My country of the Sudan borders on the AIDS belt of Africa. While acquired immune deficiency syndrome seems to be concentrated on the east and west coasts and in the cities of the United States, it has already spread throughout sub-Saharan Africa. Eighteen African countries have reported cases.
In Africa, ignorance and superstition about AIDS is still widespread. Delivering reliable information is extremely difficult, given the continent's primitive communications network, low literacy rate and multiplicity of languages.
Africa needs much more technical, financial and educational assistance. Although most African countries have already established national committees to fight AIDS, help in certain areas is especially vital.
Health professionals in Africa have appealed to the national committees in each country to help fund sex education programs. Physicians and scientists have asked the Organization of African Unity to call an emergency meeting and to come up with comprehensive regional programs and strategies that will help in combating AIDS.
In the fight against AIDS, priorities in Africa are: A safe blood supply. Safety of syringes, needles and cutting instruments in the health sector. Mandatory use of gloves by medical and paramedical personnel. Research on AIDS and childbirth is a crucial area for further study regarding the modes of transmission. Screening of pregnant women and counseling is essential. :: Enforcement of the prohibition against female circumcision, which increases the risk of AIDS because of the exposure to contaminated instruments or the hazard of loss of blood and the necessity for blood transfusion.Sex-education programs that include information on AIDS prevention. Use of condoms should be stressed as a contraceptive aid to child spacing as well as a safe sex practice. These programs should be introduced into the educational system and take into account traditional cultural and religious factors prevalent in each African country.
How much some African countries have become infected with the AIDS virus -- called HIV, or human immunodeficiency virus -- is becoming evident from a number of studies. In Kinshasa, Zaire, a city of 4 million, tens of thousands of blood samples revealed that 6 to 7 percent were HIV positive. A broad-based study in the Zambian capital of Lusaka found that 18 percent of blood donors were HIV positive.
No one knows how many now carry the AIDS virus, but western researchers conservatively estimate the number to be as high as 10 percent of the urban population of Central Africa. Dr. Peter Piot, a microbiologist at the Institute of Tropical Medicine in Belgium, who in 1983 helped make the first confirmation of AIDS in Africa, says his guess is that several million are now infected.
Equally alarming is the speed of this epidemic's spread, which scientists have measured by comparing older blood samples with more recent ones. Many experts believe up to 90 percent of carriers will eventually develop AIDS.
Further complicating the crisis may be the fact that HIV-infected Africans are exposed to a vast array of conditions that AIDS researchers call co-factors. Infectious diseases such as tuberculosis and malaria, as well as malnutrition, are suspected of playing a role. To what extent these co-factors increase susceptibility to AIDS is not well understood, but they all affect the body's immune system to some degree.
Within Africa, transmission of AIDS is also facilitated by a high tolerance for extramarital affairs by men. The AIDS virus also is passed in utero from mother to child, during delivery and possibly through breast-feeding. Research on the AIDS virus in pregnant women should be a priority to reduce the rates of transmission to newborn children. With HIV-positive rates among African pregnant women increasing rapidly, the AIDS epidemic among children will only grow worse. In Kinshasa in 1984-85, for example, 8 percent of the women in prenatal clinics tested positive. A Zambian study of 272 expectant mothers turned up with the same percentage.
Another way in which AIDS is transmitted is through blood transfusions. A large portion of the population of Africa at one time or another is in urgent need of transfusions for a variety of reasons, and the spread of AIDS through contaminated blood is widened by a number of special health problems that require transfusions. One is sickle cell anemia, a genetic disease that damages red blood cells. Of the 150,000 children born each year with this condition, 100,000 are in sub-Saharan Africa. Another is malaria, which kills 1 million Africans each year.
International support for the African fight against AIDS is increasing. The World Health Organization has launched special programs on controlling AIDS. A number of bilateral programs are also under way. One involves the U.S. health agencies, the National Institutes of Health and the Centers for Disease Control. Others are based in Europe, particularly France and Belgium. Most of all, it will take political leadership in each country to confront the epidemic.
Fathia A-Mahmoud, MD, is a research fellow in reproductive endocrinology at the National Institutes of Health. Born in Sudan, she took her residency in obstetrics and gynecology at Oxford. This article was excerpted from a paper presented at the Woodrow Wilson International Center for Scholars during a seminar sponsored by the Urban Institute June 18-20.