The New York Review Abroad

by Robert B. Silvers

  4.

  AIDS threatens African development because it kills and disables adults of working age and leaves children without parents. Societies lose teachers, doctors, bureaucrats, soldiers, businessmen, and other workers, and the rest of the world loses consumers. But AIDS is as much a symptom of social crises as it is a cause of them. Rural poverty, corruption, political mischief, human rights abuses, and a pointless war are reviving tensions that linger from Uganda’s brutal past and could contribute to further spread of HIV. There are already signs of increased insecurity. Kampala is still one of the safest cities in Africa, but there are reports that violent crime rates have risen in recent years, after a long decline since 1986, and I heard people talk casually about crime in a way they did not before. During the past few years, Kampala has been hit by a spate of bomb attacks and eight students at Makerere University have been murdered, but the killer has never been found. There are stories in the newspaper about traditional healers kidnapping and sacrificing children, because chickens and goats no longer do the trick. There are also many accounts of domestic violence, which remains an endemic problem.

  Recently the UN, a group of concerned Harvard academics, and other advocacy groups have been campaigning for an AIDS fund for developing countries that, they hope, will amount to up to $10 billion per year. There is considerable debate about how this money should be spent, if it actually materializes. Lack of AIDS treatment and inadequate funding for prevention programs in Africa are increasingly seen as grave injustices. However, injustice itself, and the many forms it takes in Africa, are a fundamental cause of the growth of the epidemic, and unless that changes, even the most well designed prevention programs may not make much headway.

  In the meantime, thousands of Ugandans are dying every year from AIDS, and there is a desperate need for better treatment. But that is not all they need. In April I accompanied a nurse from the charity Hospice Uganda on a visit to a woman who was dying at home, in a village outside of Kampala. In the small, dark room, the patient’s skeletal outline was barely perceptible among the wrinkles in the bedcovers. Sun shone through holes in the iron roof, so that the patient got soaked when it rained. “We would fix it if we had the money,” the woman’s sister said. Family members gathered in the room and asked the nurse questions as she dispensed antibiotics and painkillers. Small children came and went, and one little girl, about four years old, with a bald head and tiny shoulders, stared at me. This was the patient’s daughter. Her uncle, a man of about twenty, leaned over and asked me a question: “The other children go to school, but not this one. She keeps getting sick. What do you think is the matter with her?” I did not have the courage to tell him what he already knew.

  There is much explicit information in the newspapers and on the radio in Uganda about how to use a condom, and the feelings, manners, and techniques of romance and sex; but there is far less open discussion about what it is really like to live in a family affected by HIV. There is an odd silence surrounding these people, who now number in the millions, if you include those whose wives, husbands, parents, siblings, or children are HIV-positive.

  The family I visited was relatively lucky. The nurse comes once a week. But Uganda needs much better salaries for more people like her, and also for better medications and health centers for the roughly 50 percent of its people who have no access to health care at all.

  While I was in Uganda, I learned that these people also need not just health care, but protection from cruel and discriminatory treatment as well. I met a woman named Milly Katana, who runs an organization that monitors AIDS-related discrimination. She explained to me how, in the early days of the epidemic, people used to gossip whenever someone died. People didn’t want to sit next to someone whose children or husband was known to be sick, and schoolchildren would tease classmates whose parents had died. At funerals, rumors would go around: “If that one died, well, so-and-so is next.” But according to Katana, Ugandan communities soon realized that anyone could die from AIDS, and these cruel attitudes are slowly changing. Now, she says, a new form of discrimination is emerging, in businesses, the civil service, and other institutions. President Museveni has made a negative HIV test a requirement for promotion in the army, and the US embassy had a similar policy, but it ceased this month, after journalists accompanying Colin Powell on his recent African tour drew attention to it.

  Being HIV-negative is also an unspoken criterion for employment in many businesses. During the past ten years, under Uganda’s World Bank–sponsored reform program, state-owned businesses have been privatized and government jobs have been cut. As a result, many workers and civil servants have been laid off. According to Katana, workers whose wives, husbands, or children have died, and who are therefore suspected to be HIV-positive—what her HIV activist friends call “the so-called sick”—are usually the first to go.

  People may live with HIV for years or even decades without AIDS symptoms, and human rights groups have long argued that HIV infection should be treated like any other “latent” affliction, such as diabetes or high blood pressure. Uganda has no laws against unfair hiring practices based on HIV status, but they are in clear violation of international guidelines established by the UN Commission on Human Rights.20

  Before I met Katana, I attended a speech given by President Museveni on the subject of AIDS. Museveni is a large man, with a great bald head like polished brass, and a deep voice that carries very far, like the roar of a lion. In his speech, he told a rather strange story, tracing the origins of the AIDS epidemic in Uganda to the arrival of Europeans in the nineteenth century. Before that, Ugandan society had strict moral codes. For example, if an unmarried girl became pregnant, “the punishment then for the boy and girl was death; the girl would be tied in dry banana leaves, set on fire, and rolled down a cliff, and the boy speared. But when the Europeans and Christians came they said it was barbaric, and put a stop to it. So the tribal regime broke down into a permissive society.”

  Press reports provide further insights into the President’s attitude toward people with HIV. For more than a decade, rebels based in Sudan have launched attacks on villages and towns in northern Uganda. More recently they have been abducting Ugandan children and forcing them to join their armies, or in the case of girls, to work as slaves. The parents of 12,000 of these children have been complaining that the Ugandan government has not been doing enough to get their children back. Museveni has responded by saying that these children were by now HIV-positive anyway, so they were “no longer an issue.”21

  Shortly before polling day in March 2001, Museveni told an American journalist that his main opponent, Kizza Besigye, had AIDS.22 Later he repeated his remarks to the Ugandan press. “State House is not a place for invalids,” Museveni said. In the court case challenging the election results, Besigye denied that he had AIDS, and claimed that Museveni was spreading false rumors to dissuade voters from supporting him. But Museveni’s lawyers argued that since Besigye’s first wife and child had died in the early 1990s, it was fair to assume that he had AIDS. AIDS support groups in Uganda have claimed that Museveni’s statements were an outrageous and cynical attempt to use the stigma surrounding HIV to further his campaign, and to promote discrimination against people whose lives have been affected by AIDS.

  In Uganda, the loyalty and strength of Ugandan families and the perseverance of HIV prevention workers and AIDS treatment advocates are continually undermined by war, corruption, and injustice. HIV struck Europe and the US just as gay men were organizing to confront discrimination against them, and the struggle against AIDS became part of the greater struggle for gay rights. By and large, the people of sub-Saharan Africa have yet to assume their rights. Until the status of women improves, something that is linked to the improvement of rights for all people, regardless of tribe, political connections, or HIV status, the most generous funding for AIDS in Africa will not go nearly far enough.

  —July 5, 2001

  1. See AIDS and Reform in Africa
: Lessons from Ten Case Studies, edited by Shantayanan Devarajan, David Dollar, and Torgny Holmgren (World Bank, 2001); and E.A. Brett, “Responding to Poverty in Uganda: Structures, Policies and Prospects,” Journal of International Affairs, Vol. 52, No. 1 (Fall 1998), pp. 313–337. See also my article “Time of Indifference,” The New York Review, April 12, 2001.

  2. The poverty level is defined roughly as US $1 per day, a severe criterion. Around half of Ugandan people still lack access to safe drinking water, sanitation, and health care. See Human Development Report: Uganda (UNDP, 1998); “Is Poverty Really Decreasing in Uganda?,” Uganda Debt Network, April 9, 2001; “Dire Want Amidst Plenty Is Damaging M[useveni]’s Record,” The Sunrise, April 13, 2001.

  3. Kampala, Uganda: NRM, 1992; University of Minnesota Press, 2000.

  4. In 1996, the World Health Organization stopped supporting HIV surveillance activities in developing countries, so Uganda’s HIV statistics since then are likely to be less reliable than those from the early 1990s.

  5. See A.J. Nunn et al., “HIV-1 Incidence in Sub-Saharan Africa,” The Lancet, September 21, 1996; Maria J. Wawer et al., “Control of Sexually Transmitted Diseases for AIDS Prevention in Uganda: A Randomized Community Trial,” The Lancet, February 13, 1999, pp. 525–535; Anatoli Kamali et al., “Seven-Year Trends in HIV-1 Infection Rates, and Changes in Sexual Behaviour, Among Adults in Rural Uganda,” AIDS, Vol. 14 (2000), pp. 427–434; and The National Strategic Framework for HIV/AIDS Activities in Uganda: 2000/1–2005/6, a report by the Government of Uganda, the Uganda AIDS Commission, the Joint United Nations Programme on AIDS, et al., March 2000.

  6. See Noah Jamie Robinson et al., “Type of Partnership and Heterosexual Spread of HIV Infection in Rural Uganda,” International Journal of STD and AIDS, Vol. 10 (November 1999), pp. 718–725.

  7. See Paul Farmer, Infections and Inequalities: The Modern Plagues (University of California Press, 1999); and John Caldwell, “Rethinking the African AIDS Epidemic,” Population and Development Review, Vol. 26, No. 1 (March 2000), pp. 117–135.

  8. S. Leclerc-Madlala, “Infect One, Infect All: Zulu Youth Response to the AIDS Epidemic in South Africa,” Medical Anthropology, Vol. 17, No. 4 (1997), pp. 363–380.

  9. It is true that a person convicted of rape in Uganda is “liable to death,” but such a harsh sentence is rarely carried out.

  10. See Maria A. Quigley et al., “Case-Control Study of Risk Factors for Incident HIV Infection in Rural Uganda,” AIDS, Vol. 23, No. 5 (April 15, 2000), pp. 418–425; and Suzanne Maman et al., HIV and Partner Violence: Implications for HIV Voluntary Counseling and Testing Programs in Dar es Salaam, Tanzania, a report by the Population Council, 2001. I never learned whether Matthew’s niece was infected with HIV as a result of her rape. In Uganda, most people do not discover they are HIV-positive until they become ill. The tests are expensive and since treatment is largely unavailable to the poor, there is little reason to take a test. It is estimated that only 5 percent of HIV-positive people in sub-Saharan Africa actually know that they are infected.

  11. See Robert Desjarlais, et al., World Mental Health: Problems and Priorities in Low-Income Countries (Oxford University Press, 1995).

  12. See C. Zimmerman, Plates in a Basket Will Rattle: Domestic Violence in Cambodia (Phnom Penh: Project Against Domestic Violence, 1995); and What Women Do in Wartime, edited by Meredeth Turshen and Clotilde Twagiramariya (Zed Books, 1998).

  13. See Catherine MacPhail and Catherine Campbell, “ ‘I Think Condoms Are Good but, Aai, I Hate Those Things’: Condom Use Among Adolescents and Young People in a Southern African Township,” Social Science and Medicine, Vol. 52 (2001), pp. 1613–1627.

  14. War and its aftermath have not contributed to the spread of HIV everywhere in Southern and East Africa. Botswana, Zambia, and Tanzania have high rates of HIV infection, but have also been largely peaceful since independence. However, all these countries have high rates of rural poverty and migrancy, which may take a similar toll on social life.

  15. Report of the Panel of Experts on the Illegal Exploitation of Natural Resources and Other Forms of Wealth from the Democratic Republic of the Congo, United Nations, April 2001.

  16. Roger Tangri and Andrew Mwenda, “Corruption and Cronyism in Uganda’s Privatisation in the 1990s,” African Affairs, Vol. 100, No. 398 (January 2001), pp. 117–133.

  17. Museveni is also harassing Besigye’s wife, Winnie Byanyima, who is a very popular and articulate member of parliament. Both Byanyima and Besigye had their passports suspended, and Byanyima has been charged with sedition. Byanyima has been actively challenging corruption in Museveni’s government. Parliamentary elections are also due to be held in July, and it may be in Museveni’s interest to interfere with her campaign.

  18. See “Uganda: Not a Level Playing Field: Government Violations in the Lead-Up to the Election,” Human Rights Watch, March 2001.

  19. Charles Onyango-Obbo, “ ‘Crown Prince’ Museveni, and ‘Queen’ Janet,” The Monitor, May 9, 2001. The Supreme Court has yet to issue its written judgments in the case. Such delay is unusual.

  20. For reasons that are not clear, UNAIDS makes no mention of “institutional discrimination” in its report on HIV discrimination in Uganda. See HIV and AIDS-Related Stigmatization, Discrimination and Denial: Forms, Contexts and Determinants, Research Studies from Uganda and India, UNAIDS, July 2000.

  21. “Abducted Children’s Parents Angered by Museveni’s Words,” The Monitor, February 23, 2001.

  22. Marguerite Michaels, “Three’s a Crowd in Love and Politics,” Time, March 12, 2001.

  19

  Arrested in China

  Kang Zhengguo

  Chairman Mao ruled over a poor and almost entirely walled society. Oppression in Mao’s China was brutal and often murderous. Now that China has opened up to the world, and the Chinese economy has been transformed from a Communist autarky to a form of (Party) crony capitalism, different methods must be used to keep the population in line.

  Since the 1980s, individual freedoms have been expanded; wealthy or well-connected Chinese citizens can travel or study abroad, where they have access to information that is unavailable inside China. It will no longer do to murder dissidents or “class enemies” in savage campaigns. Not all information that is unwelcome to the authoritarian rulers can be wiped off the Internet.

  Enforced self-censorship and conformism is now preferred—through threats and intimidation, through examples of harsh punishment, and through social ostracism. By instilling enough fear in the Chinese, including those who live abroad, Chinese order will prevail. Or so the authorities hope.

  —I.B.

  A YEAR AGO, after my classes teaching Chinese at Yale were over and the students had left, I set out for my old home in Xi’an, China, to visit relatives. Early in the morning on June 15, the fifth day of my stay in my mother’s house, I had a rude awakening. Before I had gotten out of bed, eight plainclothes agents of the local State Security Bureau burst in, tersely stated their purpose, and forced me to leave with them immediately.

  They said they wanted me to take part in a “returnee interview”—which was a standard thing, they said, and nothing for me to be upset about. It was just that my mother’s house was not the most convenient place for a chat, so they would need to use the sedan they had parked in a corner of the compound to bring me to a more suitable place to ask a few questions. The car made a number of turns and then raced toward the guest house of the nearby Electric Power Institute. First I had breakfast with eight agents in the downstairs dining room; then they brought me up to the seventh floor to a room that had been prepared for me. From time to time I noticed other agents heading downstairs toward the dining room. It seemed as if they had moved in during the previous evening to get things ready for me, and now were just finishing their night duty. Agents kept popping in and out of the room, as if taking part in some scheduled deployment.

  Their first item of business was to inspect my documents. The agents took my Chinese pa
ssport and my US green card, and said they would keep them for the time being. This little move, both they and I knew, was in fact like attaching to me an invisible leg iron. Every Chinese who goes home and gets into trouble knows that once your documents are gone, they’ve got you. Even if they let you go, you can’t move. So there I was, still groggy from sleep, under comfortable detention in a guest house.

  They called it a “chat,” but it was a formal interrogation—it just started gently. In order to create a more relaxed atmosphere, they explained, they had specially recalled an old acquaintance of mine, a man who had interrogated me for six months after the Tiananmen events of 1989. I understood the terms of such interrogations, because I had been through them before. The questioner begins from the assumption that you are guilty of many, many crimes and that the police already know the details of all of them. He does not say what the crimes are; it is up to you to show your sincerity and earn forgiveness by confessing. The purpose of this approach is to get as much out of you as possible. If you fall for the promise that “confession brings lenience” and spill everything you know, you only get yourself and your friends more deeply into trouble. So I began by stating my own ground rules: since this was a “returnee interview,” not an interrogation, there would be no need for me to volunteer anything. Their side would have to initiate the questions from start to finish. I would answer what I could.

  They began by asking about letters I had exchanged with friends in Xi’an after I had left for the West. Then they asked about my contacts in the US with Liu Binyan and Hu Ping, two wellknown critics of the Chinese government. They wanted to make clear their especially profound distaste for an essay called “The Crime of Counterrevolution and the Mendacity of Dictatorship” which I had published in the Hong Kong Ming Pao Monthly in 1995 after Wei Jingsheng had been sentenced to a second lengthy prison term. But both they and I knew that none of this added up to “endangerment of national security” and that my responses were unlikely to yield much of value to them. Hence they were obliged to play their trump card, which revealed more directly why they had arrested me.