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A continent's crisis
'Unless there is a fundamental change in behavior, there will be no drastic change in the evolution of the epidemic.' - 10/10/99

The dying
'We grew up telling ourselves, "If you have one girlfriend, you're not man enough." - 10/10/99


Part 2
Esther's story
'If you would have seen me with these children, you would have thought they were getting ready to die.'
- 10/11/99

Rape
Rape victim: 'I felt myself drowning'

Prostitution
Prostitution plays key role in fueling Africa's AIDS crisis


Part 3
Most leaders won't confront the epidemic
- 10/12/99

Changing Attitudes
Couple fights AIDS virus, taboos

Officials prodded on discrimination


Part 4
US black leaders react

The Outsider
Minister tries to shame officials into action


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  • The Boston Globe OnlineBoston.com Boston Globe Online / Metro | Region / A Single Year
    AIDS AND THE AFRICAN
    CHANGING ATTITUDES
    Couple fights AIDS virus, taboos

    By Kurt Shillinger, Globe Correspondent, 10/12/99

    USAKA, Zambia - Though physically small, Kabanda Syamalevwe was once the kind of man who embodied his Tonga tribe's ideals of masculinity. He ruled his wife and children as lord and master. He took other women. His peers, he recalls now with laughter, called him a bull.

    But one afternoon in 1993 his world collapsed. A friend walked into a bar where Syamalevwe was having a few drinks and showed him a story in the local newspaper revaling that a school teacher had tested positive for HIV. The woman in the accompanying photo was his wife.

    ''Imagine the feeling of helplessness and uselessness,'' he said during a recent interview.

    For most African women, having the AIDS virus is a multiple curse. It can lead to rejection and violence. Most women contract HIV from their husbands or boyfriends, but few men willingly accept responsibility. At the time Brigitte Syamalevwe learned she carried the AIDS virus, she and Kabanda had been married for 21 years. She had never strayed. Both knew he was the source of her infection.

    Instead of destroying their marriage, however, the personal crisis of HIV started the Syamalevwes on the kind of long and fundamental reassessment of their attitudes about sexuality and marriage that experts increasingly believe is the only true solution to Africa's AIDS epidemic. It is a process that involves breaking old molds, elevating the status of women at home and in society, and redefining what it means to be a man.

    ''Men must be confronted with change,'' said Kabanda, a former health clinic officer. ''Our cultural upbringing has a bearing on our sexual patterns. So we need to focus on how social expectations shape our behavior as men and women.''

    In the six years since they learned they were infected, Brigitte and Kabanda, who live in the northern Zambian town of Kitwe, have tried to understand why men behave the way they do, how women contribute to that behavior, and how to change. Both are now involved in community-based HIV/AIDS education. In their spare time, and with their own resources, they run workshops for men and women on sexuality and marriage.

    They are now in the process of creating Africa's first Society of Men Against AIDS, a male version of programs in countries like Senegal that encourage open discussion about behavior and AIDS among women.

    As their story spreads, the Syamalevwes are quickly becoming a model for how to change sexual dynamics in sub-Saharan Africa. Responses to the AIDS crisis in the region have tended to focus on women because they are more vulnerable and also more likely to attend clinics and obtain information. But that has not slowed the epidemic, and a consensus is beginning to grow that more emphasis needs to be placed on male behavior. A study released last month at an international AIDS conference in Zambia, for example, indicated that 80 percent of men in that country have multiple sexual partners.

    ''Men are the cutting edge,'' said Salif Sow, an expert on infectious diseases at Dakar University in Senegal. ''The problem is that we're always talking about women, but they don't have the power to protect themselves. Men are the key to HIV transmission.''

    At the conference last month in Lusaka, Zambian Health Minister Nkandu Luo actually suggested that the time had come for African women to riot against men. But the Syamalevwes have a different approach: they work with each other to overcome the kind of gender inequities that have helped AIDS to flourish.

    It hasn't always been easy. The paternalistic influences of Kabanda's Tonga tribe left deep marks on their marriage. His father had three wives. Men were taught to be physically strong and emotionally remote. Women were to be weak.

    ''If I called him on an issue, he would punish me by coming back home later than usual,'' Brigitte said. ''It threatened him.''

    HIV changed the scenario. Brigitte had herself tested against Kabanda's wishes, and then did not tell him. She had seen some of her students struggle with losing their parents to AIDS, and worried about how her own children would cope in the same situation. After Kabanda read the story in the newspaper, it took several months for him to muster the courage to find out his own status.

    Faced with the sudden prospect of shortened lives, the couple began breaking free from prescribed molds. Kabanda paid less heed to peer pressure, stopped sleeping around, and took a more active role in raising the couple's 11 children. He became more supportive of Brigitte's career and flouted a traditional taboo by having a vasectomy.

    Brigitte also changed. She became more assertive. Whatever Kabanda expected of her, she held him accountable as well. ''Women are collaborators in their own servitude,'' she said. ''Pregnant women are emotionally weakened in the relationship, so I was Kabanda's slave for a long time. This experience has given me a chance to get liberated from men, to become an equal partner.''

    The Syamalevwes are a rare case. Kabanda was willing to make changes. Most Africans find it hard to discuss sex openly, and many women risk violence, blame, and rejection for having HIV. The couple say they talk about sex and AIDS with their family, but so far have not insisted that their children be tested for HIV.

    In one of their first workshops, in 1994, Brigitte and Kabanda asked the women to go home that night and ask their men for sex, knowing that their culture frowns on women who do so. The next day, 23 of the 24 women reported being harassed over the request.

    ''It should be appreciated that in our culture, promiscuity is associated with women,'' Kabanda said. ''It was never in our vocabulary to say that men were promiscuous. They reject it because of what the word attaches to their masculinity and superiority.''

    A groundbreaking program in Botswana underscores how difficult it is to change deeply-rooted attitudes. Over the past 18 months, the Norwegian-funded Men, Sex, and AIDS has run workshops to encourage men to talk openly about sexuality. Pilot programs modeled after the project are scheduled to start next month in Zambia, Zimbabwe, and Swaziland.

    By the end of each three-day workshop, most of the men overcome their initial shyness. But it is too early to tell if the work will lead to changes in behavior.

    ''Men are difficult to reach. They don't go to clinics and can't be bothered to get information,'' said MacDonald Maswabi, the program's director, in a phone interview from Botswana's capital, Gabarone. ''So our main concern for now is creating a place where men can go without being labeled. Many of the men at our workshops admit they need to change their lifestyle, but it will take a very long time, assuming we do have an impact.''

    The Syamalevwes, however, say that it is often the men who reject or ridicule their message publicly who come back privately for help. Many men are afraid to show weakness, they say, and conform to peer pressure. But what Brigitte tells them is simple: ''You don't lose your manhood through good actions.''

    This story ran on page A21 of the Boston Globe on 10/12/99.
    © Copyright 1999 Globe Newspaper Company.


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