester button-down.
Older sister Regina says Ruth didn't like conflict. When Regina wanted to complain to the parents of neighbor kids who bullied their children, Ruth said kids are kids and they'd be playing together again tomorrow.
|[|[pic] |
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|i|BETTY UDESEN / THE SEATTLE TIMES |
|c| |
|]|Ruth was a round-faced, healthy |
| |schoolgirl when she married, |
| |unknowingly, into AIDS. "Ruth |
| |didn’t know her husband was |
| |HIV-positive when she made love |
| |with him," says her sister Mercy. |
| |Richard continued to stray. Ruth |
| |continued to forgive him, nursing |
| |him through AIDS and tuberculosis |
| |until he died in 2000. |
| | |
|[pic] |
And so it was with Ruth's marriage. Richard would transgress. Ruth would forgive. Men are men.
Ruth was 17, Richard older than 30, when they met. She broke up with a boy from church to walk with him. He was suave, handsome, funny, a fine storyteller. He made good money trucking building materials for a multinational joint venture. He brought groceries for her mother, money for her father, a cassette player for her sisters.
After a year, Richard paid Ruth's parents a bride price of 9,000 Zimbabwean dollars and took her to Kuwadzana, a township about 15 minutes from Mabvuku by car. Ruth became pregnant with Martha. That's when she found out Richard had four children by two other wives even though he said he'd been married only once before. He hung around bars, had girlfriends on the side and rarely allowed Ruth to visit home because he was jealous of her old boyfriend.
All this came as a surprise, but was not without precedent. Each of Ruth's three older sisters had become pregnant by men who tricked them and soon fled or died. Besides, Richard was a driver.
Long-haul truckers, often called the "cowboys of Africa," are believed to have spread AIDS across the continent during lengthy journeys away from their families. Richard drove mostly short routes, in and around Harare. But in a country where few can afford cars, any man with wheels is prime.
"Drivers, you know, they have many girlfriends. They pick and choose," Mercy explains. "Ruth didn't know her husband was HIV-positive when she made love with him."
Ruth's father, Robert: "I was very much worried and pained when I heard about Richard's girlfriends, but we just kept quiet and thought maybe her husband would leave his bad behavior. We thought: Let's leave it in God's guidance."
Richard continued to stray; Ruth continued to forgive. Martha was born, then almost two years later, Tafadzwa. When the baby was just weeks old, Ruth and Richard came down with tuberculosis. Ruth responded to treatment and, with Tafadzwa swaddled on her back and Martha toddling at her feet, she cooked and cared for her husband for more than a year until he wasted to death in 2000.
|In a 1990 World Health Organization survey of sexuality in six African |
|countries, more than twice as many men as women reported having |
|extramarital affairs. Similar research in India, Thailand, Brazil and |
|Guatemala also found widespread infidelity among men. In Thailand, one |
|study found 28 percent of randomly sampled men admitting to sex outside |
|their marriage or steady partnership, compared to 1 percent of women. |
|In a study of American infidelity published in 2000 in the Journal of |
|Marriage & the Family, 11.2 percent of respondents said they'd had |
|extramarital sex; of those, 79 percent were men. |
TO UNDERSTAND how statistics play out in the bedroom, get your hair done at Nuplan Hair Salon No. 2, a six-dryer beauty shop in Harare that offers plaiting, braided extensions, chemical straightening, slow waxing, sets, spirals, dreadlocks, highlights, manicures and pedicures.
Listen to stylists Eva Mzunguzik, Paula Marera and Lorraine Marera talk about their ex-husbands while smoke drifts from a hot curling iron wound with coppery locks. They were able to leave their marriages because they can support themselves and their children by dressing hair. Most women in Africa do not have that option.
Eva: "Men are not satisfied with one woman. They say it's like eating the same sadza, sadza, sadza every day. They want variety in their diet. My husband used to come in the bedroom with his girlfriend and say, I paid 8,000 Zim for her for the night. You use the floor. This African culture, it's destroying our women."
Paula: "I knew my husband was sleeping around, just knew. It's just like I know if my baby is not well. You know the telltale signs. If you're married, you wash his pants. There were movie tickets in his pocket — and his cellphone! I'm an intelligent person and this same certain number would appear."
Eva: "You can smell it. Different perfume than what you've got."
Paula: "I told my husband we must use protection. He said, I won't use condoms for the woman I paid lobola for. You are property."
Eva: "Property like a chair!"
Lorraine: "If they say jump, you say, How high? Even if he comes home at 3 a.m., I have to be his waitress to give him sadza."
Eva: "This client of mine, she told her husband to use a condom and he said, OK, I'll wear a condom. But he really didn't want to so he pricked the condom package with a needle. Lots of little holes. You see? This is how the virus spreads."
|Last year, 3.4 million people in sub-Saharan Africa were newly infected |
|with HIV. |
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FIFTEEN THOUSAND clinicians, re-searchers and advocates gathered in Barcelona in July for the 14th International AIDS conference. Scientists announced a new drug, enfuvirtide, or T-20, that could help restore the health of some HIV patients whose illness defies existing medicines. Researchers also reported finding an obscure gene in HIV that allows the virus to reproduce and infect human cells.
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|BETTY UDESEN / THE SEATTLE TIMES |i|
| |c|
|Even as public health efforts push condom use, private voices push back. |]|
|Roadside graffiti reflects a deep distrust of condoms and other Western | |
|intervention in Zimbabwe. Some believe AIDS is a ploy by the West to wipe| |
|out much of Africa. Life expectancy here has dropped in half — from 70 to| |
|38 years — because of the AIDS epidemic. | |
| | |
|[pic] |
In Zimbabwe, the hopeful news seemed impossibly remote, the debate over treatment vs. prevention almost silly. A disease that might kill in 10 years can't compete with hunger today.
Here, in the open-air market stalls near Ruth's house, women queue for days in the sun, babies swaddled to their backs, to buy scarce commodities like salt and cornmeal. At night, the flimsy stalls shiver as prostitutes ply their trade behind cracked plastic tarps. Graffiti decorates a crumbling brick wall: CONDOMS WILL NEVER PROTECT YOU.
"You'll be very surprised how this disease becomes a political issue," says Anna Mandizha, a young woman who leads an AIDS prevention and support group called Youth Alive Zimbabwe. "Some think it's the West's ploy to wipe out Africa."
They resent Western access to wonder drugs Africans can't afford. They distrust donated condoms (once a huge shipment was found defective and recalled). They suspect the AIDS virus was unleashed on Africa through other vaccines run amok.
At her youth groups, Anna advocates "second virginity" as the only sure way to protect against sexually transmitted death. But it is a solution that only works for those who have enough power to say no to their partners.
"At the end of the day, people are having sex for all the wrong reasons," she says. "Do I think it can be changed? Yes I do. By making men realize that women are more than satisfaction objects. By changing people's misconception that sex represents love. Because it doesn't."
|Every day, 14,000 people worldwide become infected with HIV. That's 5.1 |
|million people a year. More than 40 million by 2010. |
NETTY MACHUKUCHE lives half a block from Ruth's house and has been teaching young brides the secrets of marriage for decades.
She is 66, has spring in her legs and holes in her black sneakers. Her voice is gravelly as dried corn husks, strong as the harvest sun. Her tidy kitchen is a little bigger than a closet, barely lit with a hanging bulb, buzzing with three flies and crowded with neighborhood women sitting on the rough floor.
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|i|BETTY UDESEN / THE SEATTLE TIMES |
|c| |
|]|Neighborhood elder Netty |
| |Machukuche, 66, gathers young women|
| |in her kitchen for traditional sex |
| |lessons. Teaching women how to |
| |please their husbands has long been|
| |Netty’s way of keeping marriages |
| |intact. Now it is her way of |
| |combating AIDS. |
| | |
|[pic] |
Teaching women how to please their husbands has long been Netty's way of keeping marriages intact. More recently, it's been her way of combating AIDS.
Her linoleum counter displays an intriguing array of herbs: a pale red powder to stir in your porridge to dry and tighten your body before sex; fibrous twigs to soak in your bath water so you'll be lucky in love; pink granules to slip in your husband's porridge so he won't be able to have an erection with others; herbs to raise your body heat; strings of colored beads to wear around your waist so "he will be fascinated, play them like music."
Netty no longer recommends the ground bark of a certain fruit tree because she says women who used it to tighten their vaginas have higher rates of cervical cancer. But she still advocates pulling the labia. A tuft of fluff resembling cotton and sage will make this easier.
Women who don't pull their labia to make them long and enticing are like cups without handles, Netty says. Unstretched genital lips, she says, are the No. 1 reason men go elsewhere for sex.
The diaphragm does nothing to protect the labia. The wide opening of the female condom does. Some women say this makes them feel safe, but what about the men? Will they tolerate it? Will men who like dry sex tolerate microbicides, which are likely to lubricate?
Satisfying your man starts with bathing in late afternoon, Netty says, so you're "smart and presentable" when he gets home. Greet him at the door, fix him a cup of tea, have dinner ready.
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|BETTY UDESEN / THE SEATTLE TIMES |i|
| |c|
|Zimbabwean sex secrets shared |]|
|woman-to-woman: Fibrous twigs to | |
|soak in your bath so you’ll be | |
|lucky in love; herbs to raise your | |
|body heat; pink granules to slip in| |
|your husband’s porridge so he won’t| |
|be able to sleep with others. | |
| | |
|[pic] |
And later, in bed? Netty shows the proper movements with a basket of tomatoes held at her hips, rotating the basket as if winnowing rice and then tossing the fruits in the air a few times. She demonstrates the same movement on the ground, rollicking in a threadbare housedress atop an empty cement sack.
The neighborhood women chime in. They have tried many other things. Magic muti herbs in the furniture polish. Traditional medicine in the floor wax. Smearing cooking oil on their bodies. Smoking sheep fat over hot charcoal in the house. Seeking prayers from religious sects.
Jesca the cabbie, always practical, says she took chinamwari, sex lessons, when she was a young bride, but her ex-husband had other girlfriends anyway.
A slim girl in white bobby socks says she's done everything Netty has told her, but still, her husband stays out all night. "I'm worried," she says shyly, looking to Netty for an answer.
Netty once had 14 children. Seven are gone. Two died of childhood headaches, two of tuberculosis, three of AIDS.
She shakes her head, no wisdom to offer the young bride. "It's no use," she explains to the group. "She might be infected already, but she shouldn't leave because then she would lose her house. She chose this husband. She has to live with this husband and maybe just die with the virus."
TWO WEEKS before we met Ruth, her 16-year-old brother Esilon came home from school to find her sitting listlessly on a stump, her hair a mess.
Can you comb my hair? she asked.
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|BETTY UDESEN / THE SEATTLE TIMES |i|
| |c|
|At 7, Anna Chiremba already knows how to sweep and mop, cook porridge and|]|
|make tea — all skills necessary for a someday wife and mother. "She's | |
|doing a good one," her mothers says proudly as her daughter washes socks | |
|in the family's yard. The Chirembas live on the same street as Ruth’s | |
|family. | |
| | |
|[pic] |
In Shona culture, girls are taught to sweep, clean and cook; boys seldom share household chores. But Esilon has many older sisters, so he learned. And he was especially fond of Ruth. She had helped him compose poetry for his literature class. He had helped her rewrite notes from her HIV support group. Ways to protect from this deadly disease: Don't have many sexual partners. Only use sterilized razor blades. Get tested.
As he teased her hair with the comb that day, she told him the disease was back. "I was shocked," Esilon says.
Ruth faded quickly, wasted by bouts of diarrhea. She lost weight, even though her sisters tried to tempt her with sadza and the cucumbers she loved. The youngest, Ireen, fed her spoon by spoon.
When she had no strength to bathe, her sisters and mother boiled water over the fire, wrapped her skinny shoulders with towels and placed cloth down to buffer her from the cold concrete floor. They rubbed her skin with petroleum jelly to ease the sores.
Momma, since I'm so sick, I might die, she told Amai Caty. If I am to die, would you please look after my children very well?
Amai Caty shushed her fears. "...OK, my daughter. Let's see what's going to happen.' I was hoping she'd be all right."
Mercy canceled a trip to visit a brother in another township. She sat by Ruth's side to play gospel cassettes, pray and blow on the fire because Ruth always felt chilled.
Will you look after Martha and Tafadzwa when I am dead? Ruth asked Mercy. "Of course," Mercy answered. "But you're not going to die."
The day after we met, Ruth awoke hungry. She wanted chicken. Mercy rushed to the market to buy the fowl, a rare treat. While she was gone, Ruth's running stomach poured. Her two oldest sisters, Catherine and Regina, held her over the squat toilet while Amai Caty tried to wash the mess from her frail body.
Amai Caty was still washing her daughter when she realized Ruth was dead.
"Everywhere I touched her was cold and she had stopped breathing." Amai Caty thumps her right palm on her breast. "I felt pained. My heart had something like a lump."
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| |[pic] |
| | |
| |BETTY UDESEN / THE SEATTLE TIMES |
| | |
| |Ruth's mother, known as Amai Caty, shows her love through her hands. She |
| |raised 12 children with her husband, Robert, who supports the family as a|
| |sweeper and messenger. Even as she cooks and cleans, Amai Caty finds time|
| |each day to heat and pour Robert's bathwater. And when her middle |
| |daughter, Ruth, was dying of AIDS, Amai Caty did not hesitate to touch |
| |her or clean her wasting body. |
| | |
|[pic] |
AMAI CATY'S HANDS are strong as a tree and weathered as leather. The veins in her arms twist like roots into fingers that are sturdy as hardwood branches. Her thick thumbnails are ridged like bark.
From sunrise until the moon is high in the sky, for as many years as she has had a family, Amai Caty has used these hands to care for them.
After her husband leaves for his job as a city sweeper and messenger, she scrubs the bathroom, washes and dresses her grandchildren, breaks kindling, splits wood with an ax, lays and lights a gumwood fire, boils porridge, carries vegetables from the market, scrubs the blackened pots with dirt, wrings and pounds the clothes, irons with a charcoal iron, sweeps and sprinkles water on the dusty paths, wipes soot from the walls, and on and on until it is time to prepare tea and bathwater to be ready when her husband returns home. To warm the bath water, she kneels on the ground and breathes life into the fire. She lifts the heavy black pot using only small rags to protect her hands from the hot metal. She pours the water into a big plastic bucket then staggers with the bucket into the bathroom where Robert waits with an old-fashioned razor to bathe and shave.
Then Amai Caty starts supper.
Her daughters share the housework, but Amai Caty has always tended to her husband's tea and bath, even when she was pregnant, all 12 times. It's her way of showing she loves him.
And taking care of her children, Amai Caty says, that is a mother's love.
So when the end came for Ruth, Amai Caty showed her love with her hands. "I would wash everything that came out of Ruth," she says. "I never used any gloves. If I was to take plastic bags, like from the sugar and mealy-meal, Ruth would see me wearing the plastic on my hands and she would have stress. "Oh, my mother is seeing me like I am a toilet. My mother does not love me.' So I was touching everything with my hands. I wanted Ruth to know that I loved her and would touch her. It was up to God as to whether I would be infected or not."
|In sub-Saharan Africa, the median age for a woman to bear her first child|
|is 19. |
|On average, women have six children. |
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|BETTY UDESEN / THE SEATTLE TIMES |i|
| |c|
|In sub-Saharan Africa, women |]|
|average six children, starting at | |
|about 19. Here, young mothers bring| |
|their 6-week-old babies to a clinic| |
|in Chitungwiza township for a | |
|check-up. | |
| | |
|[pic] |
TO BE A FULL WOMAN in Zimbabwe, you must have children. That's how you earn the title of respect: Amai, mother. Should you die without giving birth, a rat and corncob will be strapped to your back where you would have swaddled your baby so you won't go childless to your grave.
In this maternal milieu, most women have a child within a year or so of marrying. It's often through a sickly baby or prenatal testing that young women discover they are infected with HIV.
So it was with Petudzayi Nyanhandam. She was 22, swinging down the sidewalk in a smart navy blue suit with matching flats, when she met the love of her life. Maxmore was 28, handsome, kind, funny, an engineer rising through the executive ranks, pens peeking out of his shirt pocket.
In 1992, a year after they married, when their infant son, Tariro, was diagnosed with pneumonia and then AIDS, the couple learned they were both HIV-positive. The baby died after nine months without ever smiling or sitting up.
Pressure to have another child was enormous. In 1995, Petu got pregnant again.
"The desire of wanting to be a mother does not go away because you're HIV-positive," she says. "It's just natural, within us, you know, the mothering instinct, wanting to be called Mommy."
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|i|BETTY UDESEN / THE SEATTLE TIMES |
|c| |
|]|"Wanting to be a mother does not go away because you're HIV positive," |
| |says career woman Petudzayi Nyanhandam. "It's just natural, within us, |
| |you know, the mothering instinct, wanting to be called Mommy." She lost |
| |her husband and two infant sons to AIDS, and is herself HIV-positive. But|
| |she considers herself "lucky" because she can afford medicine and good |
| |nutrition. |
| | |
|[pic] |
Petu's second son, Takudzwa, also was 9 months old when he died of cerebral palsy and AIDS. Her husband died the following year.
Instead of wedding and vacation pictures in Petu's family photo albums, there are funerals and graveyards. Striped tents sheltering mourners from the sun. Her husband's handsome casket trimmed with three tiers of blond wood and silver filigree handles. Her babies wreathed in lace, their cheeks chubby, even in death.
Even so, Petu, 33, calls herself "one of the lucky widows." She's built a strong career maintaining computer networks for the nation's largest telecom company. She lives in an upscale neighborhood of jacaranda trees and servants. She can afford good nutrition, soap and medicine for her ulcers and thrush.
Yet neither money nor education protects women from a disease that preys on their strongest desires: To love and be loved and have children.
Poverty simply makes the terrible worse. Petu scoffs at reports of the government talking with donors about pricey drug cocktails. The country has hardly any Nevirapine, an effective, inexpensive drug that helps prevent transmission of HIV from mother to child. "How are you going to provide antiretroviral drugs when you can't provide mealy-meal? Can you take the antiretrovirals on an empty stomach? We need milk, we need bread, we need washing soap for home-based care."
EVEN BEFORE we enter this house of mourning, we hear the women wailing. Sobs and shuddering sighs. Wrenching ululation. Somewhere, amidst the swish of skirts, a child's familiar hiccupy cry: Ruth's little boy, Tafadzwa. Hopefully his sister Martha is nearby to comfort him.
|[pic] | |
| | |
|BETTY UDESEN / THE SEATTLE TIMES | |
| | |
|For two days and two nights after Ruth’s death, women fill the tiny house| |
|to comfort her mother, Amai Caty, while the men huddle in silence | |
|outside. The vigil is, by custom, an unabashed display of grief, dance | |
|and song, all designed to usher Ruth’s spirit along. Almost everyone here| |
|has lost someone to AIDS. | |
| | |
|[pic] |
Outside, the clothes line stretches lonely across the yard, no laundry to cheer it. A red rag is nailed to the house to let passers-by know that the family grieves. Ruth's father, uncles and brothers huddle around a msasa wood fire, staring into the flames, sometimes choking as if something wants to get out, but mostly saying nothing, their mourning so quiet you can hear the fire hiss.
Inside, the rooms are cleared of furniture, the plywood boards that walled off Ruth's room taken down. Women fill the house: church ladies in blue headscarves, neighbors bustling around the courtyard kitchen, cousins pounding sadza with tall pestles.
Ruth's sisters collapse on each other, gripping so tight their fingernails turn white. Their mother slumps beneath a picture of Jesus. A photograph of Ruth and Richard hangs nearby.
Amai Caty flings her hands, palms and knuckles slapping the floor. These are the hands that washed her dying daughter. The skin is deeply lined, the fingernails slightly cracked, but there are no open wounds, no torn cuticles — no place, hopefully, for the virus to take hold.
Each new wave of mourners unleashes a new wave of sorrow that sweeps around the room. Many untuck small bills from the folds of their cotton overskirts and donate to Ruth's funeral expenses.
· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·
FACED WITH such suffering, what do you do?
We go to the market for cooking oil, firewood, tomatoes, onions, beef, chicken and four meters of white cloth for Ruth's burial garments and casket. The bolt of cotton leans askew on the shelf as if the general store does a brisk business in it. A week earlier, a meter of fabric cost 400 Zimbabwean dollars; this afternoon, in a country where the currency collapses daily, it's 590 Zimbabwean dollars, a tenth of Ruth's father's monthly salary. The total, for four meters, comes to $6 U.S.
The women cut and stitch the cloth for Ruth's shroud. Scalloped edges, diamond cutouts, the sign of a cross. A matching design to drape her coffin. A blouse, a cap and white panties for Ruth to wear next to her skin.
|More than 20 million people have died of AIDS since the disease was |
|identified in 1981. Last year alone, the death toll was 3 million. More |
|than 1 million of them |
|were women. |
IN ZIMBABWE, when a woman married to a truck driver dies of AIDS leaving two small children to be cared for by grandparents, the story is at least partly political.
Politics is about power. Women in Zimbabwe have little power, in government, in business, in the bedroom.
Priscilla Misihairabwi, 34, is an exception, an elected member of Parliament in a nation where fewer than 10 percent of the seats are held by women.
Priscilla exudes power. Perhaps it's her elegant navy pantsuit or her confident stride in narrow heels. Most likely, it's the plain way she talks about leadership and about the relationship between women and men.
"You can't separate issues of governance from issues of HIV infection," she says. "In Zimbabwe, we knew there was HIV as early as 1985, but the leadership decided HIV was not going to be spoken about. Prevention strategies did not start at a smaller level. If we concentrated on the commercial sex workers then, it could have been contained in that core group. By the time we started dealing with the issues, it had spread to the entire population: pregnant women, married women, young girls with sugar daddies. We had lost the battle."
Consider the contrast in Uganda, where the minister of public health passed out condoms on the street. The HIV infection rate there has dropped from 33 percent to 5 percent. In the U.S. and Europe, AIDS has been largely contained in targeted high-risk populations.
Priscilla launched her political life with a petition drive to register the female condom. In 1989-90, a research group had conducted an acceptability trial of the female condom. When the study was over, the condoms went away.
Women wanted them back. But the product was not registered with the ministry of public health. So Priscilla crisscrossed the country, educating women about HIV and female condoms and asking them to sign their support. She and others from the Women in AIDS Support Network collected 52,000 signatures; the female condom was registered for use in Zimbabwe on Dec. 1, 1998, World AIDS Day.
Priscilla continues to hold workshops for women all over the country. She encourages them to know their bodies, to refrain from using herbs vaginally, to get tested, to tell their husbands condoms are for contraception — a less inflammatory purpose than protection. Talk about sex and HIV before trouble starts, she urges.
"It's amazing how the same issues pop up whether she's a poor woman in a rural area or an educated professional woman," Priscilla says. "I actually think in Zimbabwe, the greatest risk factor for AIDS is marriage. Most women in Africa — they're just sitting ducks."
|Sub-Saharan Africa is home to 11 percent of the world's population. It is|
|home to 70 percent of those infected with HIV. |
· · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·
IN INDIA, an estimated 3 million people have HIV/AIDS.
Global health workers are racing to keep it from becoming the next Africa. The Gates Foundation recently promised $100 million to fight AIDS in India because the epidemic on the subcontinent is at a tipping point, which means there's still a chance. This summer, PATH researchers cruised drugstore aisles in India, loading their shopping baskets with 170 different vaginal products. These will be tested to see if any can be effective as a microbicide against HIV.
The Global Campaign for Microbicides says scientists may have a working microbicide as early as 2007 and likely by decade's end. Even if it's only 60 percent effective, it could avert 2.5 million HIV infections in three years if distributed in 73 countries.
In Asia and the Pacific, 7 million people have HIV/AIDS. Cambodia, Myanmar and Thailand have HIV prevalence rates of about 1 percent among 15- to 49-year-olds.
In Haiti, 8 percent of adults in urban areas and 4 percent of adults in rural areas are infected.
In Eastern Europe, 250,000 people were newly infected last year, bringing the total number of HIV-positive people to 1 million. Eastern Europe is home to the fastest-growing HIV/AIDS epidemic in the world.
WHAT FLOWERS do you take to a funeral in Zimbabwe?
"Man or woman?" the sidewalk vendor asks.
"Woman."
| |
| |
| |
Then choose anything, he says. But for a man, stay away from pink. Jesca selects pink and butterscotch roses surrounded by stiff ferns.
Steering her taxi to Ruth's, Jesca tells us she has already paid for her own funeral. When the time comes, she doesn't want her young daughter to have to deal with burial costs.
"When you know your status," she says, "you have to plan your things. No one will do it for you. I want to have a house, so when I am sick, no one will chase me for the rent. When I have my own house I will be free to say, Ha! I have AIDS! I have HIV! I know where I will die!"
We exit the highway toward Mabvuku, past the condom billboard to the main street lined with girls walking to school in crimson and blue uniforms, their bare legs inviting any man's gaze. A few more zig-zags, past roadside stalls roofed with cracked plastic and men lounging on stray tires, to the little cinderblock house.
Mourners spill into the street, resting under trees, adjusting babies strapped to their backs, dancing in a dusty circle. Tafadzwa and a gaggle of cousins play with homemade cardboard tops and lumpy balls of wadded newspaper.
Martha hugs a street pole. A neighbor child pulls a copper coin from his pocket and gives it to her along with a piece of foil he picks off the ground. She sits on a rock in a brand new yellow lace dress, tearing the foil into small pieces. Someone has braided her hair in neat horizontal plaits. It's hot. The hearse from Dove's funeral home pulls up, bringing Ruth home one last time.
Her twin sisters Mercy and Ida, clutch each other, their cries screeching through the neighborhood. As young women of childbearing age who are not yet mothers, it would be bad luck for them to attend the burial, so they must say goodbye to Ruth here. Their brother Francis leans against a peeling doorjamb, face wet with tears. Martha turns her back as her mother's coffin is carried into the house. Tafadzwa is lost in a crush of legs. His nose is dripping and nobody has noticed to wipe it.
Ruth rests at the bottom of an open box, under a dangling lightbulb, topped by baskets of flowers. She looks frail and old. Tucked in the coffin's depths, wearing a scalloped white cap, she looks nothing like the portrait of her propped up amongst the flowers, a picture that captures the round childish cheeks and shyness of a schoolgirl on a sunny day.
Ruth's uncle reads from the Bible in a booming voice, invites others to speak and asks several times, sarcastically, Is anybody here from the husband's side?
The family circles for viewing. Tafadzwa tries to touch his mother's face. He tosses a piece of charcoal into her coffin so her ghost won't haunt him at night. Amai Caty gently places Ruth's favorite blouse in the coffin, the white one with red roses embroidered on the collar. Martha comes around three times, finally looks at her mother on the second pass and waves goodbye on the third. Smoke from the msasa wood fire stings the eyes, swells the throat. The women sing, always sing.
The sun shines directly overhead when the mourners scramble onto two open-bed lorries for a boisterous ride to the cemetery, which sprawls on the edge of the township. The field is stark. Shriveled maize on one side, mounded graves on the other. Each day, the mounds move toward the maize. Soon, the dead will overwhelm the crop.
Pre-dug graves yawn empty and waiting, barely two shoe-lengths apart. Uncles set two sticks across one of the open slots and balance Ruth's coffin there while relatives speak of her life: She was a good girl who never went to pubs; others shouldn't gossip about her disease because it's likely in their household too; everyone should care for Ruth's two children; even if there's no bread, they should share what they have.
Before they finish, another hearse pulls up, bearing another daughter for another funeral. Ruth's mourners rush through the final hymns, then the men jump into the grave, smooth the pit's bottom with their shovels, lay woven bamboo mats above and below the coffin, lower the box with ropes, dig, rake, tamp the dirt, fast, furious, colliding with each other, vying for the shovels as if cutting in at a dance. It's an astonishing display of strength, virility, love.
Ruth's littlest sister Ireen carries a plum-colored plastic washbasin with matching toothbrush, a white plate, a spoon and a cup decorated with butterflies. They are smashed and mangled so no one will steal them, and set atop Ruth's fresh grave, utensils for the next life. Roses are placed there, too, crawling with bees, and a potted philodendron that was Ruth's favorite houseplant, bottles of orange Fanta and Coca-Cola, a sheaf of grasses tied with twine. Aunts and cousins and sisters-in-law walk on their knees, sprinkling and sweeping the crumbly soil. Tafadzwa plays in the sand. Amai Caty holds Martha, softly rubbing the small girl's head.
A hand-lettered tin sign spells out Ruth's name in the language of Malawi, her parents' homeland:
Lute Rosemary Chimuonenji
Date of birth: 31-1-78
Date of death: 7-07-02
Two shoe-lengths away, the next coffin is already in the ground and the next wave of mourners starts to sing and dig. To Ruth's right, five holes wait to be filled. To her left, seven people were buried earlier today. Two of the new graves are simply marked with rocks and sticks. Five are covered with flowers.
All of the blossoms are pink.
|Last year, 580,000 children under the age of 15 died of AIDS worldwide. |
IN THE DAYS AFTER her mother's funeral, Martha plays in a brand new flowered dress. She waggles her tongue and runs hand-in-hand with neighbor pals under the hanging laundry. She tosses stones into a circle drawn in dirt. When the sun beats hot on her head, she snuggles against her aunt Mercy in the shade.
Of all the sisters, Mercy looks the most like Ruth when Ruth was well. Soft wide cheeks, full lips, a shy smile. She wears Ruth's clothes now. Today it's the maroon polyester forgive-me blouse and Ruth's heavy black sandals. They are tight on Mercy's swollen feet and the straps leave indents in her flesh when she eases them off.
Who will take care of my daughter? Ruth had asked.
I will, Mercy had promised.
Now she styles Martha's hair, each day a different way: zigzag braids, vertical plaits, tiny twists springing from her head. The day after the funeral, Martha asked her aunt, "Would you please make me a dress?"
They choose the fabric together, 1.5 meters of cotton with coral flowers, berries and brown leaves the same chocolate hue as Martha's skin. The dress has a scooped neck, a bow that loops at the waist and a matching kerchief for Martha to cover her hair and tie at the nape of her neck, just like her grandmother.
Martha leans against Mercy, tracing the brown leaves on her dress. "My mother," she says. "My mother cooked my breakfast. My mother plaited my hair. My mother ...
"I'm forgetting."
For a long while, she says nothing. She watches a bug crawl over a crack. She wiggles her toes. She notices her mother's sandals askew next to Mercy's ankles, and slips her small feet into them. They're way too big.
Hopefully she won't grow into them anytime soon.
JESCA DRIVES us back to the cemetery to visit Ruth's grave before we leave. It's late afternoon. Jesca hunkers down behind the wheel and declares she'll wait in the cab. "You are very brave," she says. "I'm scared to go out there."
|[pic] | |
| | |
|BETTY UDESEN / THE SEATTLE TIMES | |
| | |
|Harare taxi driver Jesca Machingura parks near the sign that marks Ruth's| |
|grave — Lute Rosemary — but refuses to walk among the dead. Jesca is | |
|HIV-positive and has prepaid for her own funeral so her daughter won’t | |
|have to worry. "When you know your status," she says, "you have to plan | |
|your things." | |
| | |
|[pic] |
In the marching mounds, Jesca sees her future.
The field where Ruth is buried holds 50 rows. Each row holds 50 graves, except Ruth's row, which is only three-quarters filled. Grave markers list the birth dates of the dead: 7/6/66, 3/12/75, 2/3/81, 4/8/58, 10/9/72, 11/5/95. Mostly people in their 20s, 30s and 40s, but a few younger, as young as Ireen. As young as Martha.
Standing here, where human life has stopped, it's impossible not to count time in weird ways.
A year to pilot production of an improved female condom.
Three years to debut a new diaphragm. Five years until anybody knows whether it protects against AIDS.
Five years, minimum, for a microbicide.
In five years, Ireen will be as old as Ruth was when she met Richard. Ireen's slim body will swell at the breast and hips, and her bright eyes will likely turn toward men, the spring in her step swirled by love. Can there be a vaccine by then?
In five years, Martha will have outgrown her new flowered dress, but she'll still be only 11. For her, maybe there's hope. For her, maybe the odds will be better than the 1 in 2 chance that a teen today in Zimbabwe will die of AIDS.
Faced with life's unrelenting calculus, what do you do?
Nine rows back (six months worth of deaths), the tinfoil crosses and plastic washbasins are shards.
Eighteen rows back, the grave adornments are dust. Back here, all the cemetery mounds have collapsed, the rusty dirt has tumbled down. Weeds creep, seeding the ground with pearly flowers.
If you didn't know, you probably couldn't tell that someone was buried here or that they died or that they ever lived at all.
Soon it will be dark.
Here, where the toll ticks, grave by grave, past 2.3 million, there is no gently lingering twilight, no miracle cure, no time to waste.
The sun slams down, insects buzz, a pregnant moon rises over Mabvuku's famous red earth, the damned fertile earth.
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| |p|p|p| |
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-----------------------
"I wish my daughter would grow up to be a big girl, get a proper education and get married to a husband who will take care of her ... Not like what happened to me."
— RUTH CHIMUONENJI, AIDS VICTIM
|BETTY UDESEN / THE SEATTLE TIMES |
|Martha and Tafadzwa, the day before their mother died. |
"As a human, it’s very difficult to think that just because of an accident of birth, somebody in Africa or Asia does not have access to a reasonable quality of health care."
— DR. HELENE GAYLE, THE GATES FOUNDATION
And the dead? "Maybe they stay around awhile. ... Like a spirit you hear in your sleep as if a voice is talking to you."
— RUTH CHIMUONENJI, AIDS VICTIM
|BETTY UDESEN / THE SEATTLE TIMES |
|The search for solutions has become a race against time and culture.|
|At Seattle-based PATH (Program for Appropriate Technology in |
|Health), Lisa Tam is helping to build a better female condom with |
|feedback from women around the world. |
"When you die, you die. ... That’s it. You don’t come back."
— AMAI CATY, RUTH’S MOTHER
"At the end of the day, people are having sex for all the wrong reasons."
— ANNA MANDIZHA, HEALTH ACTIVIST
"I’d always wanted to invent something that would help people. Not anything earthshaking, but something."
— LISA TAM, PROGRAM FOR APPROPRIATE TECHNOLOGY IN HEALTH
|BETTY UDESEN / THE SEATTLE TIMES |
|In the Zimbabwean township of Mufakose, |
|five AIDS orphans share a tiny plank shack |
|with only a carpet scrap for a bed. |
|Clockwise from bottom: King, 6; Grace, 12; |
|Leonard 17; Lovemore, 21; Linda, 14. |
|Lovemore wants to be a minister, but |
|instead scrounges for food to feed his |
|siblings. |
"Every little bit, if you make any difference at all, is going to help. I think you’re morally obliged to look at anything and everything that has any potential."
— DR. NANCY PADIAN, WOMEN’S GLOBAL HEALTH IMPERATIVE
"She chose this husband. She has to live with this husband and maybe just die with the virus."
— NETTY MACHUKUCHE, NEIGHBORHOOD ELDER
"I wanted Ruth to know that I loved her and would touch her. It was up to God as to whether I would be infected or not."
— AMAI CATY, RUTH’S MOTHER
"The desire of wanting to be a mother does not go away because you’re HIV-positive."
— PETUDZAYI NYANHANDAM, CAREER WOMAN, AIDS PATIENT
"I actually think in Zimbabwe, the greatest risk factor for AIDS is marriage. Most women in Africa — they’re just sitting ducks."
— PRISCILLA MISIHAIRABWI, MEMBER OF PARLIAMENT
BETTY UDESEN / THE SEATTLE TIMES
Ruth’s older sister Regina is overwhelmed with grief as the family holds the funeral vigil in their small cinderblock home. Millions of families in sub-Saharan Africa have conducted this ritual, but each death carries its own profound loss. Global health workers say marriage itself has become one of the greatest health risks to women in the sub-Sahara, where as many as a third of all men are infected with HIV.
"This African culture, it’s destroying our women."
— EVA MZUNGUZIK, HAIRDRESSER
BETTY UDESEN / THE SEATTLE TIMES
Narrow graves are pre-dug and waiting for the dead. If AIDS continues unabated for the next 20 years, the worldwide death toll will reach 68 million.
"My mother cooked my breakfast. My mother plaited my hair. My mother ... I’m forgetting."
— MARTHA, RUTH’S DAUGHTER
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