AIDS in Zambia

The life expectancy in Zambia plunged from 49.7 years in 1970-75 to 32.4 years in 2000-05, according to the Human Development Report for Zambia by the United Nations Development Programme.

CHAMBOLI, Zambia Thousands of wood and metal markers stud the bare earth surrounding the resting place of Enock Chinsense.

Shovels are at work a few feet from his fresh grave. In the distance, wailing rises near the children's plots. Trucks, buses and cars carrying the bereaved rumble along an unpaved road that bisects acres of makeshift tombstones.

Three people pray quietly for Chinsense amid the din, the dust, the bustle of the Chamboli Cemetery.

Chinsense, 72, died of AIDS. His mourners, Phaides Sankalimba, a niece, and her friends, Godfredah Mwelwa and Martin Chisulo, also have AIDS. Mwelwa has lost three adult children to AIDS and now cares for eight orphaned grandchildren in nearby Luangwa.

It is the dry season in Luangwa, a shantytown just south of the Congolese border in the heart of the world AIDS epidemic.

Of Luangwa's 2,000 residents, 900 either have the AIDS virus or have been widowed or left parentless by the disease, said Chisulo of the Copperbelt Health Education Project.

An estimated 600,000 Zambians have died because of AIDS in the past 20 years. By 2015, 1.5 million more are expected to join them. Out of a population of 10.6 million, 1.2 million, including one in five adults, are infected with HIV or have AIDS.

The life expectancy at birth has plunged from 49.7 years in 1970-75 to 32.4 years in 2000-05, according to the Human Development Report for Zambia by the United Nations Development Programme.

The transmission rate of new cases in Zambia may have peaked, but the effects of the disease, which takes years to be fully realized, are now hitting virtually every segment of Zambian society.

AIDS is striking down parents who have nothing to leave their children; killing teachers - 600 in the past year - who cannot be replaced by universities fast enough; and claiming the lives of social and health-care workers needed to cope with the epidemic.

Zambia is not the hardest-hit country in the region. But it presents many of the complicated problems associated with AIDS that confront the $15 billion effort President Bush has pledged to fight the disease in Africa and the Caribbean.

In Zambia and elsewhere in Africa, HIV is principally spread through heterosexual relations. The deference women pay to men, promiscuity and the hopelessness of youth all abet its transmission. Poverty is so dire in some areas that women prostitute themselves for food to feed their families.

And there are destructive superstitions at work. Chabu Kangale, an AIDS activist, says that one of the more dangerous is the belief that sex with a young girl can cure AIDS.


The poor suffer the most. According to the World Bank, the annual per-capita income for Zambians in 1999 was $330; 73 percent of the population lives in poverty. The World Health Organization says the annual per-capita amount spent on health care in 2000 was $49.

Near the banks of the Kafue River, in the shantytown of Mufuchani, Memory Mwape, 31, severely ill and a wisp of her former self, lies on a blanket and a straw mat. The mother of three rests alone on the ground in the shade of a tree.

Some rowdy neighbors have been drinking chibuku, a local brew made from corn and sorghum. Goats and chickens scurry about.

Mwape's face is pained, its flesh drawn. Her husband, Robson Kaingu, 31, joins her. He says there is no money for medicine.

The "chairman" of Mufuchani, a wiry 58-year-old named John Kabune, says 500 families live in the community's stone and mud-brick huts. "We have no school, we have no clinic, we have no store," he complained.

The day before, he said, the town buried three AIDS victims, a normal day's toll.

The drugs for treating HIV and AIDS are beyond the reach of most Zambians. Those working with victims estimate that only a small percentage receive the antiretroviral drugs. The United Nations says that at the end of 2001, 28 million people in Africa were living with HIV, yet fewer than 30,000 were receiving antiretroviral drug treatment.

Zambian officials promise that there are enough drugs available to meet the needs of the severely ill until the end of the year. One counselor said the cost is subsidized by the government and is about $10 a month.

But Lukama Imbuwa, with an orphan-assistance program in the city of Kitwe, said, "It's typical of our government to make such statements." Officials will say drugs are available in hospitals when they are not, he said.

Most nongovernment AIDS workers say that in order to obtain a steady source of the needed drugs, one must go to private sources and pay as much as $100 to $150 a month, an amount far beyond the means of most Zambians. Even those who can pay for it may have to choose between the medicine and an adequate diet.

The medications can cost too much even for employed Zambians. But businesses, such as Copperbelt Energy, have found that in the long run, it is less expensive to buy the drugs for ill employees than it is to replace a skilled worker.


The incidence of HIV/AIDS is highest in urban areas, where nearly 30 percent of even the low-risk population - those not involved in prostitution - test positive.

Girls and young women are most vulnerable, said Kangale, the AIDS activist and programs manager for the Copperbelt Health Education Project. In a male-dominated society, they are sometimes the victims of abuse by older men and relatives.

Girls orphaned by AIDS sometimes turn to prostitution to support themselves. The prostitutes further contributed to the problem in the late 1990s by offering unprotected sex - though at a higher price, he said.

Bishop Joshua H.K. Banda of the Northmead Assembly of God Church in Zambia's capital of Lusaka agrees. In many areas of Zambia, the men are in charge.

"Women do not have much of a say. The man can have many sexual partners," he said. This year, Banda was one of several African church leaders invited to the White House to discuss needs with Bush's advisers.

There are some encouraging signs. According to AVERT, a British AIDS charity, a new study has shown success in Zambian prevention efforts. The study reported that urban men and women were less sexually active, fewer had multiple sex partners and condoms were used more consistently.

Those findings are consistent with reports that HIV infection declined significantly among 15-to 29-year-old urban females, from 28.3 percent in 1996 to 24.1 percent in 1999, and in rural females ages 15 to 24, from 16.1 percent to 12.2 percent in the same period.

Nevertheless, HIV continues to spread.


Thousands who live in the Copperbelt Province in the north rely on jobs in the area's copper mines, where there have been recent widespread layoffs. Some of the jobless have turned to drink, which in turn leads to promiscuity, which in turn leads to AIDS, Kangale said.

AIDS orphans roam the streets, getting high on glue fumes, in Lusaka and Kitwe, a city of 700,000 and the second-largest in Zambia. Orphanages and child-assistance programs run by churches and charities are springing up, but they cannot meet the demand.

In Lusaka, life is a struggle enough for most. By day, tens of thousands commute on foot or in mini-buses to the markets and marginal employers near the city center.

They live in "shanty slum" areas such as Lusaka's Chainda, where children, in groups of a dozen or more, race about wildly.

Yoram Siame, program and projects manager for Youth Alive Zambia, an AIDS prevention group, says the economy is so bad that many youths live only for the moment and turn to drink just like adults.

If you talk to young people about HIV/AIDS, you also have to talk about alcohol abuse, Siame says. If they get drunk, they forget everything about AIDS safety.

The police are stretched thin. Like underage drinking, prostitution is not a high priority with law enforcement, according to those who try to aid women.

Linda Lungu, 22, a petite woman, began working as a prostitute when she was 13. Her friends had money and she did not. She says she decided to earn some the only way available.

Chade Chita, 23, started selling herself on the streets when she was 12. Her parents were dead, she says. She does not know if AIDS killed them.

The two women quit the business. Lungu left three years ago and Chita, five. Beatings, the murder of friends and the risk of AIDS became too much. They turned to the Tasintha Programme for help.

Clotilda Phiri is the coordinator of Tasintha, which helps prostitutes either leave the business or practice safe sex. Phiri says that when Tasintha first started in 1992, the prostitutes' ages ranged from 16 to 35. Now, she says, as the economy worsens and AIDS catches up with the older women, the age range is 11 to 20.

Phiri said that many are aware how AIDS is spread. "They say, 'We know it kills. But HIV/AIDS will kill us in five or 10 years' time - hunger will kill us now.'"

Many of the women who come to Tasintha's clinic are unwilling to be tested for AIDS. Lungu and Chita have refused. Though the odds are seven out of 10 that, as former prostitutes, they have the virus, they said they feel quite healthy.

Some of the sex workers have concluded they are HIV-positive without even going for a test, Phiri said. Her job is discouraging at times, but removing just one prostitute from the streets saves many lives, she said. "To us, that's an achievement."


The virus does not confine itself to the streets and poor. At Copperbelt University, with more than 2,000 students and 1,000 staff, Chisebwe Fumbeshi, 23, and David Kampeshi, 24, help run a campus AIDS awareness program.

Though cases among the students are rare, they say the incidence of other sexually transmitted diseases such as syphilis and gonorrhea indicate that HIV is likely present among students.

Dr. Charles Lalusha, who helps run the school's health program, said there are no official statistics, "but we know that AIDS has claimed the lives of many of our staff."
Because of the strong stigma of AIDS, Lalusha said, some well-educated university staff members who have contracted the disease have died without treatment rather than submit to testing and seek medicine that might save their lives.

All areas in the country are affected. Le'vi Lingwabo, 24, is with the Society for Family Health, which runs programs that make condoms available to cross-border truckers so they will not bring AIDS into and out of Zambia.

They also work in the lake area in the north where women, some of them wives and mothers, wait for fishing boats to return with a day's catch. "It's sad to see people selling their bodies so they can get fish," Lingwabo said.

AIDS patients are admitted to government hospitals such as Kitwe Central Hospital for free treatment of infections or other illnesses that take advantage of their weakened immune systems. Once treated, they return home for home care. Home care is handled by a number of groups, many of which must use volunteers to meet the demand.

Chisulo, the Copperbelt Health Education Project worker, accompanied two of his friends who are also volunteers, Sankalimba and Mwelwa, to the graveyard one Saturday last month where Enock Chinsense was buried. They work with those dying of the disease in the Luangwa area, near Kitwe.

Kangwa Samundengu, 47, does similar work. She helps manage the home care of some 800 AIDS victims in the Kitwe area with help from the Catholic Dioceses of Ndola.

She sometimes sees to it that victims receive maize flour, beans, rice and cooking oil. Antibiotics and other medicines - but not expensive antiretroviral medicines - are also made available when possible, she says.

Workers help look after the patients' children, seeing that they have shoes and go to school. Finally, she says, they assist with funerals, which can cost as little as $30, casket included.


Donald Musonda has the rough hands of a carpenter. The 32-year-old father of two started a coffin-manufacturing business in Kitwe a little more than a year ago; he said he is making a go of it.

He has two shops, each located near a hospital, and averages 10 orders a week. The coffins are built of wooden boards and particleboard and cost $17. One day last month, a dozen were sitting in the sun, shellac drying, outside one of the shops.
Some are quite small.

Amid the devastation of AIDS, many Zambians turn to their faith for hope and comfort.

One Sunday last month, the ridge-top Jordan Chapel of the African Methodist Episcopal Church in Wusakile was rocking with joy.

Just a stone's throw from a copper mine, the white, ramshackle building stood out against an azure sky. Inside, worshippers sang with an enthusiasm that belied the poverty crippling their lives and the unseen killer that stalks them.
With 120 members, the church now has 12 orphans because of AIDS. The pews grew silent as the Rev. Elias Mwansa began a prayer.

"As we come to you, Lord, we ask you, Lord, to cleanse us," he pleaded. "HIV and AIDS, Lord - we ask you, Lord, in all your power, Lord, to defeat it, Lord. We cry, Lord, we really cry."

"Amen," responded his flock.

Lives Lost, Orphans Left: Relatives take some, others roam streets

Fales Mazyopa, a slightly built 11-year-old fourth- grader, misses her father, a nice man who once bought her a blanket and a dress.

She does not remember her mother. When she grows up, she wants to be a nurse and care for people who are ill. Fales knows well the kind of work nurses perform. Recently, her scalp broke out in sores that had to be treated.

Her parents died of AIDS, and she may have the virus, too.

No country in the world has a higher portion of its children orphaned than Zambia.

In 2001, almost one in five Zambian children had lost one or both parents, primarily because of AIDS, according to figures from the United Nations and the U.S. Agency for International Development. Only neighboring Zimbabwe had as high a toll.

The nation now has an estimated 600,000 to 700,000 orphans - children younger than 15 who have lost at least one parent - and there could be nearly 1 million by 2010. The number is expected to keep growing until 2020.

No one can foresee all the long-term social, criminal-justice and economic implications of the phenomenon.

Bishop Joshua H.K. Banda of the Northmead Assembly of God Church in Lusaka, the capital, runs an orphanage for 50 boys. He says the children are devastated by the loss of their mothers and fathers.

Some suffer from depression, anger, substance abuse - mostly alcohol - and withdrawal. Some are frustrated and aggressive, he says.

Those working with the children say many must quit school. Their life often becomes more difficult with less emotional stability, and they can run afoul of the law or the strong stigma associated with AIDS in Zambia.

The more fortunate ones, such as Fales Mazyopa, are being raised by relatives. Some wind up in orphanages, while many run the streets.

Fales is being raised by her grandmother, Esnart Nakazwe, a stoop-shouldered, 75-year-old widow who carries herself with as much dignity as the privation of her surroundings permits.

Each of Nakazwe's three children is buried in a different place. She says her belief in Christ enables her to cope with her sorrow. And she also has a strong reason to go on with her life: raising Fales.

Elizabeth Chisembele is a field officer with the CINDI-Kitwe Program, which monitors and assists some 14,000 children orphaned by AIDS in Kitwe, including Fales. Other programs do similar work in the area as well.

Many of the younger children live with a grandparent or other relatives. Many of the older ones, 14 to 21, look after themselves with assistance from CINDI, which stands for Children in Distress.

CINDI has a staff of 14. The program relies on neighborhood volunteers scattered around the city to help with the work.

Chisembele says there are 65,000 orphans in and around Kitwe, a city of 700,000 and the second-largest in Zambia. It is not known how many of the orphans have HIV.

The children can fall victim to many problems. Girls as young as 12 become prostitutes, and younger girls have been sexually abused by their guardians, said Dora Chizi, also with CINDI.

Lukama Imbuwa, a CINDI program coordinator, tries to keep the children in school: "Education is very important. You can feed and clothe a child, but if you don't send him to school, you won't achieve anything at the end of the day."


One Wednesday in July, CINDI officials took a load of used clothes to the small dirt yard of a home in the Kwacha. There, 88 orphans, most ages 2 to 7, had been gathered by volunteers for one of three weekly feedings.

The feedings were organized after officials realized that the food they were leaving at the homes of the orphans' caregivers was often eaten by others. The program and its volunteers now manage 24 such feeding centers.

When the CINDI van, a gift of Irish Aid, pulled up, the children broke into a song of welcome. The volunteers mixed among the youngsters, barely maintaining order. A hedge surrounding the small yard helped contain them.

They were happy to be with one another and hungry for positive attention as well as the food.

Some of those being fed were older. Sipiwe Mutakwa looked 10 or 11, but the small, thin woman is 20. Unlike the others, she did not smile or sing. She has tuberculosis and herpes and probably has AIDS, Chizi said.

"I'm not feeling very well," Mutakwa said. She complained of the sores on her head and said, "I'm always coughing."

Another tuberculosis patient was Mary Chisulo, 10, who proudly wore a jarringly fancy white dress.

The youngest child appeared to be George Chanda, just 5 months old. His mother died of AIDS two days after he was born. His grandmother now cares for him.

Because of privacy issues, the children cannot be made to take HIV tests, so it is difficult to determine their needs, Chizi said.

The children sat on the bare ground and grabbed handfuls of nshima, made from ground maize, and dipped it into beans and a dish made from small fish and peanut butter.

When volunteers brought out a bag of secondhand clothes for distribution, bedlam broke out. Each child got something, clutching it tightly. The clothes distributed, many of the children returned to their meals.
The CINDI staff then visited a rural community, Kakolo, of about 5,000 people and some 200 orphans. The incidence of AIDS was lower because the community has less contact with outsiders.

Many of Kakolo's residents live in mud-brick huts with thatched roofs. Others live in concrete homes topped by metal roofs, built with the help of an American charity.

The people of Kakolo make a living from agriculture and producing charcoal. Some assemble brooms for sale in town.

The CINDI staff checked on some of the orphans and met with Dainess Muamba, 29, who was widowed nine months ago when her husband, John, died of AIDS. Muamba has three children, ages 9 years, 7 years and 10 months.

Chisembele pointed out a rash on the baby. She worries he may also have HIV or AIDS.


Kitwe also has many "street children." Many of them are not orphans, but they run a great risk of winding up as AIDS victims.

Kenneth Kalichi, a "street worker" for the Piano House, a refuge for street kids, says many have one or two parents but have run away because they felt abused or because their parents were so destitute that they could not feed them.

Patrick Mukula, 13, says he ran away from a shanty slum because his mother was dead and his father beat him. He lived on the streets of Kitwe for two months before coming to the Piano House.

He said, through an interpreter, that while he was on the street, "we used to depend on the loose change that we begged and that we could also work carrying parcels for people who would give us money and then we could buy food."

Mukula, a third-grader, said he needs to get an education to have a brighter future. Kalichi said Mukula "is one of the fortunate ones. He's attending the government schools from here."

On a Saturday night last month, a group of a half-dozen boys and girls, as young as 10, hung out at a dimly lit street corner.

Sisters Carol Kunda, 13, and Bwalya Kunda, 12, were among them. They said they left home because their parents were very poor.

Many of them had been sniffing glue, a way to get high and defeat the nighttime cold, Kalichi said. The fumes hung over the group of children.

One girl had a pop bottle stuck up her sleeve. Inside the bottle was glue she had been sniffing. She and three girlfriends have been living in a drainage pipe with several boys, she said.

Kalichi said some had been having sex. He recently took them to a clinic, where they were treated for venereal disease. One of the boys was 9 or 10 years old, he said.

A group of policemen, some carrying rifles, came over. They demanded to see Kalichi's identification and wanted to know why he was talking to the children. Before they finished, they were interrupted by some belligerent drunks who staggered on the scene.

The officers confronted the drunks and forgot about the children.

Food, drug shortages compound the problem

KAMFINSA PRISON, Zambia Many have gaunt, expressionless faces, their bodies almost lost in baggy, olive-drab uniforms.

Their attention is focused on the young man addressing them. Ochas Pupwe, a university student, is lecturing three dozen thieves, robbers and killers on HIV and AIDS in one of central Africa's largest prisons.

He explains how the disease spreads and tells the inmates how to avoid it. Pupwe also offers them free tests - there is little free HIV testing in Zambia - and tells them how they can best cope with the virus if they have it.

With the cooperation of Zambian prison authorities, Pupwe, 26, and a handful of other volunteers with an American-based program called Arise have brought HIV and AIDS education and testing into a corner of society many would rather forget.

The walls and barbed wire offer no protection from the epidemic outside. The medium-security prison holds about 1,000 inmates either awaiting trial or serving sentences of less than 10 years. About 40 of the inmates are women.

For those found to have the virus, there is more bad news: The prison diet is so poor, it will work against their health; there are no antiretroviral drugs to treat them; and conditions can be so crowded that other diseases, such as tuberculosis, can easily spread.

An investigation by the Inter-African Network for Human Rights and Development found that 34 inmates died at Kamfinsa Prison from January to September 1997, most from malnutrition and a lack of medical care. Current fatality rates were not available.

Most of the inmates live in wooden buildings and appear free to walk the grounds. The place resembles an Army camp more than a prison. A guard tower stands out, but it is unmanned. Unarmed officers mix easily among the inmates.

The hard-core inmates, those with the most serious offenses, live in four small penal blocks of roughly three dozen inmates each, where they have far less freedom of movement and sleep in crowded cells.

When Pupwe started the program, he was shocked to discover that many inmates shared razor blades and toothbrushes, thus risking the spread of HIV. He began passing out razor blades to the prisoners before each lecture.

Thus far, 26 percent of the inmates volunteering for tests have the virus that causes AIDS.

A study conducted in 1998 and 1999 at three prisons, including Kamfinsa, found that one in four inmates had HIV.

In his lectures, Pupwe urges the prisoners to be tested. Without knowing their status, they cannot make needed adjustments in their lives. But he is honest with them: If they have the virus, no medicine is available for them.

And their food, one of the key ingredients in staying as healthy as possible if they have HIV, will work against them. "It's quite unfortunate, but the diet is really important," Pupwe told the inmates.

"Even on the outside, the diet is bad. The economy is really bad," he said. He told another group of inmates that a complaint had been made to the appropriate authorities about the food.

According to a United Nations study, 50 percent of the Zambian population is undernourished.

The inmates complain of being fed one meal a day that is too small to maintain their weight. They also complain about a lack of medicines. Many of the inmates are thin but healthy-looking. Others appear to be wasting away.

Those familiar with Zambian prisons say inmates must depend on their families for medicine and for food to supplement their diets.

A recent Amnesty International report was critical of Zambian prisons for overcrowding and food shortages.

"Their diet is completely inadequate," said Dr. Charles Lalusha, a physician who volunteers at the prison. It is often just a serving of nshima, a maize-based gruel that is a national staple. The nshima is accompanied by a small amount of beans or soup.

The nshima arrives at the blocks in a large black kettle. It is dished out and handed through a hole in the metal door one bowl at a time.

Lalusha arranges for the free HIV tests, counsels the inmates and gives them their test results a week later.

The doctor concedes that the diet of many Zambians outside the prison is also poor. But he said that even the most destitute at least have some chance of eating better than the inmates.

Dennis Phiri, the prison's commanding officer, supports the testing program. He says he strives to maintain respect between the inmates and the officers, and he wants the inmates to be as healthy as possible.

He says he recognizes the problems with the food and medicine, but he says those are budget problems beyond his control.

Much of the discipline and control over the daily lives of the inmates appears to be in the hands of other inmates who decide, for example, what food other prisoners will eat and even when they can use the toilet.

The inmates have their own informal courts, as well, and there have been instances when inmates who have attempted escape have been beaten by other inmates.

As Pupwe lectured a group of inmates one Friday in July, a volunteer mixed fruit-juice concentrate with some rust-tinted water for the inmates. At the end of the presentation, each prisoner also would receive three buns.

Pupwe was talking to the inmates occupying one of the blocks for those convicted of the most serious crimes. Each block is a prison within a prison. Made of concrete, each block has six cells and a bathroom.

As many as eight inmates sleep on floor mats in a cell. The cell doors open into a courtyard that has fencing for a roof.

Plumbing is limited, but the area is clean and there are no unpleasant odors. However, Lalusha said, one of the consequences of crowding inmates together in close quarters can be the spread of tuberculosis, the biggest health problem in the prison.

Health authorities say tuberculosis is a dangerous ailment for someone with AIDS to contract. It is not unusual to find Zambians suffering from both diseases.

In 1999, a Human Rights Watch report complained about crowding in Zambian prisons and jails that led to the spread of respiratory illnesses and other diseases. There are about 15,000 inmates in Zambia, half the number that are in Virginia. (Virginia has roughly two-thirds the population of Zambia.)

Human Rights Watch is an independent, nongovernmental organization supported by contributions from private individuals and foundations worldwide. It accepts no government funds.

As Pupwe lectured in English and Bemba, a local language, the inmates sat on the concrete floor of the yard. The block leader, an inmate who runs many aspects of their lives, stood at the rear, a beaming smile on his face.

Unlike his fellow prisoners, he appeared well-fed. He wore clean clothes and polished shoes, in striking contrast to the rest of the prisoners, who were poorly garbed or wearing prison-issued uniforms. Most were barefoot or wore crude sandals.

Pupwe discussed the ways HIV can be contracted and answered questions from inmates. "No," said Pupwe, responding to one query - mosquitoes and bedbugs cannot transmit it.

Sodomy, however, can spread it, Pupwe warned. The inmates denied it took place in their block. Yet earlier surveys have shown that some of the men engage in it, and they are among the most likely - about 60 percent of them - to acquire HIV.

An inmate listening to a lecture from Patrick Lukama, 22, another Arise volunteer, conceded that sodomy occurs in the prison.

There is another group offering inmates AIDS education: "In But Free," an effort by Copperbelt University and the Zambian Prisons Service that was started in 1995. However, it does not offer testing and counseling. It trained some inmates as peer counselors.

As of July, more than 100 inmates had been tested, Pupwe said. An additional 300 were waiting to be tested. One of them is Everlyn Chinse, 27, who is in the women's compound awaiting trial for murder.

A petite woman with bare feet heavily callused, she said she is concerned about AIDS and wants to be sure she does not have it. Cradled on her hip was her 2½-year-old son, James Mayani. She does not believe he has the virus.

Female inmates with young children are allowed to keep them in the prison. Lalusha gave the AIDS presentation to the women, and the session was far more relaxed and animated than those with the male prisoners.

Pupwe also lectured juvenile inmates, ranging in age from 16 to 18, in one of the blocks.

"It's not automatic that you die of AIDS," he told them. But it is key for them to know their status.

Pupwe told another group that his project is contacting authorities and organizations looking for some way to obtain the drugs needed by those with HIV and AIDS. "We are doing that out of a moral obligation," he said.

Lalusha said that if the government wants to say it is at war with AIDS, "let's also extend it to the prisons. The inmates come from society and they'll go back to society. And, therefore, to protect inmates, you protect society."

The inmates listened closely and soberly to Pupwe. Some already knew a great deal about the disease, but many appeared to have been dangerously ignorant.

The odds are long that anything can be done to obtain medicine, Pupwe told them. "It's not just the prison, it's the entire country," and AIDS drugs for prisons are likely on the bottom of all lists, if on a list at all.

"We are not promising anything at all," Pupwe said. Nevertheless, "we are trying. We are trying."