AIDS in Angola

Maria: "Doctors told me I was suffering from the plague"
Maria: “Doctors told me I was suffering from the plague” (© Eric Beauchemin)

HIV/AIDS remains the number one killer in all countries of southern Africa. The one exception is Angola. Paradoxically, a quarter of a century of war largely protected Angolans from the growing epidemic in the region. But the virus has now taken a firm foothold in Angola. At the turn of the century, infection rates had increased by 250% in just two years, but most Angolans remained completely unaware of the looming crisis. The donor community and the government were waking up to the fact that it was still not too late to prevent Angola from reaching the same HIV levels as the rest of southern Africa.

Producer: Eric Beauchemin

Broadcast: August 4, 2003

This programme is part of a dossier wide-ranging dossier – Angola: Picking up the Pieces – that won the One World Broadcasting Trust New Media Award in 2003.

Transcript

AIDS is now the number one killer in all countries of southern Africa. The one exception is Angola. Paradoxically, the quarter of a century of war largely protected Angolans from the growing epidemic in the region. But AIDS has now taken a firm foothold in Angola. Over the past two years, infection rates have increased by 250%. Most Angolans remain completely unaware of the looming crisis. But as Eric Beauchemin reports from the Angolan capital, Luanda, the donor community and the government are waking up to the fact that it’s still not too late to prevent Angola from reaching the same HIV levels as the rest of southern Africa.

Roque Santeiro is reputed to be one of Africa’s biggest markets. It’s a filthy, overcrowded place overlooking the picturesque Bay of Luanda. You can buy everything here, from vegetables to appliances. Like in many other places in the Angolan capital, sex is also available for a price. One third of Luanda’s prostitutes have HIV; a third have syphilis; 2 in 10 have hepatitis B. But nowhere are there billboards, signs or any other type of information about AIDS. A recent survey showed that 65% of Angolans do not know of a single way to protect themselves. 26-year-old Maria had heard of HIV, but nothing prepared her for the news that she herself had the virus.

Doctors told me I was suffering from the plague. They had me take tests, including the one for HIV. The doctor didn’t have the courage to tell me I had it. He sent me to other hospitals. They gave me an envelope to take to my doctor. I was tired: I had been going from one hospital to another for days. So I just took the envelope and went home. That’s where I opened it. I was stunned. I knew it was a death sentence.

Maria discovered she was HIV-positive last year. Most people never find out because of the collapse of the country’s health services. AIDS is rapidly becoming one of the main threats to post-war Angola, believes Alberto Stella of UNAIDS.

Alberto Stella, UNAIDS
Alberto Stella, UNAIDS (© Eric Beauchemin)

I think we are in the exponential phase of the epidemic. We have only studies among pregnant women attending ante natal care and the figures show us that the epidemic is really increasing in terms of the number of the cases, of new infections. In 1999, the ?? survey in Luanda showed prevalence of 3.4% and actually in 2001, the prevalence is 8.6%.

Of even greater concern to Melanie Luick of UNICEF, the United Nations Children’s Fund, are HIV (or sero-prevalence) rates in the interior. They are just as high, if not higher than in the capital. IDPs or internally displaced persons are at particular risk.

We’re now getting data from some of the provinces that we had thought to be the most protected. And we’re getting sero-prevalence rates of about 12% and you also have to keep in mind that the IDPs who are probably most at risk for HIV sero-conversion have never been studied. So even though we know probably sero-prevalence in urban areas, we don’t know those who are at greatest risk in the provinces, in IDP camps.

The camps for internally displaced people are home to hundreds of thousands who had to flee during the past quarter of a century of armed conflict in Angola.

I really think the explosion of HIV here in the country can be really linked to the war because all of the things that we know are huge risk factors – migration, big risk factor, malnourishment, big factor, the disintegration of the social system including education and health services – I mean the war, you can almost make a direct link between the war and the increase in sero-prevalence. In Angola you also have huge amounts of military policing the country and we also know that any contact with military is usually indicative of a higher sero-prevalence rate.

A number of other factors are causing HIV rates in Angola to spiral. 70% of Angolans are under the age of 24. They’ve known nothing more than war all their lives. Most haven’t been able to attend school. Many have lost their families and friends.

What I’ve really seen in Angola is a youth without hopes. So when you ask a youth here what would you like to be, they don’t always know what that means. And I think that helps spread or fuel HIV because how can you tell kids or young people, you don’t want to get HIV because your future would then be at risk, when they don’t have any great impetuous to have a future. They don’t necessarily see tomorrow as being a big deal because they’ve seen so many people die.

In 1995, Antônio found out that he had HIV…the result of a blood transfusion a decade earlier.

António: "Angolans simply aren't ready for this"
Antônio: “Angolans simply aren’t ready for this” (© Eric Beauchemin)

My family know that I have HIV. When I came back from South Africa, I told them. Only my close family knows that I have the virus. They all reacted positively. They helped me as much as they could. I haven’t told my friends. I only told my family because I think it’s my business and for the moment, I don’t need to tell anyone. It’s not that I’m afraid, but Angolans simply aren’t ready for this. People who reveal their status are rejected. I don’t think I’ll ever publicly declare my status.

26-year-old María shares Antônio’s fears. The virus terrifies almost all Angolans, including doctors.

I pray to God that I won’t get sick again here. I never ever want to have to enter another hospital in Angola. The last time I got really sick, I went to a hospital in Luanda. They wouldn’t treat me. I arrived there on Thursday. No one even looked at me. I stayed there till Saturday. The doctors were afraid to walk past my bed. I was lucky to meet an Italian doctor. She got me out of there and sent me to a private clinic. They treated me, and I didn’t have to pay. When I think about falling sick again, no. I’d rather stay at home than go back to a hospital. If I were a doctor, I’d be the first to give a patient a hand. But they despise me. If a doctor feels like that, what can you expect from others?

Most Angolans have never heard of HIV and AIDS. No one told them – besides, most were just trying to survive the war. A survey released a few months ago showed that only 8% of women have what is described as adequate knowledge of HIV transmission. 65% of Angolans do not know a single way to protect themselves. The figures are comparable to those found in the rest of southern Africa over a decade ago. Until recently, the government simply ignored the growing problem; UN agencies too. Trying to alleviate the constant humanitarian crises was seen as a higher priority, says Melanie Luick of UNICEF.

I do think you can make a case that 20% of the people that you are trying to effectively save through education, save through malnutrition programmes, save through demobilisation of soldiers, if you don’t address HIV, 20% of those people are going to die. And if you just look at it – you take out human rights – if you just look at it from an economic standpoint, it makes sense to address it in an emergency situation. And in fact, time after time, in the world we’ve seen that unless you address HIV during conflict, after a conflict, you are going to pay the price for not having addressed it.

The president of Angola, José Eduardo dos Santos, has spoken publicly about AIDS, but the new openness doesn’t yet seem to have filtered down to bureaucrats. When I went for an interview with a senior official in the ministry of health, I was politely stood up. The official said that all my questions were too sensitive for her to answer. Nonetheless, there’s a growing awareness of the seriousness of the threat, says Alberto Stella of UNAIDS.

It’s increasing, actually because of the results of the last studies. And so the government is worried, is doing something. They approved the programmes of prevention of mother-to-child transmission. So, I think this is a good moment to do something because perception is higher, because there is a lot of motivation in the civil society, NGOs and also in some ministries.

Throughout the country, local people are establishing groups to raise awareness about HIV and AIDS and to help deal with the coming crisis. UNICEF is supporting a group of young people in south-western Angola.

We have an NGO in the province of Huila called Prazedor which in Portuguese is kind of the two words “prazer” which means pleasure and “dor” which means pain. That’s the name of the NGO: pleasure and pain which I thought was particularly interesting. And what they do, they do all sorts of things. They work within the school system. They work at community-based activities. They work within the hospitals, but they also do interesting things like, they closed down all the roads in Huila one day a month, one Saturday every month. And the cars cannot pass before getting a condom, a red ribbon, and a message about HIV as well as a pamphlet with all the information, and it’s a really good example of youth really taking the lead because it was the youth that sought out the military to help them. It was the youth that went to talk to the governor and I think they have really set a great example for other youth groups in Angola on how to mobilise their own political leaders and to generate political will at a very high level.

The next challenge is translating that political will into greater awareness among the general population. It also means breaking the taboos and myths surrounding HIV. A recent survey, carried out by UNICEF, found that infected people suffer abandonment, rejection and isolation. They’re also likely to lose their job. That’s what happened to 35-year-old Antônio, when he returned from South Africa, where he’d been getting treatment.

I work in public relations for a domestic company. I was fired a few days ago. I think it’s because they realised I was HIV+. When I came back from my last trip, they told me I should stay home. They said I travel abroad too often, and my work couldn’t wait. They hired someone else to do my work. But this doesn’t make sense. Yes, I’m taking time off, but I’m not out having a holiday. I’m going for treatment. Now that I’ve been laid off, I won’t have money to get treatment. I won’t have money for food. What’s left for me? To die. Without money, without anything, how can I live? It’s impossible. In this country, you have to have money for everything. Nothing is free here.

As a result of the cease-fire signed in April, the government and Angolan society can now focus their energies on tackling the growing epidemic. The extent of the epidemic is likely to become clear in the coming months, as more surveys are carried out, particularly in the areas that had been inaccessible because of the fighting. Melanie Luick of UNICEF is pessimistic, at least in the short term.

I think what we will see in the next five years is a rapid explosion of HIV, and that means the government is going to have to mobilise as is the entire international community to address those needs. Two really clear examples are that in Angola, there are only 4 voluntary testing and counselling clinics. And there are no anti-retrovirals in the country. These are two crucial areas in addressing HIV within the country.

Angola has yet to learn from the experience of the rest of southern Africa, where HIV is devastating entire societies. Tony Hodges, a prominent Angolan expert, is scathing in his criticism of the Angolan government’s failure to deal with the growing epidemic.

Unfortunately the Angolan authorities have not really yet grasped the seriousness of this threat, probably because large numbers of people are not yet dying. There’s practically no government money given to the fight against HIV/AIDS. There’s no real national body leading the fight against HIV/AIDS. It’s a problem that’s given lip service but it’s yet to be taken really seriously, but if it isn’t, this is going to be one of the really serious threats for the post-war period.

This week’s Wide Angle was produced and presented by Eric Beauchemin.