Text by Francesco Zizola, Magnum Photo
Mozambique is one of the poorest countries in the world - the United Nations Development Programme ranks it 157 out of 162 countries.
There is no cure for AIDS. There is, however, a treatment that keeps people with AIDS alive: anti-retroviral treatment. In September the famous basketball player Magic Johnson announced that 11 years after he first tested positive for HIV he is still free of AIDS. He doesn't feel ill, indeed has never felt ill. The difference between Magic Johnson and most of the 30 million HIV positive people in Africa is that he can afford anti-retroviral treatment while they can't. In Mozambique, treatment costs 350 dollars per person per year - less than a dollar per day. It's too expensive for most of the more than 1 million Mozambicans who are HIV positive, and it's too expensive for the government of Mozambique - the national health budget is only 10 dollars per person per year.
...About 13% of the adult population of Mozambique are HIV positive. And the situation is getting worse - every day 600 more Mozambicans are infected with HIV. As a result of AIDS average life expectancy in Mozambique will, by 2010, have dropped from 43 to 27 - a level not seen since the 19th century. The difference between people dying at 27 instead of 43 is best understood in terms of the children - it's the difference between being orphaned at 5 instead of 18.
Poverty also means that people live from one day to the next. There's little point worrying about a virus that will only begin to harm you in several years time when you don't know what you will be eating tomorrow. To a Mozambican youth the risk of AIDS in 5 years as a result of unprotected sex today is as distant as the risk of cancer in 20 years to a European youth who has started smoking. A risk so remote is barely a risk at all.
Poverty means poor medical services. Mozambique has a chronic shortage of doctors and nurses; hospitals and health centres are often in very poor condition. In addition, needles and syringes are used more than once and sterilization equipment is often barely functional.
Poverty makes young women and girls particularly vulnerable. In Mozambique about 16% of young women aged 15-24 are HIV positive compared to 6% of men in the same age group. Biological explanations - a woman is more likely to be infected from sex with an HIV positive man than vice versa - are not sufficient to explain this huge difference. In Mozambique there is a pattern of intergenerational sexual relationships - young women having sex with older men - in which the women have little or no say. Economic, cultural and even physical pressure means that they are frequently forced to have sex with older men.
Education ought to be a way out for these young women, offering the hope of an independent future and more control over their lives, especially in terms of sex. But in Mozambique education has its own pitfalls. School fees and uniform might be paid by an uncle or friend of the family - who then expect sexual favours in return.
Even within schools the sexual menace is present.
According to a survey by the Ministry of Education, 91% of secondary school girls personally knew other pupils who had had a sexual relation with a teacher. When asked whether sex between The Mozambican Prime Minister Pascoal Mocumbi recently warned that AIDS was becoming a worse disaster for Africa than any atomic bomb dropped on the continent. Apocalyptic words, but there is a difference. Unlike a bomb AIDS makes no noise. There is no sudden explosion, no big bang. Instead the damage is slow and steady but far more severe.
An atomic bomb would certainly provoke an immediate reaction from the international community. AIDS doesn't. The world sees the pictures, reads the statistics, and gets used to figures that are too overwhelming for the mind to absorb.
The silent atomic bomb continues its slow explosion, unimpeded by any serious global attempt to stop it.
From the text by David MELODY &
Medecins Sans Frontières Coordinators