The AIDS pandemic continues to cast its darkest shadow on Africa. Declan Walsh reports from Nairobi
Nairobi, a city of raucous African vitality, has little sense of crisis. Honking buses career along bumpy streets crowded with shoe-shiners, paper vendors and born-again preachers. By night, prostitutes line the pavements, shivering in the cool air and casting sly glances at passing cars.
But a crisis it is. On average, one in 10 people in the daytime throng has HIV, the virus that causes AIDS. Among the prostitutes, it is probably four in five. The dead stuff the shelves at the stinking city mortuary. Many cannot afford to be buried; those who can silently fill the graveyards.
Two decades into the pandemic, AIDS still has Africa by the throat and is squeezing hard. The ever-worsening statistics have reached unfathomable levels, yet demand to be repeated: according to the United Nations, up to 28 million Africans are infected with HIV, or about 70 per cent of the world's cases. Every day another 8,000 join their ranks. With no money for proper healthcare or drugs, most succumb within a decade.
The southern and eastern flanks of the continent are at the epicentre of the human carnage. At least one- fifth of adults are infected in most countries; in a few pockets, such as Botswana and Swaziland, rates reach a staggering 39 per cent. From the Cape Town flats to the Ethiopian highlands, entire communities have been filleted - schools without teachers, fields without workers, children without parents.
In tribute to Africans' great resourcefulness, life usually trudges on. But occasionally the desperation becomes unbearable. Last week in Kenya an elderly villager murdered his seven-year-old grandson. The man told police he had already seen the boy's mother die a slow and painful death from AIDS.
Gripped by a mad fear that the child would suffer the same fate, he slit his throat with a knife.
The virus is particularly ferocious on women. Of the 10 million Africans with HIV, between 15 and 24, two-thirds are women and girls.
Gender inequality is central to the assault. Rural communities cling to customs that once cemented social unity but now fuel death. For example, the Luo tribe of western Kenya stubbornly clings to "wife inheritance", the practice of "giving" a widow to her husband's brother. Unsurprisingly, Luo infection rates have rocketed.
Elsewhere witchcraft retains a deadly grip. For generations, desert nomads believed sleeping with a virgin - as young as nine - would purge any affliction or curse. Now they use the same "cure" for AIDS.
"Many people from my area have done it," one pastoralist told a reporter recently. "Many survive, many die."
Condom use is only slowly taking hold. "Why eat a sweet with the wrapper on?" is a regular excuse in some countries. In others they are simply too expensive or prohibited by Catholic or Islamic leaders. In the home, women frequently have little say in whether a condom is used. "Women have less power to negotiate their sexuality," said Ms Beryl Leach of Health Action International.
Urbanisation has exacerbated their plight. Since independence in the 1960s, millions of African men have flocked to the cities, seeking cash-paying jobs to support their rural families. But most find only poorly paid work and live in slum areas, where they take other sexual partners. Returning home, they pass the virus to their spouses.
Famine has accelerated the death toll. A food crisis across southern Africa two years ago became inextricably tied to AIDS - ill people could not till the fields, but hunger made them sicker quicker. Hunger and disease joined hands in a deadly merry-go-round that spun ever faster.
There is some tentative good news. A recent study in Kenya by the US Centre for Diseases Control (CDC) found that previous estimates may have exaggerated the HIV prevalence due to flawed statistical analysis. Extrapolated across the continent, it may mean that 21 million Africans instead of 28 million have the disease. But it remains 21 million too many.
There is also new hope for prolonging their lives. About four million people immediately need anti-retroviral drugs to survive because their CD4 count - a measure of the disease's progression - is at a critical level. Only 2 per cent are using them. Recently, the World Health Organisation and UNAIDS launched the "3 by 5" initiative - a drive to have three million people on treatment by 2005, using a cheap generic drug and a single pill formula.
Some African leaders are finally shaking themselves out of a coma. After initially doubting the link between HIV and Aids, President Thabo Mbeki of South Africa - which has 5 million HIV cases, the largest number in the world - has promised to hand out free anti-retrovirals. This month the president of Malawi, Mr Bakili Muluzi, admitted that his own brother died from the disease. "We should not be ashamed," he said.
Still, other African presidents shuffle their feet and glance around nervously when asked hard questions. Many are afraid to talk about sex. Few have followed the example of President Yoweri Museveni of Uganda, under whose outspoken leadership infection rates have plunged from 30 per cent to 5 per cent. Senegal is another rare country to have bucked the trend.
Alongside leadership, western money is also lacking. The world spent just under $5 billion on fighting AIDS last year - half as much as is needed to make a real dent, according to UNAIDS. For African countries, $10 billion is an impossible sum; for countries at war in Iraq, it is grotesquely small.
In a thinly veiled attack on the US recently, UNAIDS director Mr Stephen Lewis said: "What happened to the war on AIDS? Why conflict and not compassion? We're over 20 million dead, and counting."