DEATH WATCH: The Global Response to AIDS in Africa

In the first U.S. budget submitted after IIM 91-10005, appropriations for AIDS control overseas measured $ 124.5 million, just over half of what Americans pay annually for baldness therapy. Spending remained flat at that level for seven years. And those budgets, in global context, were considered high. The combined assistance from Europe, Australia and Japan barely surpassed them. The Bush and Clinton administrations entertained no proposal to increase the funding.

Over that seven-year period, as best can be calculated from U.N. data, 17,873,939 men, women and children--three-fourths of them in Africa--contracted an infection that has or will soon cut short their lives.

Discovery, Doubt, Denial

Summoned by improbable theory, a small team of foreign scientists touched down in Kinshasa, Zaire (now Congo), on Oct. 18, 1983. People were dying mysteriously at Mama Yemo Hospital, the 2,000-bed facility named for the president's mother. Bila Kapita, chief of internal medicine there, had followed medical reports of a new immune disease identified in San Francisco and New York. He wanted to know whether he could be seeing it in Zaire.

Peter Piot, a 34-year-old Belgian who had co-discovered the Ebola virus in his twenties, led the team of specialists from the CDC and the National Institutes of Health. He had been to Mama Yemo in the Ebola days, and he saw at once how much had changed.

"In 1976, there were hardly any young adults there except for traffic accidents in orthopedic wards," Piot recalled. "Suddenly--boom--I walked in and saw all these young men and women, emaciated, dying."

There was not yet an antibody test for the AIDS virus. It took three weeks of makeshift laboratory work--counting T-cells and lymphocytes in blood samples, confirming secondary infections associated with the new disease--to validate Piot's snap diagnosis. There were some three dozen AIDS cases in the hospital, and they were divided almost evenly between women and men.

The implications staggered Piot and his American colleague, Joe McCormick.

"There were so many women, it said to me it's heterosexual," Piot said. "That means everybody's at risk. . . . Until then I never thought a whole country, a whole population, could be involved."

Few believed the report from Zaire. The illness had been known since 1981 as Gay-Related Immunodeficiency Disease. Only homosexual contact, apart from direct exposure to infected blood, was thought to transmit the virus.

Piot, Kapita and McCormick found their submission rejected by a dozen medical journals. Peer reviewers asserted adamantly that the team must have overlooked some alternate path of transmission. At the first international AIDS conference two years later in Atlanta, "people came up to us and said this is nonsense," Piot said. "Denial has been a characteristic of this epidemic at all levels."

Governments shared much of the same disbelief. The first reports of AIDS closely followed the inauguration of President Ronald Reagan, whose "family values" agenda and alliance with Christian conservatives associated AIDS with deviance and sin. "AIDS is God's punishment," Rev. Jerry Falwell said in a famous 1983 television sermon, paraphrasing liberally from Galatians 6:8. "The Scripture is clear: We do reap it in our flesh when we violate the laws of God."