Wednesday, November 12, 2003

KALIMA, Congo — By 8 a.m., just after the sun burned off the morning fog in this lush northeastern jungle in the Democratic Republic of Congo, 20 Mayi Mayi rebels with machine guns surrounded the fields where Louise Nafisa and 24 other women were gathering cassava and corn for their families.

The rebels took the women hostage. Some of them, like Mrs. Nafisa, had babies strapped to their backs. The rebels led the women to an abandoned mining camp and raped them, said Mrs. Nafisa, 30, who told her story from a health care center in Kalima, a small mining town in Maniema province.

Most of the women escaped later that day when another Congolese rebel group attacked the camp. That was six months ago. But there is a legacy from her ordeal that Mrs. Nafisa cannot outrun — she was infected with HIV, the virus that causes AIDS. What’s more, she doesn’t even know it. And most likely the rebel who infected her doesn’t know that he is HIV-positive.

They are part of what aid groups here say is a hidden crisis: the spread of AIDS in a war-ravaged country bereft of the means to treat or even monitor its spread.

“We only have enough testing kits for blood donors and pregnant mothers. If they test positive, we usually don’t tell them because nothing can be done about it anyway,” said Dr. Gilbert Mutangilwa, head physician at Kalima’s General Hospital, where Mrs. Nafisa and her family are recovering from malnutrition.

In Congo, talking about sex and public displays of affection are taboo. AIDS carries such a stigma that those known to have it are shunned. But with 1.3 million people in this country living with HIV and AIDS, and with 680,000 AIDS orphans, the virus is destroying Congolese families. A U.N. report on AIDS in Africa has found that most people living with the virus are unaware they have it.

Congo’s five-year civil war claimed an estimated 3.5 million lives, mostly from starvation and disease, making it the costliest human conflict since World War II. But as the fighting grinds to a halt under a power-sharing agreement between the Kinshasa government and rebel leaders, many Congolese fear that the most devastating outcome of the war will be the deepening scourge of AIDS.

“This is an epidemic that’s about to explode,” said Dr. Pierre Somse, coordinator for the U.N. AIDS program in Kinshasa, Congo’s capital. “When there’s stability and people can go to health clinics for testing, the true face of the epidemic will emerge.”

In the United States, AIDS is linked to risky sexual behavior or intravenous drug use, but in Africa it is linked increasingly to armed conflict.

HIV infection rates among Africa’s armed forces are staggering. Nearly a quarter of Ugandan soldiers have tested positive for HIV, which is low compared with the 75 percent for the army in Malawi, or Zimbabwe’s estimated 80 percent. South Africa’s army — one of the best-maintained on the continent, with at least 1,200 peacekeepers in Congo — has found that more than 20 percent of its troops are infected with HIV and has stopped accepting HIV-positive recruits.

Congolese military officials and the rebel factions including the Mayi Mayi and the largest and most organized group, the Rally for Congolese Democracy, hide the numbers of their fighters suffering from full-blown AIDS, one of the few indicators of HIV infection in a country with a collapsed medical system and almost no AIDS testing.

In Kinshasa, the nation’s most populous city with more than 6 million people, only four voluntary centers test for AIDS and other sexually transmitted diseases. In the rural areas, where most of Congo’s 56 million people live, rebel forces often loot medical supplies from health clinics and hospitals.

“The militaries don’t want to show the prevalence of AIDS among their forces because it’s a strategic issue,” said Dieudonne Zirirane, regional director for Population Services International in Bukavu. “No military is going to admit that 20 [percent] to 30 percent of its force is dying of AIDS.”

Another aspect of the AIDS problem in Congo’s war, aid workers say, is that with the breakdown of information networks such as schools, many people don’t know how to protect themselves from HIV. Nearly half the people living in rural areas believe HIV infection is the result of witchcraft, and 40 percent believe they can get AIDS by touching an infected person, according to a UNICEF survey two years ago.

Although Congo is considered by many to be the birthplace of AIDS more than 40 years ago, the first large outbreak of AIDS on this continent was in Uganda’s southern Rakai district in the 1970s. Its spread there coincided with a Tanzanian-backed rebel invasion that toppled that country’s reviled dictator, Idi Amin.

Uganda’s 17-year civil war, like Congo’s, helped the virus flourish via widespread rape, displacement of hundreds of thousands of people with little or no access to health care or condoms, and the increase in prostitutes following soldiers in a ruined economy.

The conflict in Congo involves at least six rebel armies, dozens of armed splinter groups, and militias from neighboring countries, including Rwanda, Burundi, Zambia and Zimbabwe — all with significantly higher HIV infection rates than Congo.

Of particular concern for those fighting AIDS in Africa is the trail of Congo’s rape victims, numbering in the hundreds of thousands. Some aid workers estimate that one in three Congolese women have been sexually assaulted during the civil war. Many of the women and girls have been gang raped by front-line soldiers, whose rates of HIV infection tend to be more than five times higher than that of the civilian population.

“Congo was one of the most advanced African countries in the fight against AIDS. We kept our infection rate to about 5 percent, which is much lower than most of the countries that surround us,” said Dr. Francois Lepira, the medical director for Congo’s Ministry of Health in Kinshasa.

“Our studies already show a doubling of HIV infections in the government-controlled areas we’ve been able to test, but what we are seeing is the tip of the iceberg.”

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