Words That Are Not Spoken: An Inside Look at the African AIDS Crisis

Alison W. Benjamin

Introduction

My inquiries into the world of AIDS in Africa have been met with a bizarre and stony silence, as though the disease doesn't exist -- though of course I see it all around me. I am in a funny position as a Peace Corps worker. I want to pose probing questions, to really force people to acknowledge the disease, to talk about it and deal with it. But I have to keep living here, too. I need to be accepted and liked in order to stay in the community, so I hesitate to ask too many impolite or searching questions.

The house was dark, and stepping in from the white-hot Sub-Saharan sun, I had to adjust my eyes to see anything at all. It was a typical African house: concrete structure, tin roof, smudges of dirt on the walls, and a poster calendar -- 2 years out-of-date -- advertising hair oils, beauty soap, and carefully coiffed radiant women. I felt nervous, out of place, perhaps, in my borrowed 3-piece pagne ensemble, swatches of bright fabric wrapped around me like some ancient tribal queen. But I stepped slowly, with some hesitation, for another reason: I was about to visit a man, a stranger, who, I felt certain, was dying of AIDS.

I'd been living in Africa for 2 months already, staying with host parents -- the village chief and his stern, silent, broad-shouldered wife. During these months, I hadn't seen anyone I could say with certainty had AIDS. This had been a surprise. Before arriving, I'd read countless articles about the AIDS crisis in Africa: more than 10% of the population infected with HIV, millions of children left orphaned by the disease, governments and international aid organizations unable to reverse the disease's spread. I'd envisioned a continent full of emaciated bodies, welted flesh, and dying, hopeless eyes.

But this is not what I found. The Africans I met looked healthy. They danced, sang, and greeted each other with hearty, arm-pumping handshakes. They were muscled and toned from long days in the fields.

I had seen only shadows of the disease: anti-AIDS T-shirts left over from a well-intentioned campaign by a developing organization, funerals of young women and men who had died of a "malady" -- nonspecific and ominous. But the thing itself, the crisis, remained hidden.

It was my host mother who had brought me to this remote, dusty village. Over dinner the night before, she'd announced in a monotone that the next day, we'd be visiting her sick brother. She had not looked at me as she'd spoken, and I suspected something serious. Is he very sick, I'd asked? Yes, she answered. It's grave. She did not name the sickness. She shook her head and told me only that he was thin. Very thin.

The gravity of the visit was evidenced by the fact that we were stepping into this man's house at all. Life in Africa takes place outdoors, in swept, sandy courtyards. All of life's events -- preparing and eating meals, entertaining guests, discussing the best location for the village water pump, funerals, marriage ceremonies, etc. -- take place outdoors, on hard wooden chairs, beneath the cover of lush, drooping trees. I suppose, given the nature of the visit, I shouldn't have been surprised to be going indoors. But I was surprised, taken off guard.

During the long bus ride to her brother's village, I'd thought about what to say to him. I'd tucked some photos of my American family inside my bag, and I imagined showing them, one by one, with descriptions about life in America, fascinating material for most Africans. I pictured making him laugh by describing my unsuccessful attempts to cook African sauces on an open fire. And I pictured looking him in the eye, flashing a warm smile, and saying "Bon Guerison." I wish you good healing.

Stepping into the bedroom, I expected to see a man sitting up in bed. Thin, weak, deathly ill, but sitting upright nonetheless, extending a bony arm toward me in greeting. Instead, I saw a woman, his wife, seated on the edge of the bed, and next to her, a tiny figure curled beneath a blanket.

Oh, I thought with surprise and confusion, he's just a child. And then I went cold, realizing that no, this was, in fact, a man. A tiny man, emaciated and hollowed out. His lower half was hidden by a blanket, revealing the skin that wrinkled over his rib cage and the bones in his arms. His eyes were slightly open, but they registered nothing -- not our arrival, not his motionless wife, nothing. He moaned as he breathed, a rhythmic lament of pain. Only his head and his barrel chest hinted that he'd ever been of normal, adult size. He seemed barely material, barely of this world.

The room was dark. A shutter window let in the slightest crack of air and light, and the outside world seemed suddenly, shockingly vibrant. I heard a flood of sounds: children playing, the crunch of footsteps on the packed sandy road, the cry of infants, and the up-and-down melody of the adults speaking the local language of Atie.

Inside, it was dark and still. No one talked to him. No one took his hand. No one told him we were there. After a couple of minutes watching his chest rise and fall in time with his moans, my host mother shook her head and said softly, "Il souffre seulement." He only suffers.

It is estimated that 83% of the global AIDS deaths since 1980 -- 18 of the 22 million - have taken place in Africa. Sub-Saharan Africa is the epicenter of this AIDS crisis, and Côte D'Ivoire, the country in which I live, is one of the 6 African nations most affected, with an estimated 10% to 15% of the population infected with the AIDS virus. By year-end 1995, nearly 32,000 cases of AIDS had been reported to the World Health Organization here.

But these are only the reported cases. The vast majority are not. The disease tends to die with people as it lives with them -- in silence.

I live in a small African village. Each day, I visit neighbors, talk with the local health workers, call out friendly greetings in the local language. I can say with certainty that as I write, it has been more than 4 months -- over 130 days -- since I have heard anyone, save myself or another development worker, say the words "Le SIDA," the name given to AIDS here.

The silence about the disease takes many forms. It is the village committee to fight AIDS, created with the help of an international development organization, that never holds even a single meeting. The literally hundreds of women's health consultations that I have witnessed on the part of the village midwife, never once hearing mention of safe sex, of disease. The grand funeral of a beautiful young woman in her twenties, the wife of a village leader, who died of an illness that no one dares name. The words that never pass between men and women --conversations about sexual histories, infidelities, self-protection.

I have been to dozens of village funerals. I have danced in the ritual circle of mourning for young and old. I have listened to the cries of women grieving for their loved ones: children, parents, cousins, siblings, and neighbors, an eerie number of whom have fallen victim to some nameless disease. Do they know, I wonder? Do they really know, but choose not to discuss? Choose instead a collective denial, because the reality is too menacing? Perhaps the disease is too prevalent, the personal chances of infection now so great that they choose simply to be silent, let others do the same, and cast their fate to the gods, the ancestors, the things beyond our reach.

The funeral of the 20-something wife of the village leader was held only recently. It began, like all funerals here, with the ritual crying that accompanies the arrival of the corpse. There were hundreds of people present -- literally, the whole community -- and the cries were deafening, with a pitch and intensity that chilled my bones. People wailed -- earthly cries of despair that echoed through the footpaths and courtyards of the village. People stared heavenward, teary-eyed, stumbling, jaws moving up and down, up and down as they cried. Many collapsed, writhing and twisting in pain, grief made bare for all to see. I could make out no one person's wail in particular. I could not hear a single, individual cry, and it seemed almost like people were crying without noise, a type of silent film set against the cacophony of a single, collective, animal howl.

Standing there watching, I remembered something that a woman I'd known in Chicago had said to me years ago. She'd been active with the gay community there and had just returned from the funeral of a friend, an athletic, friendly entrepreneur who had died of AIDS. "The thing about these funerals," she said to me, "is that when you're active in the gay community, you find that you cannot cry. There are so many. So many that if you begin crying for this friend, this death, you'll cry not just for him, but for the friend who died before, and before. The tears will never stop. You'll be crying for everyone."

I think about the wife of my host mother's brother. His dutiful wife who sat on his bedside, adjusting his blanket, watching and waiting. Her arms looked so fat, so fleshy and alive, and I realized, watching her, that this was almost certainly how her life would end, as well. It was like having the grimmest sort of crystal ball -- one that could show me only this room, and the millions of dark rooms just like THIS one. Rooms in which dim light hides withered bodies and the stifling hush of a crisis for which there are no words.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....