By Karl Vick
Masogo, Kenya - No one knows where Aids began, but researchers have traced the spread of the epidemic from Congo, the remote heart of Africa, eastward across the Great Lakes of Kivu, Tanganyika, Albert and Victoria.
In Kenya, the virus showed up first and most virulently on Victoria's eastern shore, where the Luo people had settled hundreds of years ago after travelling up the Nile from Sudan. Some of the customs that came with them would help Aids along: Luo men are uncircumcised, a condition that in poor countries parallels increased risk of all sexually transmitted diseases. (In west Africa, where circumcision is far more common, there is a markedly lower Aids rate.) The tribe also requires that a widow be wed to a relative of her late husband - a caretaking custom common across Africa, but practised with particular strictness by the Luo.
The virus also created its own opportunities. Lake fishermen had always looked for female company after dragging their long, narrow boats ashore each morning. But only in recent years, after Aids created widows with no other means of support, have women come down to the beach in numbers, trading sex for a portion of the catch.
"They call it 'extending the boat'," said Jane Uwuor, a merchant in Usenge beach.
By 1993, 20 percent of the residents of the area's large port city, Kisumu, tested positive for HIV. By 1998, the rate had galloped to 35 percent. Although rates varied widely, the same acceleration was seen across much of Africa, where 24,5 million people are estimated to carry the virus. In most places, because the disease can incubate in the body for more than 10 years, communities were slow to recognise how deeply it had settled in their midst.
"People don't believe anybody who hasn't got full-blown Aids is infected," said Eric Otieng, a peer counsellor.
The Luo saw the proof of the connection before most. So many in the tribe were infected in the early 1990s that the approach of the millennium brought the reality home.
The death toll of Aids in Africa - 5 500 a day, two million a year - became a family affair. And although the deaths were private, the burials were not. An African funeral is a major public occasion, a ritual of eulogy, burial, feasting and music that takes an entire day. Traditionally, that day is Saturday.
But by the late 1990s, so many were dying that "we bury every day of the week", said Elijah Owaga, a Masogo minister.
People in Masogo say it was the explosion of funerals in the late 1990s that finally pushed Aids into the open. As it happened, the first effective information campaign arrived in Masogo around the same time. With British aid funds and a gifted local health worker named Alfred Abande, the Futures Group set about offering training on Aids and other sexually transmitted diseases to community health workers.
The health workers, almost entirely women, were mostly midwives and traditional healers. They took what they learned into the homes around them, each assuming responsibility for 10 neighbours under the ambitious but geographically limited Futures plan. The agency even pays a stipend, though the women are urged to regard the $13 (about R90) a month as temporary, and to generate income from chicken farms or other small trade that might sustain the programme.
There are other compensations. The health worker positions carry a status that the women reinforced by sewing themselves uniforms of forest green. To cement local support "opinion leaders" were designated among the elders, who retain significant authority even in a changing Africa.
But if basic information on Aids was, at long last, arriving in a few patches of western Kenya, there remained the question of what people would do with it. Infectious disease experts note with distress that the countries in Africa whose infection rates are among the highest - Botswana, Zimbabwe, South Africa - also boast the continent's best communication systems.
"The biggest gap is not in information," said Elizabeth Pisani, a medical demographer in Nairobi. "The biggest gap is turning that information into safer practice."
A little bit of knowledge, moreover, can be a dangerous thing. Along Kisumu's "beer belt", a string of bars where commercial sex workers charge the equivalent of $2 for intercourse, health workers pressing the bar girls about condom use were stunned recently to hear this reply: Having heard that Aids in Africa was a "heterosexual disease", the prostitutes had figured they could outfox the virus. They were offering customers unprotected anal sex - an extremely high-risk practice that spread the disease among gay men 20 years ago. But there was also a hopeful precedent for changing behaviour taking shape next door in Uganda. Ravaged by the disease in the early 1990s, the country was one of the first to launch an aggressive public education and prevention campaign.
Led by President Yoweri Museveni, the abjectly poor country solicited foreign donors to support the effort. Although millions had perished, by the late 1990s Uganda was the first African nation where the rate of new infections had declined. It became a model for the continent.
In Masogo, leaders, at least, appeared to be getting the message. Besides wearing the tall white cap of his office, Owaga, the minister, also worked as a "trainer of trainers", responsible for teaching basic primary health care to other lay health workers in his division, population 66 220. But as recently as two years ago he was still too poorly grounded about Aids to feel comfortable enough to help a woman deliver a child, out of fear that the contact might infect him.
"I came with much fear," Owaga said. "I had not been so much informed on modes of transmission and infection."
Finally, in September 1998, he spent days learning specifics at a government health seminar. It made all the difference.
"Now I'm eager to meet Aids patients," Owaga said. "I even look for them. I don't want my people to suffer. I'm fully trained. Before, I could be suspicious, even resist. Now I feel like somebody involved."
There are other encouraging signs. The condom dispenser at the Masogo health centre needs refilling every morning.
And, at least in the town centre, the flow of information has reached a point where Jael Achieng, a community health worker, asked an American visitor about anti-retroviral drugs, the still expensive medicines that are extending life indefinitely among Aids patients in the West.
Despite drug companies' promise this year to lower prices on some treatments for Aids, the life-saving drugs that cost $11 000 a year in the United States are not likely to slip under the $17 per capita Kenya now budgets each year for health care.
As a practical matter, medical experts are more encouraged by the Kenyan government's decision to allow Aids awareness to be taught in school. The emphasis must be on children, they say, because after 20 years running almost unchecked in Africa, the virus has a depressingly firm grip on the sexually active adult population.
"We don't follow customs anymore," declared Moses Omondi, 20, one of six modishly dressed young men. "We live in the current world."
The men, aged 17 to 32 and free at midday on a workday, each nodded when Omondi said he almost never uses a condom.
"It's very rare," said Eric Owino, 23. The reasons he recites echo those of the male teachers at the Ogilo primary school. Myths about reliability. Objections from women. ("She says it means you don't trust her.") Most of all, the lack of sensation.
"And then there is this thing in the Bible, too," said Moses Mbeda, 18. "In the Bible they say these are the End Days, and there will be a disease that has no cure."
"I believe so," said Omondi, to more nods. "The end of the world is about to come." It's a matter of selecting what you want to believe. "If a dying person has not been tested for Aids, maybe he has chira ," Omondi said, "because you are married and you did not follow the rules."
Such a possibility - that Aids is really not killing us - can also ease the way at a funeral, which has proven to be another tradition of Luo life still honoured among the young. After the burial and the feast, there's almost always music. It might be Luo benga, or reggae. But usually it's the Congolese dance music that all of Africa seems to love, endless and hypnotic and almost all hips.
"You talk, you dance, and you end up engaging in sex," Owino said. "You don't have a condom ... " He shrugged. "Sometimes it's very hard to reverse nature."
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