The Chronicle of Higher Education
From the issue dated March 2, 2001
African Universities Begin to Face the Enormity of Their Losses to AIDS
By BURTON BOLLAG
During one week this month, the University of Nairobi's vice chancellor, Francis Gichaga, sent out condolences to the families of three members of the college's teaching staff who had died of AIDS.
The week wasn't that unusual.
AIDS is ravaging universities across Africa, and threatens to snuff out the lives of substantial numbers of students and graduates
-- the young, educated people the continent desperately needs.
The University of Nairobi estimates that 20 to 30 percent of its 20,000 students are H.I.V. positive. Officials say most don't know they carry the virus, and may be infecting others. A large majority will not get sick until after they graduate.
"You train and start your career," says Josphat K. Kirimania, personal assistant to the vice chancellor, "and then by 30, you die. This is the tragedy of the universities in Africa."
The deaths caused by AIDS are leaving gaping holes in university faculties, says Sobbie Mulindi, head of the university's department of behavioral sciences. When a senior faculty member dies, the death represents the loss of 30 years' investment.
"I'm appealing for help," he says. "These people are very hard to replace."
Yet for more than a decade, most universities in Africa, like the countries they are in, refused to confront the growing epidemic.
In the early 1990's, Mr. Mulindi, a senior lecturer in psychiatry at Nairobi, was one of the first to sound an alarm. "I was looking at the national data on H.I.V. infection from prenatal clinics," he recalls. "I told people we were sitting on top of a time bomb. They thought I was exaggerating."
Now the Kenyan government has officially endorsed the warnings voiced by Mr. Mulindi. A little more than a year ago,
President Daniel arap Moi finally declared the epidemic a national disaster. Mr. Mulindi has been put in charge of fighting the epidemic at the university, and, as a member of Kenya's National AIDS Control Council, is responsible for coordinating AIDS policy at all universities.
According to official figures, one million Kenyans have died from AIDS-related illnesses and two million more, 14 percent of adults, are infected with H.I.V. The United Nations estimates that 8.8 percent of the 269 million adults in sub-Saharan Africa, or about 24 million people, have the virus.
An infected professor or university administrator occasionally may find the money to travel to South Africa to receive the anti-retroviral drugs that allow people with AIDS in industrialized countries to lead almost normal lives. But most
H.I.V.-infected people in Africa can't afford the travel or the drugs, which cost thousands of dollars a year. So they die.
In a report on AIDS and African universities, the Rev. Michael Kelly, a professor of education at the University of Zambia, and a Jesuit priest from Ireland, says that, except in South Africa, universities on the continent have done little to confront the crisis. Father Kelly presented his findings to a meeting in Nairobi of the Association of African Universities last month. He wore a small red ribbon on his lapel.
"In general, there is silence at the institutional and personal level," he told the riveted audience, "even though this epidemic stands ready to destroy higher-education institutions."
The 76-page report was based on case studies of seven institutions in six countries: Benin, Ghana, Kenya, Namibia, South Africa, and Zambia.
Generally, African institutions do little more than give students some factual information about AIDS prevention as part of orientation at the start of the academic year, Father Kelly says. University health centers often have no resources to test for
H.I.V. African universities are often expected to provide drugs to their staff and students, but medicines to treat the opportunistic infections that plague those with AIDS are often in short supply.
In any case, Father Kelly cautions, universities should not see AIDS primarily as a health problem, but as "a total human problem." Senior officials, he says, should take the lead to create an atmosphere in which people at their institutions don't have to hide their illness or go off campus to seek help.
More effective than simply exhorting students to change their behavior would be to "mainstream" AIDS education into all teaching programs. Graduates in architecture, political science, or sociology, for example, should be fluent with issues that might affect their professions, such as how to cope with Africa's AIDS orphans -- already 12 million and increasing quickly. New disciplines, not usually found in African universities, such as the study of bereavement, may be needed. "All graduates," says Father Kelly, "must be AIDS-competent."
The report found that no universities were adjusting their admissions of students in response to the early deaths of large numbers of people in certain professions. AIDS is creating a shortage of schoolteachers, for example. The United Nations
Childrens Fund -- UNICEF -- estimates that in 1999 alone, 860,000 children in sub-Saharan Africa lost their teachers to
AIDS. Swaziland estimates that, over the next 17 years, it will have to train twice as many teachers as usual, just to keep schools staffed at their 1997 levels.
Universities are already bearing increased costs -- health care for staff and students, and rising premiums for campus health insurance. African institutions typically pay funeral expenses for staff members. In many cases, universities are eating up their annual budgets for such expenses in the first month or two of the year, says Father Kelly.
Institutions report a greater rate of AIDS among the staff than among lecturers or senior faculty members. Professors and administrators report that students sometimes bring prostitutes into dormitories, although the practice may be less tolerated today due to AIDS.
But the practice had already helped spread the AIDS virus among male students, and probably played a role in spreading the disease among nonacademic employees. Security guards, for example, may extort sexual services from prostitutes they find on campus. A climate more accepting of sexual exploitation appears to contribute to a high rate of H.I.V. infection among campus cleaning women, who may be pressured by staff members or students into providing sexual favors.
Those faculty members who have AIDS typically take repeated periods of sick leave. Colleagues must fill in. Work days are lost as staff members attend a growing number of funerals. "Staff morale, cohesion, and productivity can all go down," says
The AIDS problem is compounded by poverty and a sharp economic downturn experienced by many African countries.
Professors and administrators say some female students have turned to occasional prostitution to earn the money they need to continue their studies, putting them at risk of infection.
The dean of students at Nairobi, Emmy Sumbeiywo says some students go without food because they can't afford the equivalent of a dollar for a hot meal in campus cafeterias. Mr. Mulindi, the psychiatry lecturer, has proposed rewarding students who learn how to counsel other students about AIDS by giving them vouchers for free meals.
Educators and students say the pressure on female students by male students and faculty members to consent to sex, in societies in which women may traditionally assume a more submissive role than in Western countries, contributes to the spread of H.I.V. "In our generation, more women feel empowered to say: I want safe sex," says Helene Namisi, a law student at
Nairobi. But, she adds, many women, especially from rural areas, will give in to a faculty member or a more senior student who pushes for sex, or to a boyfriend who insists, "If you really love me, you'll agree not to use a condom."
Mr. Mulindi is preparing a strategic plan on AIDS education for the University of Nairobi. It will call for helping women learn how to resist pressure for sex, and centers where women can report harassment anonymously if they wish. The plan will also call for voluntary H.I.V. testing, with guarantees of confidentiality and nondiscrimination.
Although thousands at the University of Nairobi are infected, up to now there is no official support group for people with H.I.V. and AIDS.
"There's still a lot of stigma," says Wycliffe Kimani, a medical student at Nairobi. "You can hardly find a student who admits:
'I'm H.I.V. positive.' "
The ones who get sick, he says, just drop out and disappear.
Nairobi's administration first allowed Mr. Mulindi to organize a one-day AIDS workshop for all department heads only last year. The move came, in part, in response to an incident in which students watched a lecturer get thinner and weaker and concluded, correctly, that he was sick with an AIDS-related illness. They refused to attend his classes, apparently fearing for their own health, and forced him to stop teaching. A few months later, he died.
Other institutions have also taken some initial steps to fight AIDS, though generally in a piecemeal fashion. Kenyatta University, which includes Kenya's largest teacher-training college, last year started a compulsory course on AIDS for all future teachers.
Institutions in South Africa, where 20 percent of adults are infected, are generally ahead in coping with AIDS. Several have internationally recognized centers of research on the medical or social aspects of the syndrome. The University of
Durban-Westville has an intensive counseling and support program. The University of the Witwatersrand has an AIDS Law
Project, and the University of Zululand has an innovative project that uses drama and performance to educate the public.
Piyushi Kotecha, chief executive officer of the South African Universities Vice Chancellors Association, says AIDS-fighting efforts in South Africa are still uneven. The association is working closely with staff and student associations, to develop AIDS policies and standards for AIDS-prevention efforts at universities. "We're trying to make this a strategic issue at all institutions," she says.
In South Africa's neighbor, Namibia, the national university held its first H.I.V.-AIDS week last spring, with lectures and performances. Students also went out to speak in schools about AIDS.
Mobilizing students and staff members to deal openly with an issue involving sex and death is not easy in conservative African societies, but Father Kelly told the university leaders gathered here that Africa's struggle with AIDS will be to a large extent won or lost on their campuses. "This, ladies and gentlemen, is a wartime situation," he implored. "There cannot be business as usual when you are dealing with AIDS."
2 VIEWS OF AIDS AT U. OF ZAMBIA
The following quotations were collected from students by the Rev. Michael Kelly, a professor of education at the University of Zambia.
"The course really suffered, and we couldn't blame him. We knew what was happening. He had lost a lot of weight and used to get infections, and he wasn't motivated and it wasn't really his fault. So the course that he was teaching really suffered because we were left to our own resources. A lot of times, he wouldn't come for lectures. We would feel really sorry for him and also that hindered us when we didn't agree with something he said in lectures. We couldn't bring ourselves to tell him because we knew he had personal depression. So we just left him. It was very depressing for us as well."
"Nearly all the students interviewed indicated that those who are suspected of being H.I.V. positive are isolated and sometimes they are taunted. One student went to a counselor and complained that some students spoke about her in riddles as she walked past them:
"'Ee, tulefwa. Twakulafwa kuli AIDS. Tulefwa. Tuleonda no konda. Mona boyi efyo ngondele! (Yes, we are dying. We'll be dying from AIDS. We are dying. We are even losing weight. Look at how much weight I've lost!)'
"Because of this kind of taunting, students living with H.I.V. / AIDS spend most of the time in their rooms. When they do get out of their rooms, it is just to attend lectures."