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No Joke: The politics of AIDS in Burkina Faso

John Liebhardt

Mr. John, you must be joking with us. Everyone knows that AIDS did not start in Africa. It began in the United States.

That is my English class, and we’re engaging in debate, spending the year covering the issues affecting their lives, their future careers, their countries. They are all very bright students pursing graduate degrees in engineering, hailing from all over francophone West Africa. Coming into their classes three days a week, I notice the chalkboards are often left with the detritus of the previous course. Complex models lay up there, the proper flows for latrines, techniques to build small dams; garbage systems; designs for new pumps. Before I erase these intricate formulas and designs, I’d make the students explain them to me in simple English.

With all this elaborate information in their heads, it is easy to figure out why my course is a blow-off for them, even though the European administrators at the school are adamant about graduating students with at least a marginal competency in English. At first I was a little apprehensive teaching there until I was handed the best English speakers in each respective class. This made the course outline all the more easy for me: groups of two would prepare a presentation on a topic of their choice, speak for 10 to 15 minutes each while the others write questions which would form the backbone of the debate on this topic, which hopefully will round out the rest of the period. It was a plus for me because it gave me very little to do save assisting with new vocabulary words, point out faulty constructions and keep sleeping students awake.

The classes were full of what you’d think of as typical graduate students, and I heard a lot of schemes about redistributing the wealth through revolution or social ills like the grotesque examples of school teachers sleeping with students at the Lycée. The discussions were lively and mostly easy going. When the topic of AIDS came up, I never foresaw it being a controversial discussion. It started out like you’d expect, and during the debate, I harmlessly cut in to inform them of a documentary I saw regarding the origin of AIDS began from the jungles of Zaire. The students didn’t know what to make of this. Some were stunned; others broke out laughing.

“No, the disease came from Americans,” said Moustapha, shaking his head. He was seconded by his colleague Djibril, who rarely spoke in class. It’s our lifestyles, he hinted, our reckless disregard for morals. Another suggested the CIA had invented it and brought it to Africa. To do what, I countered? “To keep Africans poor,” the students said in unison.

Up close, the spread of AIDS is both more routine and complex whose implications I didn’t truly understand until I started hanging out with a guy I learned to call the Giant, a tall, lanky dude with south-side Chicago written all over him. He’s been living in different corners of Africa pretty much since the late ‘80s; a blue jean wearing, motorcycle riding, chain smoking, chain swearing old-African hand. Often we’d sit on his porch late into the night and talk, drink beer and he’d play music so loud I wondered how his young daughters learned to sleep through it. He is a storyteller, so I heard a lot about Africa, and he’d bring me into his world, development, where he could sometimes be dismissive (“The four pillars of development: computers, air conditioning, 4 x 4s and per diem.”), but something kept him working on the continent, which I didn’t see until he took me out to the field with him.

The Giant’s title reads something like Country Representative, but in reality he considers himself a social marketer. Working with his organization in Burkina Faso that means also being tangentially involved with AIDS: Selling inexpensive condoms to shops and boutiques all over the country to help control the spread of the disease. A year or so before the Giant arrived in Burkina Faso a hubbub broke out regarding conflicting reports on the prevalence of the disease. In 2001, UNAIDS found that according to their sentinel studies of various health clinics around the country, the national AIDS rate stood at 6.5 percent, much higher than anyone predicted and closer to the epidemic levels commonly found in the countries of Central and Southern Africa. Never mind the fact that any numbers from UNAIDS, a body that advocates for more AIDS funding, should be taken with a grain of salt. The problem also lies with the Sentinel survey itself. By only tabulating AIDS rates of patients at health clinics, researchers hope to better track the people or groups who most likely contribute to the expansion of the disease, which provides them a leg up when combating a concentrated malady like AIDS.

However, a host of reasons allow the findings of sentinel surveys to vary wildly. That appeared to be the case when researchers conducted a similar study the following year and found the rate to fall to 4.2 percent and after repeating the study once again, saw that average tumble down to 2.3 percent by the end of 2003. About the same time, a different group of researchers published the results of a more thorough, but time consuming household-based study that offered a larger sample size which found the national AIDS rate to be around 1.8 percent, with only 1.3 percent on average of rural people infected and 3.6 percent of people living in urban areas. Yet, even these numbers can be deceiving: In the predominately Muslim rural north, for example, only .1 percent is afflicted with AIDS, while up to 3.7 percent in the far southern part of the country. The study also found that prevalence for AIDS in the capital Ouagadougou is as high as 4.2 percent.

Throughout the seemingly different signals these studies were sending, the Giant and his people stayed on the sidelines. What he came to understand is there are already plenty of local groups educating people about AIDS around the country, and these reports told the Giant that for the most part, he could concentrate his resources on fighting the disease with groups on the fringes of society who may not have heard the message. By that he meant prostitutes, truckers and miners.

We drove out to spend a day in what Burkinabé call a traditional mine not far from Ouagadougou, a place where the gold vein has become too isolated and weak to extract with heavy machinery, so the international mining concern picked up and left, letting the locals and freelancers try to winnow it out with their rudimentary tools or, more commonly, their bare hands. The place was unlike any other I’d seen. Instead of a somnolent village you’ll find most everywhere in this country, this mining settlement was a cacophony of activity and noise: We had to scream over the water pumps that forced sludge through a screen, hoping to trap the gold; kids everywhere were pulverizing rock and sand, then panning it out; men worked scales in huts placed at every corner, small bottles of mercury at the ready to clot the gold.

Most of the work here involved surface mining, but we spoke to a few shirtless men who extracted gold below the surface by climbing into what looked like a small, skinny ravine, descending nearly 100 feet below the surface, with only flashlight strapped to their heads and an extra pair of batteries in their shorts pockets. They told us that at that depth they could only last 45 minutes, which is only why they brought two extra batteries.

We were here to observe the Giant’s trainer, whose job it was to jump-start conversations about AIDS, sexually transmitted diseases and their prevention through the use of condoms. I watched the Giant’s trainers over the day or so follow much of the same script: I have been traveling away from my wife for the past six weeks, and now I am going home, but my heart is heavy and I don’t know what to do: I had unprotected sex with a woman I met on the road and I don’t know whether I should tell my wife. It’s a question the Giant came up with to force a discussion about the efficacy of condoms. It consistently works. While observing truckers at a border crossing on the frontier of Togo, I watched a fat Malian trucker preparing ablutions before prayer, arguing heatedly against the existence of AIDS (another ruse by the white man) up until the moment he stepped onto his mat to pray. Like releasing a pause button, he picked up the argument immediately when he finished a few minutes later.

Discussions weren’t that confrontational at the mines. Truckers have been known to wait for up to three days at the border worrying about their loads while their paperwork is processed. Miners seem much more relaxed with their down time. Over the din, the trainer, who everyone referred to as “the doctor,” begins his spiel on a group of miners and eventually pulls out a wooden penis to demonstrate how to apply a condom. Like the border, a crowd magically turns up whenever the wooden penis appears.

Later, we spoke to a woman who lives about 20 kilometers from the mine, and she said that men from all over the area had laid down their tools to get a piece of the action. There’s money to be made at the mines, of course, but what is interesting is an entire industry has been set up to facilitate the separation of miners from their hard-earned money: boutiques were all well stocked as were the bars and video stores. A few women worked at these stores or ran their own little restaurants, but the female population increased each night with the help of a small bus chartered, most likely, from a bar in Ouagadougou.

Of the groups most at risk to contract AIDS, miners in Burkina Faso have a prevalence rate only behind sex workers. Mines attract a type of person and that’s why the Giant put his people here: Watching out over the fringes of society, mobile workers in dangerous professions with very few familial obligations tying them down. Add in the fact most everybody is making pretty good money and worries spread that we’ve got a recipe for a mini epidemic.

Making matters worse, the mine doesn’t exist on local maps. By the looks of the two gendarmes sitting under a tree at the mining village, the state doesn’t appear to exert much of an influence either. The chief, whose village owns the land, collects a portion of the profits and most likely sends nary a penny to state coffers. Yet this no-man’s land has replicated itself in other parts of the country. The Giant tells me of countless other mines like this spread all over the country with names like Al-Qaeda because nobody out there seemed to get along; they call Monrovia another because the preponderance of Liberians at the site.

The ironic thing is it’s my engineering students who will one day help design and build the infrastructure that should expand the reach of the government, which can more easily watch over the communicable diseases these miners and their companions may be spreading. Until that infrastructure is built (if ever) it’s up to small groups like the Giant’s to send people out and be the eyes and ears on the ground, a household survey on the fly.

There are many who like to point out that AIDS is a perfect metaphor for Africa: A slow, silent killer that preys on people too uneducated or too stubborn to respect its dangers. The disease will only spread further because of a deteriorating medical infrastructure that is not equipped to handle the delicate balance of caring for the sick and preventing more people from falling ill.

Yet the continuing spread of AIDS on the continent says more about how we deal with Africa and our unquestioned power over the lives of many Africans. The disease has been hijacked by what William Easterly refers to as the ABCs of the aid and development industry: antiretroviral drugs, bureaucracy and consultants. Our economists, patent lawyers and pharmaceutical companies cannot come to terms on the proper method of distributing cheap drugs to sick people. When we try to track the epidemic on the ground, we are equally flying blind, because politics, bureaucratic turf wars and institutional procedures get in the way. As we fight and argue, as my students would say, we’re keeping Africa poor.

The hopeful ending of this story is the very next school year at the engineering school, two female students brought in condoms and gave pretty much the same demonstration the Giant’s trainer offered at the mine. Uncharacteristically, I kept my mouth shut and didn’t offer any theories this time on the origin of AIDS. After all, I am just trying to help.