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Twin curse of Aids and famine threaten death toll never witnessed before; A major education programme is being undertaken in Malawi in an attempt to halt the spread of the deadly HIV virus; Completing her reports from Malawi, Anna Ralph looks at the devastating impact of Aids.

Byline: Anna Ralph

SEVENTY-TWO-year-old Colida Mhone has no answer to the problems facing her family. They have no food, relying only on the meagre meals they prepare from banana tree roots and maize husks gathered from nearby fields.

Unlike their fellow villagers they didn't harvest this year because they were too sick. Colida's husband, Henderson, keeps collapsing, weak from hunger and more than a month of diarrhoea and coughing. The traditional herbs he gathers from near his home in Chibisa village, Malawi do little to ease his symptoms.

Their 10-year-old granddaughter Nawoma is also sick, scabies covering her arms with sores. It's been like that since February and with no money to buy medicine it looks likely to get worse.

The only member of the six-strong household who might be able to help is Alufeyo, Colida's son. But he too is battling against illness.

Next week he will be tested for the HIV virus. If positive there is a strong chance his wife Maizie, Nawoma and his one-year-old daughter Falesa will also be infected.

Their story is typical of the massive problem facing countries all across Africa today. Disease, in the form of dozens of Aidsrelated illnesses, has weakened millions. Now one of the worst famines in living memory threatens to rob them of a future.

Aids is killing Africa and the human suffering it causes is devastating. It has orphaned 470,000 children in Malawi and it is estimated 15pc of the adult population are infected. But without widespread testing or an infrastructure to cope with such a massive epidemic, it is feared the real figure could be much higher.

VSO volunteer Phil Sweeney is at the centre of the fight to halt the spread of the disease. Eighteen months ago he left his home in Miskin near Cardiff and his job as a finance manager and moved to Malawi.

There he works as a management adviser for the Malawi Network of Aids Service Organisations (MANASO), channelling the efforts of more than 200 community organisations as they tackle the problems which has given Aids such a powerful grip on the country.

Many of these are cultural, such as initiation ceremonies which use a single razor blade to carry out dozens of circumcisions.

Wife-sharing also plays a part. It is tradition in Malawi that if a husband dies his brother will take over responsibility for caring for his wife.

``Changes are not something you can impose from the outside,'' explains Phil. ``The issues have to be raised and discussed within the communities themselves.''

The result of a lot of hard work by HIV/ Aids clubs has ensured that many people now know what HIV is and how to avoid it.

``Now we need to translate that awareness into actual changes in how people behave,'' Phil says.

Thankfully healthcare workers and volunteers like Phil have the support of the Malawi government. Having woken up to the problem of Aids, condom advertisements are finding their way on to billboards in towns across Malawi.

But despite an increase in condom sales many still view the message of safe sex as pornographic. Sex is a taboo subject for many and as such the images are censored or removed by the very people they are aimed at.

While education and changing behaviour patterns are critical to prevent further spread, Phil highlights the importance of dealing with those who are already infected. The outlook is depressing. The average period between infection and death is estimated at six years. At first common diseases appear, such as pneumonia, diarrhoea and tuberculosis. At this stage, unless an HIV test is taken, people may not know, or deny, their illness is Aids related.

As the disease progresses, bouts of sickness become increasingly frequent and opportunistic diseases appear, those which can only occur in people with a suppressed immune system.

Oral thrush or herpes, blindness, constant diarrhoea, coughing, convulsions and cancers add to the pain but there is often very little in the way of relief and when death finally comes it is usually at home, many miles away from a hospital.

Anti-Retroviral (ARV) treatment, which can prolong the lives of those infected with HIV, is scarce and only available to those who can afford it. A single treatment lasting one month costs 10,000 kwacha (pounds 86). With average earnings barely reaching 12,000 kwacha a year it's easy to understand why so many people fail to see the point in being tested.

``There's a chronic drugs shortage here and the medical infrastructure is poor,'' says Phil. ``People in rural areas live many miles away from the nearest district hospital. Without the hope of treatment, there is little incentive to be tested.

``That's why the work of home-based care groups is so important. It offers those suffering from Aids some degree of help to ease their pain, even just cooking or cleaning. Occasionally they can provide medication such as aspirin.''

Some have suggested that the wealthy West could provide ARVs and tackle the Aids crisis in the same way as the current famine. But this is to misunderstand the predicament.

``Even if we were to find ourselves in the position of being able to offer ARV treatment to these people, it is not like distributing food aid. You can't hand out ARVs on a football field like you can bags of maize,'' says Phil. It is clear that change at grass-roots level is critical if Aids in Malawi is to be controlled.

More volunteers are needed to educate the masses and pressure must continue to be put on drug companies to lower prices.

People in Africa have lived with the fear of hunger for many generations. Now Aids poses a modern threat, one which has weakened millions ahead of the current food shortages. It is this deadly combination which threatens to exact a death toll never seen before.

African perspective

u Only 16pc of medical sales are to the developing world, where four-fifths of the world's population lives.

u Total pharmaceutical sales to Africa are $4bn. Worldwide sales of Viagra alone account for $2bn.

u Around 36 million people worldwide are HIV positive, 95pc live in the developing world.

u 30pc of teachers in Malawi are lost every year to Aids, faster than they can be trained. Last year a quarter of the education budget was spent on funerals.

u 30pc of mothers infected with HIV in Malawi pass the virus on to their unborn child. Such children are unlikely to reach their second birthday. The highest rates of infection are among women aged 25-29. In the 15-24 age group there are three times more women infected with HIV than men.


BLEAK FUTURE: Seven-year-old Gideon, who is HIV positive, remains on the sidelines as other children at Saso orphanage play football; Picture: Glenn Edwards; VOLUNTEER ADVISER: Phil Sweeney
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Comment:Twin curse of Aids and famine threaten death toll never witnessed before; A major education programme is being undertaken in Malawi in an attempt to halt the spread of the deadly HIV virus; Completing her reports from Malawi, Anna Ralph looks at the devastating impact of Aids.(News)
Publication:Western Mail (Cardiff, Wales)
Geographic Code:6MALA
Date:Aug 1, 2002
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