Henning Mankell - I Die, but the Memory Lives on

In conversations overshadowed all the time by death, silences are often long and full of meaning. I have interpreted what I heard and tried to understand what was not said. I have named some people by name, but the text also contains other people and other stories.

I am full of respect for all the dignity, all the strength I found.

My worry is that we do not all of us in our part of the world understand that these people need – and have a right to – our solidarity.

H.M.

Sweden

AUGUST 2003

Abridged afterword to the original Swedish edition of this book

It will soon be 20 years since the HIV/Aids epidemic first cropped up as a very real problem in our societies. We know now that some individuals had died of Aids before then, but it was not until the mid-1980s that HIV could be identified clearly and unambiguously. It started as an inexplicable epidemic among gay men in the San Francisco area. After a while we started to hear more and more reports from Africa about a new type of immunodeficiency illness that was affecting many of the countries south of the Sahara.

There was immediately a flood of publicity surrounding this new epidemic. Once the virus had been identified and the ways in which it could be passed on clarified, barely a day passed without enormous headlines in the press and the rest of the media. HIV was portrayed as a horrific plague, in the same league as the Black Death in the Middle Ages. Newspaper reports came from African villages where hundreds of people were ill or dead, from American sauna clubs and drug districts in Zurich and Barcelona. American and European experts competed with each other to describe worst-case scenarios of the future spread of the disease.

Even so, it seemed that the epidemic was not really being taken seriously. One explanation for that might be that the pattern of infection seemed to vary in different parts of the world. In the USA the infection was spread most quickly among homosexual men, and close behind them came drug addicts who injected. Other groups were hardly affected at all in the early days. It was more or less the same in Europe. In Africa, however, a much wider cross-section of society was under threat, with the majority of those infected being women.

Many people in our part of the world drew the somewhat too hasty conclusion that HIV was first and foremost a problem among certain minority groups, notably gay men and drug addicts. That meant that the majority of the population could wash their hands of the problem. This pattern did not apply to the rapid spread of the infection in certain developing countries, it is true: it was maintained that in such areas the problem was due to widespread poverty and poor levels of general health and health care among the population at large.

Nevertheless, governments in Europe and the USA reacted quickly and resolutely to the new virus. Large-scale propaganda campaigns were organised, explaining clearly how the disease was being passed on. Every individual who had indulged in unprotected sex with a stranger was urged to undergo tests. The campaigns were successful, and the spread of the virus was curtailed. Indeed, the campaigns were so successful that most people in the industrialised world no longer consider HIV a potential threat. This is true not least of the younger generation. As a result, the number of those infected has again risen, most of all in the USA.

The HIV epidemic is a catastrophe for Africa

While the situation is largely under control in the OECD countries, the picture is much more gloomy in the rest of the world. It is most serious in Africa. There, the disease has spread like wildfire. UNAIDS, the UN organisation devoted to Aids, calculates that there are at least 30 million people testing HIV-positive in Africa. Almost 10 per cent of the adult population of sub-Saharan Africa is estimated to be infected. The situation is even more serious in certain countries. In Botswana, for instance, 39 per cent of adults are infected, and in neighbouring Zimbabwe the figure is 33 per cent.

Most of those who test positive for HIV develop the immunodeficiency disease Aids and die within a few years. Nowadays, of course, there are antiretroviral drugs (ARVs) on the market. In the correct dosage, they have been able to prolong the life of many hundreds of thousands of HIV-positive patients in the USA and Europe. But they are expensive and, moreover, it is difficult to administer them in poor villages where there are not usually any health-care facilities. The combination of these circumstances means that only a tiny fraction of those afflicted in Africa have access to the new medication.

The rapid spread of the infection and the increase in the number of deaths has resulted in a drastic fall in average life expectancy in many countries. Take Zimbabwe, for example. Before HIV/Aids, mean life expectancy was 60. But the onset of Aids means that has now sunk to below 40 years of age. The US Census Bureau forecast recently that the mean life expectancy in at least eleven countries in sub-Saharan Africa would be around 30 years of age by the year 2010! Despite an increase in the birth rate, the Aids epidemic will lead to decreasing population levels in the near future.

From the demographic point of view, the main problem in the short term is that thousands and thousands of people will die in their prime. Those left behind will for the most part be children and the elderly. This will lead in turn to an acute shortage of labour, mainly in agriculture but also in other professions. The catastrophic famines that have afflicted some countries in southern and eastern Africa in recent years are not entirely due to a lack of rainfall. The Aids catastrophe is at least as important a cause. There is simply not enough manpower in agriculture. Another grave and worsening problem is how to replace all the teachers who are succumbing to Aids.

The HIV epidemic is estimated to have caused the deaths of between 20 and 25 million people throughout the world, of which 90 per cent have been in Africa. Last year at least 3.1 million people died of Aids, and it is now the fourth largest cause of death in the world. As the disease affects mainly those of a sexually active age, one of the tragic consequences has been a rapid increase in the number of orphans. It is estimated that overall more than 13 million children, most of them in Africa, have lost one or both parents due to Aids since the end of the 1980s.

Not only Africa is affected

We are now quite sure that HIV originated in Africa. It was then spread to the USA and Europe by a small number of individuals. Reports from other continents referred at first to only a very few cases. Exceptions were Brazil and the Caribbean countries. The virus spread rapidly there, leading to the same humanitarian and socio-economical difficulties as in Africa.

Asia is about ten years behind Africa when it comes to the advance of HIV. This meant that when the epidemic was first identified, it was not possible to discuss prevention programmes with representatives of countries such as China and India.

It will be a long time before I forget a visit I made to New Delhi in the autumn of 1987. I was general secretary of the Swedish Red Cross at the time. We had been working closely together with the Indian Red Cross for many years, especially in connection with disaster relief. After the experiences I had of the HIV epidemic in various African countries, I found it natural to discuss the matter with my Indian friends. The Indian Red Cross plays an important role in ensuring that there are sufficient stocks of blood in the country. I therefore offered help from Sweden in the form of equipment to screen the supplies of blood held centrally for HIV. The response I had from my colleague, Ajit Bhomwick, was a mixture of superiority and contempt. He said that the HIV epidemic was not a problem in India. This was because Indians did not have the loose sexual mores characteristic of us Europeans, not to mention Africans. He therefore declined any offer of assistance in this area.