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5 February 1998
The Economist
(c) 1998 The Economist

With their government’s mind on politics, Kenya’s young are dying of AIDS


NAIROBI - “DON’T worry about the elections, all the voters will be dead.” So read a placard carried by a striking nurse during Kenya’s recent election campaign. The country’s long-neglected AIDS epidemic means that her prediction will be on the way to becoming true by the time of the next vote, due five years from now.

While new infections with HIV, the virus that causes AIDS, continue to fall in neighbouring Uganda, the figures in Kenya just keep mounting up. The government estimates that around 8% of the country’s adult population has HIV. International health experts put the figure at twice that. In Nairobi and some other big cities, one pregnant woman in three is infected.

Life-prolonging drugs, costing over $10,000 per person per year, are available in the West. But these are out of the range of a country that spends under $20 per person on health in a year. So it is safe to assume that most of the people now infected will indeed be dead by the next election.

Botswana, the world’s hardest hit country, is watching life-expectancy sink back to levels last seen 30 years ago. Because of the impact of AIDS—between a quarter and a third of the entire reproductive-age population is infected—Botswana skidded an astonishing 26 places down the UN’s Human Development Index in a single year last year. Things are not yet that bad in Kenya: although international bodies are careful not to publish an AIDS league table, specialists generally agree that Botswana, Zimbabwe, Namibia, Zambia and Swaziland all have higher rates of infection, making them, with Kenya, the world’s six most infected countries. All of them in Africa where, as new research shows, the disease was born around 1950 (see article).

Sorrow aside, the illness and death of a breadwinner costs a family most of its income. And it is clearly breadwinners that are dying of AIDS. New data from studies in Tanzania and Uganda show that well over half the people who reach voting age can expect to die before retirement. Between the ages of 25 and 35, four deaths in five are HIV-related. Even in these relatively low-prevalence areas, AIDS knocks 16 years off life expectancy.

In high-prevalence areas, such as Kenya, the effect looks like being worse. Companies that rely on skilled labour will be hard hit. Kenya’s national AIDS programme itself has had to cast around to replace senior staff killed by AIDS—although the stigma attached to the disease has prevented even people involved with fighting it from acknowledging it as a cause of death.

It is hard to know exactly how badly the impending surge in deaths of young workers will affect Kenya’s development. The circumstances that favour the spread of HIV—widespread poverty, poor educational and job prospects, crumbling health services—undermine the country’s prospects even without the disease.

What is clear is that the added impact of AIDS could be reduced, given the political will. Although Kenya hates to be reminded of the fact, it need look no farther than Uganda for an example. Uganda was one of the first countries to be badly affected by HIV. This meant, however, that by the time President Yoweri Museveni came to power 12 years ago, people were ready to see the country’s problems, including AIDS, tackled head on. Quantities of public information and condoms a-plenty have helped halve the infection rate among young urban Ugandans since the beginning of the decade.

Why has Kenya been unable to emulate its neighbour? The country got off to a bad start. Wanting to protect its tourist industry, it insisted it was AIDS-free even as studies among Kenyan prostitutes showed that 60% were HIV-infected. The inaction has continued ever since. President Daniel arap Moi does not share Mr Museveni’s taste for radical solutions. “He doesn’t want to see how big the problem is,” says the head of a group that helps women in Nairobi’s slums cope with their infection. “For him, nothing is bigger than politics.”

Mr Moi’s “see no evil, hear no evil” attitude has permeated most of Kenyan society. The young faces staring out of photographs in the newspaper death notices are mute testimony to the refusal to acknowledge the disease. Relations are careful to record the cause of the few deaths that are not HIV-related. But the vast majority die simply of “a long illness bravely borne”.

Mr Moi, whose approval is needed for all big policy decisions, is content to keep the disease invisible for as long as possible. With a thin majority in the new parliament, he cannot afford to offend important interest groups. Most Kenyans are Christian and Mr Moi is acutely aware of the power preachers can exercise over voters. It is easier to pander to their ideal of the monogamous Kenyan family than to confront the difficult reality of widespread extra-marital sex.

In response to pressure from religious groups, condom advertising has been pulled from the government-run media. Three attempts to include sex education in schools have flopped. After three years of wrangling, parliament last September approved a paper on AIDS. But, seemingly exhausted by the act of discussing the issue at all, the authorities have done nothing to implement the paper’s provisions.

For Mr Moi, avoiding the AIDS issue may seem to make political sense. Money is scarce and Kenya’s needs are many. After years of neglect, the country’s infrastructure is melting away, public-sector employees are dissatisfied, epidemics of other, more visible diseases such as cholera and Rift Valley fever abound. Quick-fix spending on road repairs or civil servants’ salaries is likely to win more votes than teaching children about safe sex—at least among those who are still alive to come to the polls.

 

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