Waking up to HIV/AIDS

Three pm on a Monday. It is hot and dusty in the sprawling shantytown of Rocha Pinto near Luanda's airport, but dark and cool inside Chico's Bar. A soft kizomba is on the sound system. A teenage girl dances alone, eyes closed, with small movements. She seems absorbed, but shows off her lithe body in hip-hugging jeans and skimpy top. A sprinkle of men, seated at several tables, drink beer and watch her. Maria da Conceicao strides into the bar. She is young and trendy, in braided hair and equally hip-hugging jeans. Maria warmly greets the owner, then calls the dancer and other young women, who come in yawning from their rooms in the back. "You are new here, right?" says Maria to the dancer. "You haven't seen my book." As the girls giggle, Maria pulls out a book with grim pictures. Penises oozing pus, scarred testicles, vaginal sores - a catalogue of genital horror. "This is how you are going to look if you don't use condoms with your clients," says Maria to the stunned dancer. The others nod in agreement. "You must use condoms, sweetie," says Maria. She is an activist with Fraternidade para a Infancia, Solidariedade e Humanismo (FISH/Fraternity for Children, Solidarity and Humanism), an Angolan NGO doing peer education among sex workers in Luanda. FISH and a handful of NGOs are trying to stop AIDS in Angola before it reaches catastrophic proportions. All the ingredients are here: four million people displaced, lots of soldiers with weapons and no control, appalling poverty, high unemployment, low education, crowded "musseques" (shantytowns), lots of young women with no jobs, no education and no possibility of earning an income except through their only asset - their body - and lots of men willing to pay for sex. Add to that the breakdown of communities and a national psyche scarred by 30 years of civil war. "War contributes to HIV/AIDS," says UNAIDS adviser Dan Odallo. "When there is violence, hunger and displacement, sex is exchanged for food, goods, money and protection. Sex becomes a commodity." Infection rates in Angola appear a modest 8.6 percent, compared to rates of 20 percent and upwards in neighbouring countries. An estimated half a million people, out of a population of 13.4 million, live with HIV. But this data is limited, coming from a UN children's agency UNICEF study conducted in three provinces out of 18. However limited, it shows a frightening 250 percent increase in HIV infection in women at antenatal clinics. "The rate is spiralling and a lot is still not known," says Dr Melanie Luick, UNICEF HIV/AIDS programme officer. The UNICEF data is disturbing. Among pregnant women in antenatal clinics in Luanda, 8.6 percent have HIV, 19 percent have syphilis and 6 percent have hepatitis B. Sexually transmitted diseases are a good proxy indicator for HIV/AIDS as they make infection easier. Among sex workers in the capital, one-third have HIV, one-third have syphilis and two out of 10 have hepatitis B. The girls at Chico's swear they now use condoms with every client - except with the riot police and the presidential guards. They storm in drunk, don't pay, will not use condoms, and if the girls refuse, beat them up and rape them, under the complacent eye of the bar owner. He cannot operate without police protection. Local newspapers, including the state-controlled media, often carry stories of women raped and gang-raped by drunken policemen and soldiers. In Huambo province, in the centre of the country, the Angolan NGO UAJCA, with UNICEF support, works with the authorities to make soldiers and military police aware of the AIDS risk. Now Angola's civil war is over, UNICEF plans to blanket the quartering areas for 55,000 rebel soldiers and 300,000 family members with condoms and STD and HIV/AIDS information in four national languages and to train peer educators and military health staff. In Huila province in the south, youth peer educators from the NGO Prazedor target long-haul drivers. It is the right time. As Angola opens up, following the ceasefire after the death in battle of rebel leader Jonas Savimbi in February, truckers can spread HIV further. "Truck drivers are hungry for information, surprisingly open about HIV/AIDS," says Luick. This and other youth-led efforts in three provinces are funded by US $1.8 million from Telling the Story (TTS), an offshoot of the United Nations Foundation endowed by CNN mogul Ted Turner with US $100 million a year. In southern Africa, the Foundation sponsors youth projects in seven AIDS-affected countries. Among them is Angola, where seven out of ten people are under 24. "Young people present the best opportunity for prevention so they can enter adulthood HIV-free," explains Odallo. On a hot morning in late May, two dozen young men and women clad in white t-shirts with a red logo gathered at the Marie Stopes clinic in the populous Cazenga neighbourhood in Luanda. Here are the warehouses of Malian and Senegalese traders, centres of smuggling, money changing, drug dealing and informal commerce. From these warehouses, every day, thousands of women scatter all over Luanda, carrying on their heads wares to sell, from plastic bowls and zippers to cellphones and golden chandeliers. One way of getting goods is by having sex with warehouse managers. At 9.00 am, the Stopes crew fans out into the Cazenga market to tell people about family planning, sexually transmitted diseases and AIDS. A recent survey by the National Institute of Statistics found that only eight percent of women have adequate knowledge of HIV transmission and prevention. Information is lowest in the north and south, slightly better in the capital, where 20 percent of women could name three ways of preventing HIV/AIDS. Countrywide, six out of ten women aged 15-30 don't know any way to prevent HIV transmission. Condom use is nearly zero among sexually active people. Fernanda Luis, manager at the Stopes clinic says: "Young men come to us with fear and doubts. 'Will condoms make me infertile? Does AIDS really exist?'." Yet few take the free test and counselling provided. "We have a lot of work to do," adds Luis.