Africa's AIDS fight aims high

The stuffy waiting room at the AIDS Information Center (AIC) is always packed by noon. Balding men, weary young mothers, and girls in heels and tight Capri pants sit shoulder to shoulder in front of a blaring TV as they wait out the hours for their HIV test results.

But just across the courtyard, in the private, air-conditioned waiting rooms with potted avocado plants and plush chairs, there is never a line. Here, clients are ushered in through a red-carpeted hallway from a discreet back parking lot.

The "executive wing," as the clinic calls this new HIV testing and counseling service specially aimed at government officials, businessmen, and other VIPs "with a reputation to protect," is the first of its kind in Uganda. Its goal is to reach a class of African society that has long confounded health workers battling AIDS: the elite.

In Africa, unlike in other AIDS hotspots around the world, the well-to-do play a major role in the spread of the disease, according to experts. They say that tackling the problem among this social stratum is a key component to the AIDS fight here.

"Many, many big people are HIV positive," says Sam Wangalwa, a doctor at AIC.

It is an open secret among Ugandans: Urban African men of means have long been considered by health workers to be "core transmitters" of AIDS. But the affluent, especially, fear the stigma that accompanies AIDS. On a continent where everything from movie theaters to maternity wards have designated VIP sections, admitting one is HIV-positive means risking status, promotions, and friends. So some quietly seek treatment through private clinics or go abroad. But others never even take HIV tests. Many public figures in Africa live until their deaths without ever admitting, even to family members, that they have the disease.

When Michael Wamalwa, the Kenyan vice president, died recently, various causes were reported in the local press. But buried in some of the newspaper accounts was the fact that Mr. Wamalwa was being treated by one of Britain's top AIDS specialists at the time of this death. Obituaries habitually state that a well-known person died "after a long illness." Death certificates and family members rarely mention the word AIDS.

Uganda is internationally praised as providing the rare African AIDS success story, having brought down its HIV prevalence rate significantly in recent years. Today, about 1.5 million Ugandans are said to be living with the disease, about 6 percent of the population. President Yoweri Museveni receives much credit for encouraging campaigns to raise awareness of the epidemic. Yet when Mr. Museveni himself was campaigning for reelection in 2001, he sought to smear his main opponent by accusing him of being HIV-positive.

Dr. David Serwadda was among the first to study AIDS in Uganda in the early 1980s and now heads the Institute of Public Health.

"Everybody here knows somebody who has died of this disease," he says. "But I've yet to go to one burial where they say, 'This person died of AIDS.'"

Particularly in the early years of the epidemic, experts considered AIDS in Africa "a disease of affluence."

"And is still is, by and large," says Dr. Serwadda, "in the sense that it is these rich guys who tend to spread HIV to younger, much poorer girls."

Though precise statistics are unknown, health workers say that AIDS disproportionately hits the wealthy. They tend to have more sexual partners and often do not wear condoms for fear of being branded as HIV-positive, observers say. It is for this reason, too, that they are reluctant to visit the AIC.

A member of Parliament who was recently invited to tour the new VIP testing services at AIC refused to park his car anywhere near the clinic. The service, which costs five times the fees charged just across the courtyard, offers extended hours and absolute privacy. Since it opened in July, the wing has served about 100 clients, the number the regular clinic tests in a single day.

Staff members are grappling with how to advertise the service while keeping it discreet at the same time; they are quietly trying to spread word of the clinic at government offices and businesses in town.

Ideally, they would like to move the executive wing to a more "suitable" location, perhaps in a downtown office building. The clinic is now across the road from a pool hall on the outskirts of town.

One of the only public figures in Uganda who is open about being HIV-positive is Maj. Rubaramira Ruranga. Major Ruranga learned he was infected in 1989 after fighting in Uganda's civil war and announced it over a microphone at a public gathering in 1993.

Members of Parliament, well-known professionals, and other Ugandans of high station often come to him confidentially to discuss issues surrounding AIDS and their own HIV status, says Ruranga, who now runs a support organization in Kampala for people living with the disease.

Ruranga and his group try to battle discrimination against those who are HIV-positive. He strongly encourages people to be open about their status and not to regard it as a death sentence.

But men of status, he says, are particularly difficult to convince. Such men, he says, customarily return to their villages at holidays and seduce much younger, poorer women. "As long as they keep hiding, change will be slow," he says.