DEATH IN AFRICA : aids decimates a continent.

Early in June, I was an observer at a workshop organized by unaids in Dakar, Senegal, whose purpose was to create an "International Alliance for a Religious Response to aids in Africa." The fifty participants were largely people active in the worlds of health care and of religion; many were physicians, several were Protestant pastors, one was a Catholic bishop (from Senegal), several were Muslim imams. Most were from Africa, with participants from France, the Netherlands, and Thailand.

The Thai delegate was a chubby, smiling Buddhist monk in saffron robes and sandals, with the title "Venerable," whose calling card announces he has degrees from Oxford, Harvard, and Chulalongkorn universities. "Venerable" took delight in informing the other delegates at this conference of religious that "there is no god, you know." This didn't knit as many brows as his other reminder, constantly reiterated, that we must not "confuse truth with reality," by which I took him to mean that we ought not confuse our take on what's there with what's actually there. His admonition may have been superfluous; there was more reality for these participants to conjure with than effective truths to wield.

Looking at the class photo of us all, standing in front of the Hotel Meridien President, sitting on a spit of land that is the most western promontory of all Africa, I am struck by the colorful ness of the costumes, religious and native, and by the cheerfulness of the countenances. We are all smiling with some reason. Differences of religion, language, geography, and disparities of income had not sunk us, nor had the lively rivalry between Anglophone and Francophone countries. We had made the UN-desired "response" and had set up the required "alliance," concretized by a permanent secretariat sitting in Dakar, headed by a pastor who is himself afflicted with hiv.

This about exhausted the smile pretexts. For the rest, the "reality" we confronted with our several "truths" is a light year beyond grim. Sub- Saharan Africa dwarfs the rest of the world on the aids balance sheet. Since the start of the epidemic, 83 percent of all aids deaths have occurred here. An estimated 34 million people living in this region have been infected, of whom 11.5 million have died, a quarter of them children. That is roughly the population of Argentina and nearly double the population of Australia. By comparison, in the United States and Canada, there are around 890,000 people living with hiv/aids; in North Africa and the Middle East, around 210,000 cases.

In 1998 alone, aids killed 2 million Africans. In some regions- Botswana, Namibia, Swaziland, and Zimbabwe-it is anyone's guess what percentage of the population aged fifteen to forty-nine is infected with hiv: a quarter? Certainly. A third? Quite likely. In some testing sites in Zimbabwe, 20 to 50 percent of pregnant women were found to be infected. A third of these will pass on the virus to their children. Children born in the next decade will have a life expectancy of just forty years. Without aids, it would have been seventy. In one year, thanks to hiv/aids, Botswana dropped twenty-six places down the human- development index, a ranking of countries that takes into account wealth, literacy, and life expectancy.

The particular "truth" with which we at the conference were engaged in dubious battle is the stigma attached to hiv/aids-the scornful look, the refusal of family or friends to care for you (or even touch you), being fired at your job on a flimsy pretext. The shame attached to hiv/aids in this part of the world is so great that people often decline what slight care is available because its acceptance implies acknowledging they have hiv/aids. Even among those who are caring for hiv-infected patients, fewer than one in ten admits that the person in their care is suffering from aids. It is worse for a woman, who risks being beaten and thrown out of the house by a husband if her medical status is revealed. Nor will it make a scintilla of difference that she was infected by her husband. She, not he, will carry the blame for the deaths of the children. She, more than he, has no hope of being cared for.

In any event, care for persons with aids in Africa means, at the very best, a cot to lie and die on, a concerned hand to wipe your forehead, and maybe an aspirin or two. The "cocktail," which has all but put a halt to aids deaths in the United States, wasn't once discussed at the Dakar workshop. A high-level Tanzanian health official, a physician, became slightly impatient when I pressed him. "Let me put it this way, Mr. Englund," he said. "If I came down with hiv, there would be no cocktail for me. I doubt we have anyone who even knows how to administer it."

Early and sustained prevention efforts would undoubtedly lower the rates of infection in Africa, as has in fact happened in one or two countries-Senegal being the best-known instance-but for the reasons of shame and stigma. Early and sustained prevention seems to be out of the question for now. To date, only four or five governments out of the thirty-five or so in the region have publicly acknowledged "the invisible epidemic." (The new president of South Africa was one such, but his President's Partnership Against aids is an invitation with few takers.)

Thus, the goal of this conference of African religious and health leaders is to try to bring pressure on their governments-organized religion being a more potent force in Africa than in other parts of the world-so that the governments will begin to make public statements and enact public policies. It is a very big hope with a very small budget. The new alliance will have to seek money from donors; it is unlikely that it will ever have $1 million to play with. By contrast, the annual budget of the Gay Men's Health Crisis in New York City is between $20 and $25 million.

When the conference ended, participants dispersed without a prayer, partly because nobody wished to arouse differences among the competing religious truths represented, and then too there was so much reality to confront.

Steven Englund, a previous contributor, writes on assignment from unaids, Geneva.