Rose Mukantaganda lies on a makeshift bed in a tiny, borrowed room, waiting for her day to die. The 28-year-old learned she has AIDS nine months ago and has since sent her child, who also has AIDS, to die with her husband's relatives.
If not for her pastor, Puer Nzabonantuma of Church of God in Kigali, Rwanda, Rose would have no place to go. Her husband died of AIDS two years ago, and she is alone. Moaning, Rose complains that she aches all over, especially in her back. Visitors from Good News Church and World Relief ask to pray for her and comfort her with Scriptures.
"It is good that you pray for me, but I have great pain in my chest," she says. "I cannot see. In my back is pain. Today I tried to raise up so I could go to the toilet, and I fell down. I have been relieving myself inside the house."
Being treated with the expensive cocktail of drugs available in the West is hardly an option. In the United States, AIDS treatment costs between $10,000 and $15,000 per patient, reported Doctors Without Borders, a humanitarian group that offers medical assistance in developing nations. The annual GDP per capita in many developing nations ranges from $140 to $6,190, making it virtually impossible to access medication.
Here in Rwanda, just getting HIV test results can take a month, especially in the rural areas, where 90 percent of Rwandans live. The health budget already is stressed without treating the 11 percent of the population, or roughly 800,000 people, infected with HIV. Rose can't be treated even for the pain.
"One day you're not going to have this body that hurts so much," says Ruth Calver, wife of World Relief president Clive Calver, as she sits on the dirt floor next to her.
Heaven may be the only place where Africans like Rose will find relief unless the West intervenes, says Dr. Emeka J. Okoli, who is a part of Intercessors for Africa and leader of Vital Link Ministries, which seeks to bring development, relief and the gospel to Africa. The AIDS epidemic is worsening throughout Africa, south of the Sahara Desert, which stretches across northern Africa, separating "black" Africa from the Middle Eastern north.
In this region, roughly 25.3 million Africans are infected with AIDS; 2.4 million died last year; and at least 10 million children have been orphaned by the epidemic. Every day 6,000 Africans die of AIDS; another 11,000 are infected. The U.S. Agency for International Developement (USAID) estimates that by 2010, the number of orphans will rise to 40 million; there are about 47 million students in America's public schools.
For the fourth time in a year, the United Nations Security Council has met to discuss the AIDS epidemic as a threat to global security. But the strategy for fighting AIDS in Africa has been limited to awareness campaigns, condom distribution and care for the dying. Africans like Okoli, who is Nigerian, believe the West would be doing more if the victims were white.
"It goes back to the assumption that black life is not as important as white life," he says.
The Joint United Nations Program on HIV/AIDS (UNAIDS) estimates that $3 billion annually would effectively combat the disease in the hardest hit regions--such as Botswana, where 30 percent of the population is infected, or South Africa, where 4.2 million people (20 percent) are HIV-positive, the largest number of AIDS sufferers in the world.
That $3 billion does not include treatment for those already infected. Boston pastor Eugene Rivers is encouraging Western churches, particularly African American believers, to lobby the U.S. government to eliminate Africa's debt and contribute more than the $325 million it currently gives annually toward curbing AIDS in Africa.
But right now, Elijah T. Kawamugire, an evangelist from Good News Church in Kigali, Rwanda, and World Relief staffer Louise Nunviyabagabo are concerned just about lobbying Rose to trust in Christ. Kawamugire reads Psalm 23 to Rose in Kenyarwandan, her native language, and she is visibly moved. He then repeats it at her request: "The Lord is my shepherd..."
The oft-quoted words are the only salve these believers have, but it helps. The psalm ends, and Rose still cannot see. But now she's smiling and testifies that she's beginning to discern patches of light.
Christians working in Africa believe they are seeing glimpses of hope, too, as churches mobilize to meet the growing needs AIDS creates. More and more believers are describing the grave situation as an opportunity for churches to demonstrate Christ's compassion by nursing the sick, feeding the poor, and caring for widows and orphans. What's more, they say, the church specializes in what is perhaps Africa's greatest need: hope.
"Only the church can approach AIDS with hope," says Clive Calver, president of World Relief. "Not only do African churches have the local presence and moral authority to address behavioral issues, but they have a unique message of hope to offer to people living with AIDS."
Stella Kasirye, World Relief's Malawi field representative, says AIDS may even present a kairos moment for the church to become the glue that holds Africa together. Believers can fill the voids left by dying teachers, meet physical needs and be the hands that comfort the dying, who are ostracized in African society.
"If Africa comes out of this fire refined, amen to AIDS," says Kasirye, who is Ugandan. "Or we can let this moment pass. We have to be deliberate about it in order for it to be an opportunity."
Here in Rwanda, World Relief, the humanitarian assistance arm of the National Association of Evangelicals, has been working among local pastors for two years, seeking to raise awareness about how AIDS spreads and encourage ministers to provide pastoral care and counseling. They've also produced home care manuals designed to teach even children how to care for those dying of AIDS. Often children nurse their parents until they die, then care for their younger siblings.
Led by AIDS project manager Emmanuel Ngoga, the organization hopes to empower local churches to offer food and assistance, either by supplying grain and tools for farming or by forging partnerships with food distribution groups such as USAID.
Initially some pastors were reluctant to get involved, believing AIDS is a punishment from God or is a nonissue among churchgoers.
"I didn't know I should have any personal concern about AIDS," says pastor Munyakarama Anastase of Evangelical Church of the Living Word in Ruhengeri, Rwanda. "After the counseling workshops...I knew that especially I had to love those people and build new hope in their lives. And I discovered that it is even one of the responsibilities of a pastor."
Now Anastase is working with other pastors in his community to launch the "Don't Be a Slave to Sex" campaign, which includes a drama to target youth.
Today groups such as UNAIDS also are partnering with churches and Christian organizations in the hardest hit regions to curb the disease's spread. They look to Uganda's example, which mobilized churches, civic groups and the government to bring the nation's infection rate down from 15 percent to 9.7 percent in a decade.
Because HIV in Africa is spread mostly through heterosexual sex, church leaders, who are said to be very influential in Africa, are asked to promote abstinence and marital fidelity, as well as to challenge some cultural traditions that exacerbate the epidemic.
For example, several African people groups practice "wife inheritance," which encourages a widow to marry her deceased husband's brother. The tradition was originally a type of social checks and balances that ensured that widows were taken care of, says Dr. Elhadj Sy, a representative for UNAIDS in New York. However, HIV could spread to another family if the husband died of AIDS and the wife was also infected.
"People are now aware that if a certain practice of our culture can bring us to AIDS, they avoid that [practice]," says pastor Munyakarama Anastase.
But an even tougher tradition to confront is a cultural taboo against discussing sexuality, which is sacred to some because of its link to procreation and creation, says Emeka Okoli of Vital Link Ministries. "Barriers are created culturally to make sure you don't break this taboo," he says.
In Rwanda, pastors add that many people are simply stubborn. "People still don't want to admit they have AIDS," says Mpire Fabrice, pastor of Good News Church in Ruhengeri. "How do we help people move around their ignorance of this situation? There is a Kenyarwandan proverb: 'In order to be cured and become well, you have to admit that you're sick.'
"Another big problem is to communicate that just because you have AIDS doesn't mean it's the end of the world."
Just ask Valerie, an HIV -positive mother in Kigali, Rwanda. At the close of a Bible study at Free Methodist Church one cool afternoon in September, she and a host of 200 women and children dance jubilantly in a simple, round church structure that has become their refuge. The music seems to appear out of nowhere, as a room full of HIV-positive women and children begin to stomp their feet rhythmically and play homemade drums and tambourines.
"I thank God for the church," says Valerie, who discovered she was HIV-positive in 1987. "The church is paying for my child's school. They give us food and bedding. I thank God I am in the church because if I weren't...I wouldn't be getting that help.
"Through my experience I have been able to help those who have just found out they are HIV-positive. I let them know that they can have hope, that they can still dance."
Created with 45 women and 10 children, the Bible study was formed after pastor Rwihaniza Jonas attended World Relief training at his bishop's insistence. It amazed both men that the group grew so quickly, suddenly making this parish the largest in the area.
"It is very important that we should come out and speak about AIDS," says Bishop Erasto Iyamuremye, head of the Rwanda Free Methodist Church. "The way to attack this problem is to say it to as many people as possible so they will all hear about it."
That's Dr. Innocent Ntaganira's philosophy too. At a Sept. 19 meeting with national church officials--which was broadcast on the national news--Ntaganira, program manager for the National AIDS Control Program in Rwanda, applauded World Relief's home care manuals. He encouraged pastors to partner with the government and civic organizations to develop a cooperative strategy.
Some ministers fear the government will pressure them to promote condoms. World Relief recommends that pastors advocate abstinence and marital fidelity, but encourage condom use for those who refuse to follow the biblical design. Some pastors say that sends a mixed message. But Ntaganira asked ministers not to make condom distribution a divisive issue.
"We know the church has the moral authority," he said. "You promote the means you believe in. What's important is that we take care of an already infected population...We have to understand that we are fighting the same enemy."
Is There Hope?
Though few know how Africa will rebound after losing a generation, Intercessors for Africa, a network of believers dedicated to praying for Africa, prophesied last year that God was going to transform the continent in the next 10 years. Explosive church growth across Africa confirms to them that God is bringing a revival.
Yet perhaps that revival must be preceded by repentance. Eugene Rivers of Boston believes AIDS in Africa is the fruit of generational sin.
"When Israel was defeated by their enemies, in part it was God saying, 'I'm going to let your enemies defeat you because you disobeyed me,'" Rivers says. "...The reality is, this is sin...If we're willing to confront the sin of the African man, who has raped and abused the African woman, God will forgive us if we repent. [But] right now the Africans still aren't willing to own their promiscuity."
Others believe this epidemic is simply a demonic distraction. "If God wanted to do some judging, we have enough going on [in the West]," says Bishop Wayne T. Jackson of Great Faith Ministries in Detroit, who oversees more than 200 African pastors through his Greater Works in Christ International ministry. "When I go over there, I see people who are hungry for God. I believe because of the great work God is going to do [in Africa], the enemy has these people under attack."
Promiscuity plays its part in the spread of AIDS, and observers say many Africans have come to devalue their lives in light of poverty and war. But African women also face unique cultural challenges. For example, in some people groups women who refuse to sleep with their husbands because they suspect infidelity face being disinherited, according to UNAIDS senior technical adviser Jacob Gayle. Many who do surrender are subsequently infected with HIV. The women, often blamed for transmitting the disease, are then put out of the family, robbed of their children and viewed as outcasts.
The biggest victims of what Eugene Rivers calls "Africa's holocaust" are the children, who make up 80 percent of the world's pediatric AIDS cases. Traditionally African communities have had a strong extended family structure that embraces orphaned children. But AIDS and war have caused some Africans to move into survival mode, leaving many children on their own.
Kagarama Friends Church in Kigali offers food and schooling to homeless children each day, teaching them how AIDS spreads, as well as how to sew and make crafts to sell at the market.
"We want to give them hope and a future," says Jackie Nikuze Zawadi, who teaches at the school though the funding that supported her salary was recently cut. "But we must teach them about AIDS, for that could destroy their future."
Several other groups target youth in their AIDS campaigns.
World Vision recently launched a campaign to raise $30 million to enhance their existing work in Africa, which includes health education, prevention programs and orphan care. In Malawi, the group has built an orphanage where they care for 130 children.
World Relief's Stella Kasirye fears placing children in orphanages will disrupt Africa's community structure, but observers say some regions have too many orphans to absorb.
Jos Holtzhausen, national director for Youth for Christ Namibia, is raising money to build children's homes, launch an awareness campaign and teach abstinence in schools. He says the need is enormous; the Namibian government predicts that half its adult population will be dead by 2010. The most affected are those between 24 and 36, who are the chief economic producers.
"This is a satanic onslaught on the human race," Holtzhausen says. "The church [needs] to wake up to the opportunity God is giving to minister to people; 800,000 will die of AIDS in the next 10 years. We can reach those people with the gospel."
He encourages Western churches to support ministries working in Africa with prayer and finances. For $4,000 a month, he says, a Namibian church can care for 50 children.
In Ruhengeri, Pentecostal pastor Gabriel Rutikanga and his wife, Marie Florance Musabyimana, support 14 AIDS orphans--not including their own children--with just $125 a month. Ten of the orphans, some of whom have died of AIDS, were his brother's children. The other four couldn't care for themselves and asked the couple for help.
Caring for relatives' children is part of the African way of life, they say. Helping those in need is Christlike.
World Relief's Clive Calver hopes the global family of believers will see things the same way. "It is tragic that the church in Africa is under-resourced and ill-equipped for the enormity of the task," Calver says. "They have taken this on, but I believe that the breadth of their impact relates to our response...We can seize this opportunity to empower our African brothers and sisters to truly make a difference."
Adrienne S. Gaines is an associate editor for Charisma and Ministries Today magazines. She traveled to Kenya and Rwanda in September to compile this report.
Charisma is helping to fund World Relief's work among AIDS victims in Africa. Send your tax-deductible gifts to Christian Life Missions, AIDS Project, P.O. Box 952248, Lake Mary, FL 32795. Make checks payable to Christian Life Missions.
The Return of Joseph
Boston pastor Eugene Rivers believes God is calling the black church to help fight AIDS in Africa. His Pan African Charismatic Evangelical Congress has organized an elaborate strategy and is challenging black leaders to get involved.
As HIV infection rates climb in Africa and international groups such as the Joint United Nations Program on HIV/AIDS (UNAIDS) and the Centers for Disease Control (CDC) search for ways to mobilize African churches, one Boston pastor is seeking to tap another resource: the African American church. Describing AIDS as a sexual holocaust in Africa, Eugene Rivers, pastor of the Azusa Christian Community in Boston, believes black Christians are uniquely positioned to challenge the immoral behavior fueling the disease's spread. What's more, he describes black Americans as "Josephs" who are called to help Africa. "We were sold into slavery," he says. "Now God's calling us to go back and save those who sold us." While visiting Harare, Zimbabwe, in December 1998, Rivers was challenged by a Roman Catholic activist named Michael Auret to raise awareness in the United States about the epidemic in Africa. He was already busy, but the suffering children broke his heart.
"I went to my hotel room and looked at my daughter and started to cry," Rivers told Charisma. "I looked at my daughter, and I looked at these little African girls, and I said, 'They're never going to have a chance.' I thought: How can I...get back on the plane and ignore all those children?"
When he returned to the United States, friends encouraged the activist Pentecostal pastor--once featured on the cover of Newsweek for his work among gangs in inner-city Boston--to take up yet another cause. Rivers founded the Pan African Charismatic Evangelical Congress, whose goals include lobbying the government for at least $3 billion, building homes for the 40 million orphans expected in the next 10 years, and partnering with groups already working in Africa.
In December 1999, Rivers issued an open letter to the black religious, intellectual and political leaders, urging them to take up the challenge. Bishop Charles Blake, pastor of West Angeles Church of God in Christ in Los Angeles, is one of a handful of signatories to the letter. "Knowing about how much this epidemic is devastating Africa compelled me to act," Blake says.
Blake notes that the combined wealth of African Americans is greater than the combined wealth of many African nations. "We are called to utilize those assets in our hands. But this does not relieve the majority white culture," he told Charisma.
Yet as the number of HIV infections rises in Africa, so are they rising among African Americans. For the last 12 years, Pernessa C. Seele has been empowering black churches to lead in the struggle against AIDS in the United States through her group, The Balm in Gilead. Each year the organization hosts the Black Church Week of Prayer for the Healing of AIDS, to be held March 4-10.
"[The black church] is our rallying point," she says. "...If you want to address the issue, you have to get the pulpit talking about those issues because it's not really real in our community until the pulpit says so."
She believes the same is true in Africa. In recent months, she's been getting four to five calls each week from African churches seeking her help. Seele and Rivers agree that uniting the African and African American churches could have lasting impact on both parties. African churches can help blacks discover their cultural roots. And African Americans can help Africans discover their worth.
"We have gone through a process of understanding our self-esteem, and that's what I believe the African American church has to give to the African church, that process of self-empowerment, that you are worthy to live," Seele says. Some black churches already are working in Africa. Bishop Wayne T. Jackson, pastor of Great Faith Ministries in Detroit, leads a network of 200 African pastors, whom he is training to fight AIDS with resources and pastoral counseling. He says he hopes other black megachurches will follow his lead.
He and Rivers agree that African churches want to partner with black churces. "In Johannesburg, [South Africa]; Harare and Lusaka, [Zambia]...the Africans were looking for black Americans, who in most cases they saw as their brothers," Rivers says. "They said: 'Look, you black American churches have access and influence. Please use it to plead the cause of the orphan and the widow.'"
For more information about the Pan African Charismatic Evangelical Congress, visit www.pacec.org. For more information about The Balm in Gilead, visit www.balmingilead.org.
Where Did AIDS Come From?Though many scientists believe HIV transferred to humans through contact with chimpanzees in Africa, two recent reports allege that humans played a crucial role.
Florida dentist Dr. David Acer shocked the nation in 1989 when reports surfaced that he injected six of his patients with HIV, the virus that causes AIDS. His action spawned a plethora of medical ethics debates and prejudiced the public against visiting dentists.
A large dental and medical supply company hired another dentist, Dr. Leonard Horowitz, to find out what really happened, hoping to restore the public trust. His three-year investigation led him to the White House, where he believes AIDS was born. Horowitz concluded that Acer, a gay man living with AIDS, intentionally injected his patients with HIV-tainted anesthetics to retaliate against the Centers for Disease Control and the U.S. government for their role in creating and transmitting the AIDS virus through experimental hepatitis B vaccinations.
Horowitz says his findings were covered up to protect the guilty. AIDS, he alleges, was manufactured in a laboratory as a means of biological warfare and population control, a conspiracy laced with racist undertones.
In his 500-page book, Emerging Viruses: AIDS & Ebola, Nature, Accident or Intentional? Horowitz traces the money trail, naming the key players. His theory hinges around the document that he says made Acer believe he was dying of genocide: a 1969 appropriations hearing for 1970 Congressional funding for the development of viruses that were "descriptively and functionally identical to what the AIDS virus is and does." "We're not just dealing with God's wrath against humanity with viruses spontaneously mutating and jumping species," says Horowitz, a Messianic Jew. "You have behind this a very insidious, very disturbing biological weapons agenda." The mainstream medical community mostly ignores conspiracy theories. They've heard dozens since doctors first discovered AIDS in five gay men in Los Angeles in 1981.
A majority of the scientific community believes HIV (human immunodeficiency virus) descends from SIV (simian immuno-deficiency virus), which is carried by African chimpanzees. The two are genetically similar, says Dr. John R. Diggs Jr. of The Physicians Consortium, which investigates family public health issues. SIV in chimps is harmless, yet in humans, scientists say, it mutates into HIV.
Scientists aren't sure how SIV may have transferred to humans, a process called zoonosis. A popular hypothesis is that the virus jumped to humans as early as the 1930s when hunters slaughtered chimpanzees or ate their meat.
Yet British journalist Edward Hooper believes the origin of AIDS falls chronologically closer to the outbreak of the epidemic and that humans were critically involved. In his controversial 1999 release The River: A Journey to the Source of the Origin of HIV and AIDS, Hooper contends that SIV was transferred to humans through an experimental oral polio vaccine (OPV) developed in the 1950s by Hilary Koprowski. Hooper argues that Koprowski's vaccine was contaminated by SIV from chimps, whose kidney tissue was used during the manufacturing process. Though the world's first oral polio vaccine was later superseded, nearly 1 million people in the Congo, Burundi and Rwanda received an experimental version of Koprowski's OPV between 1957 and 1960.
Hooper's theory has been widely disputed. The U.S. State Department, United Nations and World Health Organization all issued statements saying there was no connection between the polio vaccine and AIDS. In September two independent lab tests also concluded that there was no link.
Both Hooper and Horowitz say mainstream science can get political. Both theories would undermine decades of AIDS research. "Different groups are threatened by the arguments; that's the heart of it," Hooper told The Atlantic Monthly, regarding the controversy surrounding his theory.
Some African officials embrace the alternate views. South Africa President Thabo Mbeki and Kenya President Daniel arap Moi both challenged prevailing scientific thought regarding the origins of AIDS early last year. Mbeki questioned whether HIV causes AIDS and suggested that poverty and malnutrition were the real culprits.
He has since curbed his comments. But Horowitz, who has been featured on Trinity Broadcasting Network to discuss alternative medicine, praises both presidents for their stance. He believes AIDS has a cure and contends that the health community is dismissing as quackery several alternative treatments, such as oxygenation and bioelectric therapies.
Groups battling AIDS in Africa frequently avoid the debates. "Even if the conspiracy theory is true, so what?" asks the Rev. Eugene Rivers, a Boston pastor fighting AIDS in Africa. "You've still got to fix it."