Living with Death — AIDS in Africa
Worldwide AIDS: 25 million in Sub-Saharan Africa
Commissioner David Edwards makes new friends at the Bethany Home for HIV/AIDS positive abandoned children in Soweto, South Africa.
Sub-Saharan Africa’s story is one of bright promise…and a bleak future: of developing nations gaining self-determination, education, and national leadership, only to be decimated by the devastating tide of HIV/AIDS.
It is impossible to talk about this region of Africa–which has the highest number of HIV/AIDS cases in the world, nearly 25 million out of a total 35 million worldwide–without noting The Salvation Army’s involvement in the battle against this killer.
The Army has been a recognized leader in the war against AIDS in Africa for the past decade and has remained in the forefront in its fight to modify behavior–especially in tribal and cultural practices, including ‘wife cleansing’ and adolescent circumcision, that spread the virus. That work began at the Chikankata Mission in Zambia
“We were the first to sound the alarm on HIV/AIDS,” says Lt. Colonel Damen Rader (R), mission chaplain at Chikankata. “We were the first to realize this disease is not curable; it will spread.”
Due to the economic situation in Sub-Saharan Africa, medicine is not available as a means of treating HIV/AIDS, as it is in the U.S. Most people who are infected will die of malaria, TB, or other illnesses as a result of their immune system being weakened by the disease.
Much work has been spent in educating communities on the nature of the disease and ways in which it is spread, identifying behavior that needs to change to stop the spread (including prostitution and tribal practices), and then learning how to care for the sick at home. The Chikankata ‘model’ is in widespread use and the Army often serves as a consultant to government and international health agencies.
The importance of community involvement has become evident as towns and villages attempt to stem the tide of HIV/AIDS. The Salvation Army’s focus has been to partner with the community to empower people on a local level. This includes organizing care and prevention teams to train health workers and counselors, instruct in home based care, and work with orphans. Currently, so many are dying of the disease there is often little room in hospitals for those close to death–and so people are learning how to care for the dying at home.
Community involvement and practical caring also provide an entry point for sharing the gospel: “In some ways, we help people hear the music of the gospel so they’ll be interested in hearing the words,” says Rader.
The disease is killing a significant number of gifted people, leaders in the community and in government–those who would model a successful, educated and productive life for the next generation–and causing grandparents to raise orphaned grandchildren.
“We have soldiers in Lusaka,” says Lt. Colonel John Hassard, chief secretary, Zambia and Malawi Territory, “who have 11 grandchildren living with them.” Out of a population of 10 million, there are nearly 1 million orphans in Zambia; an estimated 20% of the population between the ages of 15-49 is HIV positive. Life expectancy has fallen dramatically: 47% of the population is 15 or under. Young men are dying at 35 and 40.
Rader notes that the disease permeates every aspect of life. Everyone has friends and family who have died of AIDS-related illnesses. The emotional toll is staggering. Grief fatigue, he says, is now setting in and people struggle to keep hope alive. “You don’t get over one death before the next happens.”
He recalls that on one day at Chikankata, a worker and his son were buried next to each other. “It’s not uncommon for aged parents to bury their whole family before they die. That’s not fair. It’s wiping out a whole generation.”
The Salvation Army is not immune. This summer, the mission lost seven staff members to the disease. “They were key people, and two were senior teachers,” he notes.
Cadets are tested for HIV before entering training college. A number of sessions ago, four cadets were sent home from training because they were HIV positive.
“In the midst of it all,” Rader says, “It is beautiful to see what God is doing. These people know how to pray and sing and dance in thanksgiving. They experience genuine joy in the fact of great sorrow and suffering. They have a living hope in Christ.”
Abandoned HIV positive babies receive love and nutritious food at the Ethembeni Home in Johannesburg, So. Africa. Nineteen have died at the home so far this year.
The Salvation Army pioneered HIV/AIDS work in South Africa as well, when it opened the Bethesda House for abandoned HIV infected babies and orphans in Soweto Township in 1993. The home cares for 22 children ages birth to 6 years. “We provide optimal care, even though the life span of the child is often brief,” says Director Major Lenah Jwili. “It is our belief that the quality of life and caring should not be compromised.” When it opened, it was the only facility of its kind in the country.
Government statistics report that 200 babies a day in South Africa are born with the AIDS virus. Thousands are abandoned each year. Many are placed in Salvation Army children’s homes, often after being left in horrific circumstances, naked, starving and discarded in rubbish bins.
According to the Southern Africa Territory Reporter newsletter, after being admitted to a Salvation Army home for abandoned HIV positive babies and receiving love, attention, and a nutritious diet, up to 40% of the babies reverse their HIV status by 18 months.
The Ethembeni (Place of Hope) Home for abandoned HIV positive babies in Johannesburg also provides a loving environment for babies and children up to age 5. Opened in 1996, the home has room for 60 children, many of whom are HIV positive due to sexual abuse.
In addition to caring for children, the home has a program for rehabilitated sex workers, which includes basic life and job skills raining.
Tribal Practices Change
“The Salvation Army has a unique and effective training program to combat AIDS in communities at the local level,” says Captain Ted Horwood, extension training and community development, Malawi Region. “AIDS in Africa is devastating. It’s worse than any war.”
According to Horwood, 30% of the population in urban areas in Malawi is HIV positive. Communities struggle to keep middle management people in place, especially in fields such as banking, police, and the post office, due to the high death rate from AIDS related illness. Some institutions are weighing the cost of training workers for specific skills against the knowledge that a sizeable number will undoubtedly die from AIDS within a short number of years.
Working within communities, the Army is making advances against cultural practices that foster the transmission of HIV/AIDS. “We will gather a group of 150 people together from a village, under a tree,” says Horwood, “and ask what they know about AIDS, get them to acknowledge the problem, explore solutions, and determine action to take.”
While in Malawi, Commissioners David and Doreen Edwards met with Lt. Alfred Banda who, with his wife Lt. Pamela Banda, are corps officers of the Migowi Corps in the Pholombe District. Traveling over rutted dirt roads for more than an hour, they arrived at the village to meet with tribal initiators and soldiers who are actively involved in helping the community change tribal practices. Horwood facilitated the meeting.
A group of 10 gathered to discuss the Army’s program. Four of them–two men and two women–were tribal initiators, who take youth to special camps at puberty, separated by gender, and instruct them in family matters, hygiene, and sexual practices, among other things. Each initiator teaches up to 200 youth a year.
Some of the practices that have been affected are ritual circumcision for the boys, where the whole group would be circumcised by the same knife–thus transmitting AIDS. Now, each boy brings his own knife. “We used to tell the boys to go sleep with a girl after the camp, to prove their manhood,” said one initiator. “Now, we don’t. We have seen a tremendous change.”
Girls were also encouraged to find a sexual partner to practice what they had been taught; they are no longer instructed to do so. “It was very difficult for the community to understand the need for changes, but they have come to do so,” said another initiator. “I am so thankful for this project, for what it has done.”
Local tribal chiefs played a significant role in community acceptance of the changes, and have supported the Army’s work. “We trained 200 tribal initiators,” said Banda, “and they formed an association. They will not let anyone be a trainer in this area who has not gone through the Salvation Army program.” The initiators report that they all have had relatives die of AIDS.
Of the 22 high risk cultural practices which the community identified, the Army is working to change six significant ones at the moment. ‘Wife cleansing’ is one of those practices. “When a husband died, the custom was that the wife must be ‘cleansed’ by assigning a man in the village to sleep with her. If the husband had died of AIDS, the wife would have the virus and then pass it along to the man who slept with her–and he would pass it along to his wife and family.” Now, that practice is being changed by creating a different ritual that doesn’t involve a sexual relationship, often using herbs as a cleansing means.
The project has opened doors wide to the healing ministry of the church. Part of the training Salvationists received was in counseling victims and families. “Our soldiers have helped many prepare for death,” says Banda. “Most of the time, the community neglected those dying from AIDS. This project has helped the corps very much-they are not just preaching open airs, but are going door-to-door, visiting people in their homes. People have seen the love of God through us and doors have opened through our caring to tell of Christ and the next life. In addition to teaching people about the AIDS virus, we are telling them about Jesus and the Bible.”
Kwetu Counseling Center in Dar es Salaam is unique in its ministry: for the past six years, it has targeted street girls and commercial sex workers, offering them help in changing their life style and thereby reducing the risk of transmitting HIV/AIDS. Through counseling, education, vocational training, and micro-enterprise opportunities, the girls and women receive the support and skills they need to make a new start in life. Some have been reunited with their families in the villages.
According to Lt. Colonel Jean Burrows, prostitution is a poverty issue “They have no way to get food for their children.”
One difficulty in addressing the issue of AIDS, she says, is that many people are still in denial of the situation. “HIV/AIDS is an unacknowledged problem. Even doctors won’t sign death certificates as AIDS related.”
Burrows, who is a nurse, brings a medical background and perspective to the program. She explains that the government reports 95% of the population is aware of HIV/AIDS, but that people haven’t changed their behavior. That’s a significant concern in Dar es Salaam,
where there are an estimated 2,000 young street girls and 8,000 commercial sex workers.
The Army’s ministry is well known: workers are on the streets at night, letting prostitutes and young girls know they can get help at Kwetu. For those who think they can’t –or won’t–change their behavior, they pass out condoms supplied by the government–up to 10,000 per month.
“Our preference is that they abstain or change their behavior,” Burrows says. “If that does not happen, then condoms offer a measure of protection against the spread of HIV/AIDs.”