What You Don't Know, Can Hurt You

The Deep Roots of AIDS
By Nicholas D. Kristof
The New York Times

YOKADOUMA, Cameroon

It was about 70 years ago, evidence suggests, that a man somewhere in this remote forest area of southeastern Cameroon butchered a sick chimpanzee — and the AIDS virus was born.

Chimpanzees here carry a strain of simian immunodeficiency virus (the monkey version of H.I.V.) that is genetically close to the main human variant. So the scientific betting is that the virus jumped to humans here and then traveled with human hosts by river south to Kinshasa, Congo, and then eventually to the wider world. The first proven case dates from Kinshasa in 1959.

I’m traveling with Casey Parks, the student who won my contest to accompany me on a reporting trip, and we’ve been talking to people about AIDS here in its possible birthplace because the world can’t address global poverty unless we tackle AIDS effectively — and in places like this, it’s obvious that still isn’t happening.

We met the family of Pascal Nttomba beside the fresh mound in the garden where he was buried two weeks ago. Mr. Nttomba was the breadwinner for the 20 people in the family.

The Nttombas were relatively well off, living in a nice wooden house and sending their children to technical schools to learn vocations that would take them up a notch in the world. But then Pascal became sick.

He could no longer work, and the family used all its savings to try to cure him — first paying a traditional healer and then a doctor. Neither did any good, although the doctor charged more.

In theory, antiretrovirals are available here to control the disease. But they are mostly for middle-class victims in the cities, and as in most of Africa, an ordinary person in a remote area has next to no chance of getting the drugs. And so Pascal died, and now the family is destitute.

“There’s nothing to eat in the house, since this morning,” said his father, Valeré. The women in the family were planning to scour the fields for cassava leaves to cook for dinner. They say they can also go into the forests to look for edible wild plants, but malnutrition looms.

The children in technical school have dropped out, because there is no money. One of them is Hermine, a 19-year-old, who is now at risk of being approached by an older sugar daddy offering gifts in exchange for being his mistress, a common arrangement in Africa that has led to high infection rates among young women.

“I’d do it,” she acknowledged — after all, the family needs money.

The family’s predicament underscores how the virus not only kills people but also further impoverishes the world’s poorest. And while the hardest-hit countries in southern Africa are doing a bit better against AIDS, others in the middle range like Cameroon or India haven’t woken up to the severity of the problem.

An essential challenge is that 90 percent of those with H.I.V. worldwide don’t know it, and you can’t begin to tackle the disease when no one knows who has it. Here, for example, neither Pascal’s wife nor any other member of his family has been tested.

The mantra has been “voluntary counseling and testing,” but this tip-toeing approach is costing millions of lives.

It’s time to move to routine testing. Sure, that will cause difficulties; despite efforts to safeguard privacy, some who test positive will become pariahs and will be driven from their villages. But the present approach is even worse and is on track for a worldwide death toll of 70 million by 2020.

So unless they specifically opt out, people in high-prevalence countries should be tested whenever they enter the medical system, marry, enter the armed forces, take a job in the civil service, or get pregnant. That should be coupled with a pledge to try to make treatment available to all who test positive.

That emphasis on testing could be incorporated into the extension of President Bush’s fine program against AIDS, which will save some nine million lives and is up for renewal next year. That program, which provided huge increases in spending and will be Mr. Bush’s best legacy, should be extended with even more money, while dropping its obsession with abstinence-only programs.

With AIDS still killing 8,000 people every day worldwide — and infecting 14,000 more — we need to acknowledge that the present strategy isn’t adequate. We need a more aggressive approach, built around greater testing, so that we don’t go through another few decades with the Pascals of Africa dying needlessly and the Hermines selling themselves into sexual bondage.

Photo credit: Nicholas D. Kristof. (Fred R. Conrad/The New York Times)

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