AIDS, Culture, and Africa

Preface

Preface Kigali, Rwanda, August 1985: I was in the main hospital, Centre Hôpitalier de Kigali, in the Rwandan capital interviewing AIDS patients there to try to find out how they became HIV infected. Back in the United States, most people with AIDS were gay men; but here in Africa, I was being told that most were heterosexual. What in the world was going on? Why should the same disease behave differently in two different places? Maybe, I thought, extreme homophobia was preventing the truth to come out. Perhaps African men were secretly having lots of sex with other men, but no one wanted to talk about it. Or maybe, just maybe, male and female couples were routinely engaging in anal sex in order to prevent pregnancies. So there I was, literally sitting by their deathbeds, ready to stay as long as necessary until I learned from my informants the truth. Nine of the ten patients were men; most were fairly wealthy men who traveled throughout central Africa on business. After gaining their informed consent, I asked them about their health history and their sex history. Were they having anal sex with their wives or mistresses? All of them insisted that they were not. Were they having sex with another male? Again, they all insisted that they were not. One had confided to me that he often had vaginal sex with female partners even when he had an outbreak of genital herpes. But absolutely no same-sex or heterosexual anal sex behavior. On my final visit to the hospital, I was told of one last AIDS patient, a woman, on a bed in the rear of the hospital ward. When I approached her, I was startled by what I saw. All skin and bones, her eyes closed, with dozens of flies swirling around her. I thought she had already died. But then she began to stir, her eyes opened, and I introduced myself and told her about the study. With great effort, she managed to sit up, and she agreed to participate. Her face was very gaunt, and her voice was little more than a whisper. And she told me her story. Rangira (a pseudonym) was thirty-six, Tutsi, a mother of three children. When she started developing AIDS symptoms, her husband began to blame her for becoming infected, and angrily threw her out of the house. The children stayed with the husband and his family, while Rangira had no choice but to return home to her mother. The bitter irony is that Rangira had remained faithful to her husband during their long marriage, and it was her xii husband who undoubtedly had an extramarital relationship and infected her, though he had not yet developed symptoms. Over several months, her health continued to deteriorate and her weight continued to drop, until finally she was admitted to the hospital, too weak to walk on her own. She told me how she was shunned by her family, friends, and neighbors, as the word spread that she had AIDS. But as she talked, I was drawn to her quiet sense of dignity, her resolve not to let the disease conquer her spirit, even as it destroyed her body. As she attempted to sit up straight on her hospital bed, she told me how important it was to her to make sure that her health and sexual history that she was giving me was totally accurate. She had never had anal sex; she knew that her husband was seeing other women; and she was a faithful wife and devoted mother. At the end of the interview, as I was leaving, a reporter for the British Broadcasting Corporation (BBC) was also in the hospital ward covering the then new story about AIDS in Africa. She asked if she could photograph the female patient that I just spoke with outside in the daylight. I told her that the woman was far too ill to be moved or bothered. But when Rangira heard that the reporter wanted to photograph her, she insisted that it happen . With the assistance of one of the nurses, she managed to climb into a wheelchair and was wheeled out to the daylight for her close-up. She wanted to be remembered and for the world to know about her experience, as she solemnly posed for her photo. Within days her photo was broadcast throughout the world. For a time, she became the face of the ravages of AIDS in Africa. A few...