Henning Mankell

I Die, but the Memory Lives on

A Personal Reflection on Aids

Translated from the Swedish by Laurie Thompson

The Mango Plant

1

One night in June in 2003 I dreamed about dead people in a coniferous forest. Everything in the dream is very clear. The smell of moss, steam rising after rain. But it isn't summer. Fungi are growing around the roots of the trees. The dream landscape is autumnal. September, possibly October.

Unseen birds take off from damp branches.

My dream is about dead people in a coniferous forest. The faces of the dead people are let into the tree trunks. It is as if I were walking through a gallery of unfinished wood sculptures. Or I am in a studio hastily abandoned by the artist.

The faces are contorted, but no screams come from their half-open mouths, only silence.

They are black faces, African faces, yet the forest is in Sweden.

The dream is unexpected. There again, are not all dreams unexpected? No dreams can be planned nor do they turn up to order. The messages of the night can never be prepared for, nor can they be averted when they do come. These messages often disappear without trace, without their meaning being interpreted.

Dreams are like skilful jesters: whimsical, surprising, never quite possible to keep tabs on.

The dream fills me with uncertainty. But one thing is unambiguous, on one point there is no uncertainty.

The black people whose faces can be made out among the tree trunks have died of Aids. The skin is tightly stretched over the bones of their faces. The dead people are thin, fading away, in great pain. Nowhere is there a trace of calm or resignation.

Their screams are silent.

2

I often dream about death. My own death, the deaths of others, the death of everybody. The images are usually clear and distinct. Realistic, you might say. A dead person is dead. The dreams are most often well scrubbed, stripped of symbolic implications. There is no room for metaphysics. My dream-maker does not allow any religious or supernatural excursions.

That is why I am surprised by this coniferous forest with its remarkable, lifeless faces. It is as if the dream has intruded upon my subconscious, is there without permission.

Afterwards, when I wake up, it strikes me that nothing like it has ever before taken place in my brain while I've been asleep. Not at any rate according to what I have been able to remember of my dreams afterwards.

Most dreams evaporate into their own secret archives, to which nobody has a key. But that those archives exist I have no doubt.

Dreams can be deceptive. Hard to pin down. Not least when they have dressed themselves up as real life.

This dream upsets me. It seems to me that the images of the conifers and all the dead people have been visiting the inside of my head by mistake. As if they had no business to be there.

3

It is dawn, one morning early in June, in 2003. I am in a borrowed house right on the sea. In the grey light of dawn beyond the window, I glimpse a deer through the mist. When I move my arm only slightly, it bounds away out of sight. The sea laps almost noiselessly against the shore. The strong wind from the previous evening has slackened or shifted to another direction. It is so early that the vigilant terns have not yet started their screeching. I go down to the shore and think about the dream that has woken me.

The images are clear. They follow one another like glittering links in a carefully directed film. Not a skimped job. It is a plot in which I take part as well as observing it.

My dream, as I recall it:

I am walking along the edge of a coniferous forest. It is somewhere in southern Norrland, in the north of Sweden. The light is hazy, the sky is grey, as after a long spell of rain. Afternoon, early autumn. I can hear a bird flapping its wings somewhere, taking off from a branch and vanishing.

The dream changes at that moment. I recognise the scene, but I also have the impression that I have never been there before. There is a moment of hesitation: maybe I ought to steer clear of the path leading into the trees. But I follow it even so, walk down a path which might not be a path but only my imagination. The air among the trees is heavy with smells. The forest is soundless, not even the usual little rustlings can be heard.

It is a gentle sort of dream, nothing is threatening or dangerous. I walk peacefully through the soft, damp mossy woodland. The smells are acrid, lively. A cone falls from a tree.

Then suddenly I notice that the trees are not trees, but that they are human beings. They are partly carved out of the tree trunks, they are like half-finished wooden sculptures. An impression flutters past: a great many sculptors have lately been at work on these trees. But something has happened that something has made them run away as fast as they can go. They were trying to help these images or people out of the wood. The people trying to get out of the tree trunks have been abandoned, and now they are stuck in the trunks like dead, half-rotten remains. Broken branches are the arms, the needles their hair, the cones are maybe eyes or bones from their elbows. These are people who have themselves been running away. But they were caught and died attempting to escape.

In my dream, I wonder why I am not afraid.

I contemplate all these dead people, one by one. Slowly I make my way through this remarkable gallery of people who are half-finished sculptures carved out of trees in a northern Swedish forest.

But there is something odd about them. Their faces are black. And I know they have died of Aids.

I am still calm, I feel no fear.

Most of them are children, or teenagers; a few are very old. But all of them are dead. Their faces are not giving up their secrets. None of them speaks to me. I begin to retrace my steps. The bird I heard seems to come back to his perch again. The flapping of its wings fades. Then it is as if the sound tape of the dream has been cut. Cleanly. I stop and I have the feeling there is something behind me. Something I ought to see.

When I turn, I find myself looking into Aida's face.

And then I wake up.

4

Soon afterwards I stand by the window and gaze out into the whiteness. In mist, all landscapes can seem similar. The floorboards in my room are pine, with that distinctive smell. They are cold under my feet. It is as if the sensation of damp moss was still with me. But even so, the landscape out there in the mist could be Africa.

That's the way it is: really clear dreams accompany you out into reality, they take on a life of their own, freed of their subconscious origin.

5

It is two weeks since I met Aida in her village, a few miles north of Kampala in Uganda. The earth there was red and the banana trees grew in dense clumps. It is two weeks since she showed me where she had hidden her mango plant.

6

I had gone to Kampala by car from the airport in Entebbe. Kampala is a cluster of hills, seven or eight, and tucked tightly between these hills dotted in elegant houses with large gardens was the town itself, with far too much traffic, far too many people.

Africa is always a conflict of opposites, of urban muddle and vast, empty regions.

I say Africa, but Africa can be divided into any number of parts. Some countries within this continent are the size of all of western Europe. There is no clear-cut, single entity that you can think of as Africa. This continent has many faces, but wherever I have been the dense urban muddle and vast, empty spaces have always been side by side.

Aida's village is like all the other African villages I know. The houses are made of clay or sheets of corrugated iron or the strangest mixture of materials that happened to be at hand for the builders. But all of the lived-in houses I saw in her village had a roof.

On the other hand, there were also abandoned houses that had collapsed. When I asked why this was so, I was told that the people who had lived there had died of Aids.

African houses often have a distinctive character. Perhaps you could say it is the equivalent of the Scandinavian passion for ornate carpentry at the end of the nineteenth century. In Aida's village two doors from an old American car make up the gate in a ramshackle fence round a house where a hairdresser is plying his trade. As we pass, he is cutting a customer's hair in the shade of a tree. Shortly before we came to Aida's house – or rather her mother, Christine's, house – I notice two men, their backs running with sweat, building a wall made of rusty pieces from old petrol drums between two corner-posts.

African houses in rural areas are a hymn to the imagination, if you like. But of course they are also an expression of poverty and destitution. Around the houses are small gardens, gravel roads meandering all over the place, and apologies for fences. Nearly all of the windows have broken panes with curtains flapping behind them.

Life proceeds at a leisurely pace in these villages. Haste is a human error that has not established very deep roots in the African countryside.

7

But none of this is important. I do not need to describe houses and roads, as if this were some sort of travelogue from a country in Africa. I have other reasons for being here.

In this very village, Aida's village, there is something else that all the other villages in the area have in common. Many of the villagers have Aids. Many are already dead from the disease. You can already see the big gap: lots of children, quite a few old people, but not many in between. Aids generally kills people from fifteen to twenty years old to those in their early fifties. The old people have to look after their grandchildren when their parents are no longer alive. When the old people die, the children are left to look after themselves. What that means is obvious to everybody. Children who have to be one another's parents have a pretty distorted start in life. They slip up.

Even if life goes on as usual, it is as if there is an endless silence all around them. Daily events, everyday events, take place under a cold shadow. Many people, too many people, are going to die. That shadow is not black, nor is it white. It is just not visible. It is like a cold gust of wind.

In Aida's village the silence was so tangible that it did not need to be visible.

8

There were various sorts of waiting among the people I met in Uganda. Those who knew they were infected and spent every day looking for symptoms. Those who didn't know, those who had refused to be tested, but nevertheless looked for symptoms every day, from the moment they opened their eyes.

But there is another kind of waiting. For the people who find themselves in the same position as Aida. She is only a child, she knows that she is not infected, but she will become mother to herself and her siblings the moment that responsibility is passed on to her.

And now I see her again in a dream. It is not a very long time since we were together. The last I remember of her, she is waving vigorously. Even when she could no longer see me nor the car, no doubt she went on waving.

We all do that when we hope against hope that somebody will change their mind, decide to do something different. Come back, break off the journey, stay behind.

9

But in the dream she's dead. Her face appears as an unfinished wooden sculpture. That upsets me. And it's not right. It must be somebody else, somebody who looks like her. She is not the one who is dead. It is others who are dying. Not Aida. She is alive. She hasn't grown thinner, she isn't covered in sores, she hasn't lost all her strength so that all she can do is lie on a bast-mat in the shade, staring up at the sky or at the big leaves of the banana trees.

10

The answer is obvious, of course. I'm mixing things up. Dreams do mix things up. The first thing that strikes me when I meet Aida is how much like her mother she looked. And Christine, her mother, is ill. She may well be dead by now. The same applies to Aida's aunt. Both of them could well be dead, even though it is only a couple of weeks since I was talking to them. Aida's face is there, out in the mist. She comes very close to me.

11

One windy day, in the middle of this most unstable June, just before I start to write down my story about Aida, about her mango plant, and all the people around her in Uganda waiting to die of Aids, I visit one of the many medieval churches on the island of Gotland. It doesn't matter which one. The darkness of these old stone-built churches is the breath they all breathe. Darkness has no individual identity. Darkness is eternal, and has no face, no name.

A lone man is tending a grave. The gate at the churchyard entrance is black and heavy. The handle is difficult to turn.

Somebody, a friend from the old days, once told me that dark churches made him afraid of death. It is precisely the opposite for me. In the darkness of a medieval church on Gotland, time ceases to exist. Or perhaps all time, the past, the present, the future – all of them are compressed into a shared moment. Going into certain churches you feel at peace the moment the door has closed behind you. Nothing else is needed. The church creates its own universe.

12

I have a special reason for coming to this particular church. It feels cool within those thick stone walls. The noise of the lawn mower working away outside cannot penetrate the stone or the windows.

I contemplate the frescoes on one of the walls. The skeleton of Death is chasing a human being, smiling wryly and wielding his scythe. The man is terrified of Death, which always comes untimely. In this ancient place I am faced with pictures of the Black Death, the Plague. Time stands still, but the reality of past time is present even so.

It occurs to me that amongst all these images of Gotland peasants, I can see Aida. A black face among the medieval farmers from Tingstäde and Roma. Solidarity among men and women is as much present in horror as it is in joy.

Among the people portrayed are her mother, her brothers and her sisters. Death pursues them all down the ages. The images frozen onto the walls of the medieval church are in some ways a moving picture. The figures come running towards me, gliding through arrested time.

Then it was the Plague, now it is Aids. Then it was bacteria, now it is a virus. But death is never visible. Whence does the illness come? Where do the sores come from, what causes the emaciation?

Why should bacteria and viruses be so small that they cannot be seen? Why should they have this unfair advantage?

13

I sit in a pew in the dark interior and reflect. When did I first hear about this insidious and mysterious illness that seemed at first only to affect gay men on the west coast of America?

I cannot remember.

I have searched my memory and gone through newspapers from the early 1980s to see if there might be a headline I recognise, that could help me to fix a specific date. At certain times in my life I have kept detailed and seriously intended diaries, but they have not been able to help me either. I cannot find a moment that I can point to with any degree of certainty and say: this is when I realised that something momentous was happening. A new epidemic illness had put mankind under threat. Nor do I recall any conversations with friends about the illness, definitely not before 1985 or 1986.

Perhaps it was the sight of the actor Rock Hudson on a stretcher in Paris. I remember that distinctly. There were photographs on the front pages of all the main newspapers. It was immediately clear that the man who – not least together with Doris Day – had made so many films over so many years in which he had played a husband in an idealised and hence dishonest American marriage, was in fact homosexual. What had he been thinking of as he wandered around in his striped pyjamas, always immaculately ironed, Doris Day at his side, also smiling non-stop and fussing around?

Now he was dying, not at all old. His last journey to Paris in a chartered aeroplane was reminiscent of the handicapped faithful who tried to recover their health by going on a pilgrimage to a shrine of the Madonna. A last desperate attempt to keep death at bay by trying a new form of treatment that was said to be available in France.

I remember reading that he slept twenty-three hours a day. The one hour he was awake he devoted to telling stories about his life. I shuddered.

That news photograph of Rock Hudson is among my earliest intimations of Aids. At that time we had not yet been exposed to the mass of pictures and documentation. All the photographs from Africa, with anonymous men and women, emaciated bodies, sunken eyes, people without hope, without strength.

I also recall a young African quoted in a newspaper: "Must we die because we are in love?"

But the first decisive impression? I am pretty sure it was Rock Hudson. It was as if a sculpture guaranteed unbreakable had nevertheless shattered. And yet I am not absolutely sure.

On the other hand, I can say precisely when Aids became real for me, when I myself became frightened of the illness, terrified that I had been infected.

I knew, of course, how one became infected. And, yes, I had friends who were doctors and they assured me that there were no short cuts that the infection could take to attack me. Nevertheless, the fear was there. I know it is a fear that I shared and still share with many people.

14

It is easy to lie about this. Easy to boast that one has never experienced any trace of the irrational fear of being infected, despite the fact that common sense tells you that you have not been exposed to any risks. That is how it has always been. People ten or so years older than I am have stories to tell about a similarly needless fear of having been stricken with syphilis. They will tell you about the Wasserman test they had to take before being accepted as a blood donor, and that it was a good way of establishing that one did not in fact have a syphilis bomb ticking away in one's body. I remember as a teenager being scared stiff by stories about gonorrhoea. I don't think I've spoken to a single person in connection with venereal disease who hasn't felt a cold shiver down the spine at least once in their lives.

But the fear of HIV and Aids? I recall it very clearly. There was a period in the 1980s when the fear was especially widespread. All kinds of horror stories were circulating in the mass media. There was an account of how a passenger suffering from Aids was not allowed to board an American flight from China. The captain refused to allow him on board. There were those who argued that people infected should be branded, or tattooed in the groin. Or why not herd them together and maroon them on remote islands, there to await their deaths?

There are moments when the frescoes in the Gotland churches seem to be speaking directly to us, right now. Not only addressing us, but speaking about us, and that we are part of their story.

It was also in the mid-1980s that people started looking for scapegoats. Politicians with extreme views started fishing in muddy waters, but they were not the only ones looking for scapegoats, a lot of "ordinary" people were also carried away by the fear. Homosexuals were branded the guilty party, the ones who were spreading the disease. Just as in the past it was the Jews who had been blamed for spreading the deadly plague by infecting people's wells.

So it was the homosexuals who should all be branded, especially if they were black men. All black men seeking asylum in Europe should be subjected to HIV tests. Those infected should be turned away.

When the history of Aids in the 1980s comes to be written, a lot of ugly truths will emerge with full and frightening force.

In our part of the world at least, the absolute terror is no longer with us. There are nevertheless some people still who maintain that the Aids epidemic is the wages of sin. The scapegoats exist, be they asylum seekers, homosexual men or Russian prostitutes.

15

I well remember the moment when I myself was struck by this fear. It was in Lusaka, in November 1987. I was staying at the Ridgeway Hotel. I'd just driven there from Kabompo where I was living at the time, high up towards Zambia 's north-western border with Angola. I was on my way to Europe. The flight was going to leave the following day. I was dirty and tired after the long journey and had checked into the Ridgeway. That evening, after dinner, I went for a walk around the hotel and its grounds. At one end of the hotel I discovered the entrance to a casino. I took a look inside the dimly lit room and was immediately solicited by several prostitutes who were stationed along the wall next to the roulette table. Young and pretty. Dangerous. I thought at once that several of them were bound to be infected. How many men in my situation, visitors to the hotel or the casino, would succumb to the temptation offered by the girls? A night in the hotel, then goodbye. But death would be there already, inside their skin, sowed into their blood, flowing through their veins.

I drew back in alarm. There before me, a smiling mask, was death. The virus I was so afraid of. The girls were indeed young and pretty, but what they were offering me was death. I would have to be an idiot to accept. And, what is more, be willing to pay for it.

The fear, irrational though it was, stayed with me for many years, certainly until the mid-1990s. Perhaps it is still there, even if my fits of baseless anxiety have become increasingly rare. I took a test once, even though I had absolutely no reason to be scared. But scared I was, no matter what. And, I know, many others, very many, have experienced that same fear.

16

It was in Zambia too that I first encountered someone who quite definitely did have Aids. It was a young man. He staggered from an overcrowded bus in Kabompo. He fell at the feet of the people who had come to meet him. He was taken to the hospital in a wheelbarrow. He was as thin as it is possible to be.

Two days later he was dead. He had only just made it home from Kitwe, back to his mother in order to die close to her. His name was Richard. He was 17, and he was not gay. This was in 1988.

17

At the same place, Kabompo, I listened to a Dutch doctor giving a talk about this terrifying disease. It was an evening in the rainy season. The roads were a sea of mud, but people came from all points of the compass and a number of tribal chieftains were there. The premises belonged to one of the missionary groups and were the biggest in Kabompo, but still the place was packed to the rafters. There were others standing outside, looking in through the open windows. It was unbearably hot.

The doctor described in simple, straightforward terms – and what he said was translated into the local language by an interpreter – what happened in the body once HIV had entered the blood. He said that promiscuity was the principal culprit in the spread of the disease, and there was a rising hum, like a swarm of bees, from the women present. It was a pregnant moment. When the doctor had finished, one of the chieftains, a very old man, rose to his feet. He said: "We must all protect ourselves. For the sake of our children. There must be a stop to all unnecessary travelling. Families must stick together. Men must remain faithful to their women, women to their men. If not, we shall all die."

That was in 1988, during the rainy season. I often wonder how many of those who were there listening to the Dutch doctor were already infected. And how many of them are still alive today.

18

The mist is dispersing. I stare out to sea and I think about Aida and her mango plant. As she showed me it, I felt no doubt that it was one of the moments I shall remember for as long as I live.

19

Just how it came about, I don't know. Nor do I know when Aida made up her mind to take me into her confidence and share her secret with me. But I saw it the second time I visited her and her family.

The first time I met her, it was a very hot day. We left Kampala early so as to avoid being stuck in the chaotic traffic that envelops the city's roads every morning. Beatrice, who was the person helping me to make contact with people carrying the disease and writing memory books, had told Christine that I would be coming. At that time I didn't know Christine had a daughter called Aida. In fact, I knew only two things about Christine: that she had Aids, and that she was prepared to talk to me about it.

When we left Kampala that morning I felt the same distaste I'd been feeling ever since arriving in Uganda. There was something almost obscene about asking fatally ill people to talk about their suffering and their fate with a complete stranger. Somebody who, to make matters worse, had flown in from a distant corner of the world – Europe, the West – in which the terrible disease had almost been tamed and turned into a chronic but not necessarily fatal disease. The same disease that now is killing indiscriminately the length and breadth of the African continent and in other parts of the Third World.

I had slept badly because I had been worrying about the task ahead. My unease was not difficult to understand. I was dreading it because I knew I would find the fate of Christine and the rest of them very hard to take.

Beatrice had given us very efficient directions as to how to get there. We turned off the main road and, as always in Africa, we immediately found ourselves deep in a different world, a world usually, but wrongly, called the real Africa. Africa is always "real", whether it be savannah or slum, old ramshackle urban district or a grim and difficult-to-pin-down shadowland between bush and desert.

Christine had two houses. In one of them lived her mother and father and some of her brothers and sisters. When I arrived and got out of the car, the first thing I saw was her father, who was sitting peeling some kind of vegetable I had never seen before. He was unshaven but very dignified. Eventually I discovered that he was about 80, although nobody could be sure exactly how old. He had a keen eye, and was surrounded by an aura that immediately captivated anyone who approached him.

He went on peeling his vegetables all the time I was talking to Christine. Occasionally some child or perhaps his wife or one of the other women would give him something to drink.

He was like a measurer of time who would reject a normal clock with scorn. For him, a better way of measuring progress in his life and that of others was peeling vegetables.

Christine was thin and tired. I could see at once that she had put herself out in anticipation of our meeting. Her choice of clothes, her face carefully made-up, her meticulously brushed hair. She was typical of all the people suffering from Aids whom I met during my visit to Uganda: the last thing they were forced to surrender was their dignity. That was the ditch that had to be defended at all costs: after that there was nothing but death, and it often struck quickly once their dignity had been lost.

Christine said:"I have a daughter."

We were sitting on two brown stools behind the open but covered room which the family used to prepare food. Christine said something in her native tongue. Her daughter emerged from a clump of banana trees. She was wearing a dark blue skirt, which was ragged and torn, a red blouse, and she was barefooted. She was slim and tall and took after her mother: they had the same features around their mouths and noses and eyes. Aida was shy, she spoke in a low voice and her eyes were cast down. When I shook her hand, she withdrew it as quickly as she could.

Aida was nowhere to be seen for the rest of my long conversation with her mother. It was almost afternoon, when we had to leave to drive back to Kampala and had other appointments, before I saw Aida again. She was with Christine's mother and some of the other girls, not Christine's daughters but the daughters of her sister. One sister had already died of Aids. They were preparing dinner. I watched Aida fetch the vegetables that Christine's father had been peeling all day.

Christine said:"When I'm gone, Aida will have to take on a lot of responsibility. I am trying to live for as long as I can for her sake."

"Does she know about it?"

Christine looked at me in surprise.

"Of course she knows about it."

"What did you tell her?"

"What had to be said. She will become the mother of her brothers and sisters, and if my parents are still alive she will become their new daughter once I'm gone."

"How did she react?"

"She was distressed. What else would you expect?"

We went to the car that was parked in the shade of some tall trees whose name I have never managed to remember. I had said goodbye to everybody, and worked out that Christine's family comprised sixteen people. Christine, who had been a schoolteacher and still worked whenever she had the strength, was the only one in this large family who had any income, and even that was extremely modest. She had a very direct way of assessing her wages in relation to her own fate.

"The monthly cost of antiretroviral drugs is precisely twice what I earn."

She shook her head before continuing.

"Obviously, you have to ask yourself if it is the drugs that are too expensive, or if it's me who isn't earning enough. The answer is straightforward. My small wage has always been sufficient to feed my family, but it's not enough money to save me from death."

So Christine wasn't taking any medication at all. She said she felt more weary now than she had done the previous year. She had been feeling ill for seven years. When her husband suddenly began losing weight and fading away, she knew. The day after her husband died, she went for a test. The result was no surprise. She kept everything to herself for a year. Then she told people, first her sister and then her mother. Whereupon her sister told her that she too was ill.

"I told Aida once she had celebrated her thirteenth birthday. I noticed that the disease was beginning to affect me. It was no longer dormant in my body. It had started moving."

"What did she say?"

"You've asked that already. She said nothing. She was distressed. I believe she already knew that I was ill."

"How could she know that?"

"Aida's a bright girl who listens to what people are saying. And she's not afraid to ask. But most important of all is that she doesn't believe all those people who say that this disease does not even exist."

We had reached the car. The driver was asleep. Flies were buzzing around, there was a smell of crushed banana and wet soil. Christine looked at me.

"You are not surprised? You must know that lots of people, many too many, still think there is no such disease as Aids. Or else they think it's a disease they can get rid of in various terrible ways."

I nodded, because I did know.

When we drove off, Aida was standing with a huge pan in her hand. Christine waved, as did her mother and other members of the family. Aida didn't wave because she was holding something in her hand. But I knew even then that I would be returning.

How can you sometimes know things you don't know? You just know.

20

That evening I thought about what Christine had said. About all those people who still refused to accept that there was such a disease as Aids. And those who did not deny the existence of the disease, yet maintained that there were strange and wondrous ways of curing it. I remembered a sign I'd seen fifteen years before in Zambia, somewhere between Kabwe and Kapiri Mposhi. "I'll repair your bike while my brother cures you of Aids."

I thought about what is happening in South Africa right now. The incidence of rapes has been growing for a long time. Until only a few years ago, most of the rape victims were grown women, or at least teenagers. Not any longer. Since 2001, in some parts of the country, there has been an increase in the number of rapes of children, and most repugnant of all: rapes of infants. This has to do with the widespread, lunatic belief that you can be cured of Aids by having intercourse with a virgin.

How can one fight such mad ideas? People are desperate. How will it be possible to control the Aids epidemic if people continue holding such impossible beliefs?

Christine had talked about her work. About her work as a teacher of the next generation.

She said: "Every time I face my class, it's as if my vision becomes blurred. The same as it is with my father's eyes. Sometimes he complains – although he is not the complaining kind – that everything round about him seems to be duplicated many times over. He sees ten of me, and just as many of my mother. It's the same with me when I'm standing in front of my pupils. Despite the fact that I don't have a problem with my eyesight. Not yet, anyway, although I know that many people with Aids go blind before they die. I see my pupils multiply before my eyes. And I see all the children who have not yet become my pupils. All those who will never learn how to read and write. Being able to read and write means being able to survive. How else can you find out how diseases are spread, how else can you learn how to protect yourself and survive? Of course medicines are important, of course I wish my wages were sufficient for my treatment. But it's just as important that all the children I see as blurred images have access to the knowledge that could save them from an all-too-early death. I want them not to have to write memory books for their own children because they die so young."

That is what Christine said. Several times. She wanted me to remember. That's why she kept repeating it.

21

Memory books. Writings as death approaches, about death and about life.

This is what this text I am writing is supposed to be about.

I did not go to Uganda so that a girl named Aida would show me the mango plant she tended with such care and concealed under a pile of twigs so that the family's pigs wouldn't gobble it up. I had travelled to Uganda to meet people who were preparing for death by writing little books for their children.

I do not recall the first time I heard about these memory books, but I recognised straight away that they were something I ought to find out more about. These memory books, small exercise books with pasted-in pictures and texts written by people who could barely recite the alphabet, could prove to be the most important documents our time has produced. When all the official reports, minutes, balance sheets, poetry collections, plays, formulae for the control of robots, computer programmes, all the archive materials that represent the foundation on which our life and our history is based – when all that has been forgotten, it could be that these slim volumes, these memoirs left behind by human beings who died too soon, prove to be the most significant documents of our epoch.

Five hundred years from now, what will be left from our time and the ages that preceded us? The Greek tragedies, of course, Shakespeare, and a few other things. Most treasures will be lost, and if not completely forgotten, then kept alive only by a tiny minority. But these memory books could well live on and tell future generations about the terrible affliction that affected our age, that killed millions of people and made millions of children orphans.

There were a lot of questions to be asked. How does a person tell his or her story when he or she cannot even write? I was privy to many different types of story. Memories can be smells, drawings, they do not need to be photographs or written texts. What is the essence that tells others who we are? No doubt the diaries of some people will have something to say about me. But what do the words mean? Apart from the fact that I laugh or cry or smell of garlic?

Storytelling involves words. In olden times stories were handed down by word of mouth from generation to generation, and in many parts of the world that is no doubt still true today. But what is to become of the story when so many links in the human chain disappear? What can children say about their parents if they do not remember anything because they were so young when their parents died? Or to put it another way: how can parents explain who they are to children who are so young that they can't comprehend?

This is what Memory Books are all about.

How does a person tell his story if he cannot write? When he can no longer pass his story by telling it to the next generation? The answer dawned on me. Everybody can tell his or her own story. Words make everything simpler, they are the best method. But it seemed to me that words could be replaced. It must be possible for illiterate people to tell their stories. Smells, imprints, drawings or perhaps pictures taken by cheap disposable cameras. Why not supply everybody who wanted to leave behind a memory book with one of these single-use cameras? It isn't true, of course, that pictures say more than a thousand words, words usually tell more; but a face, a smile, a body, a person standing in front of a house wall or a clump of banana trees could be just as significant.

This is what Memory Books are all about: children must be able to tune into their parents who are no longer alive. Recollections of physical contact buried deep down inside, words and voices that are only vague memories, as something in a dream.

22

I went to Uganda in order to understand all this, so that I could write about it. In order to be able to tell readers that these Memory Books, or Minnesskrifter, Libros des memorias, Errinerungsbücher, Livres de mémoires, are important documents of our time.

Important. But at the same time, there ought to be no need whatsoever for there to be such books. The ultimate objective of the Memory Books programme has to be a contribution towards the task of ensuring that one day they will be no longer necessary. Nobody should have to die early from Aids. The search for vaccines and cures must all the time be intensified, and existing antiretroviral (ARV) drugs have to be made accessible to all. Nobody should need to write memory books in future.

But millions of these memory books still do need to be written. And it goes without saying that everybody should have the right to do so and receive help where they need it. No orphaned child, whether they live in a village north of Kampala or in some village in China or India, should find themselves growing to adulthood knowing nothing about their parents.

Apart from the fact that they died of Aids.

How many people today in a country like Sweden, my country, know what a terrible disease Aids is? Have we forgotten already the pictures and descriptions produced ten and fifteen years ago when it was not at all sure whether we would be able to control the epidemic? Those who have the disease know, their relatives know and the carers who look after them know. But for most other people Aids is a disease that makes you very thin and fade away, possibly gives you black patches on your face, which leads to the collapse of your immune defence, which leads to persistent infections and eventually perhaps fatal pneumonia. All this is correct. But the fact is that Aids often also involves extreme pain, difficult to alleviate, or very difficult to eliminate altogether.

In Sweden, highly qualified and devoted care is available for as long as it is needed. About ten years ago so-called anti-retroviral drugs began to appear. It was possible to get to grips with HIV, because ARVs delay the onset of Aids. People infected could start to hope that they might be able to live a long life even so. But in a poor country in Africa, where medical care is already primitive? They have to cope with a constant lack of resources, everything from clean sheets to the most advanced medication. And in such countries, the squeeze on what care and assistance may be made available is all the time increasing. What are the prospects there?

To suffer from Aids in Sweden and to suffer from Aids in a country like Uganda are two entirely different things. The gulf between the two peoples is as between the rich and the poor. In all areas. Even when it comes to nursing. Even when it comes to pain.

If you happen to be born in a poor country, the risk of being forced to suffer unimaginable pain is infinitely greater than in a country like Sweden. In a poor country there is a devastating relative lack of resources, as also the medical capacity to alleviate pain. This is incredibly cruel. If you are doomed to die, the agony you are condemned to endure should not depend on where you happen to be born.

23

The day that Christine showed me the memory book she had written for Aida, Aida herself took me secretly to show me her mango plant. The two things were connected, of course, what Christine did and what Aida did. But it was not a prearranged plan. Plans often emerge of their own accord when it comes to death and the sorrow that is in store. Every time the memory book was mentioned, Aida sought consolation in her mango plant. In order to endure the prospect of death she had to make an invocation to life.

24

The little memory books follow a basic template.^* An outline is provided on pre-printed pages. There is a simple logic in the headings printed on the various pages. But all the memory books I read in Uganda were original. No two were alike.

* A sample memory book is printed at the end of this volume.

People choose their own roads along which to travel. The most important thing is not to follow the manual but to tell about the very special things that only the writer has experienced. They don't need to be told about that. People think like that of their own accord. Everybody knows what is special about themselves, even if most people are modest enough to think they are no more than ordinary. But an ordinary person is always a person with unique and surprising experiences.

25

I spent a large part of one of the evenings I was in Uganda thinking about what precisely the memory of a person is. I thought about myself, of course. What do I want people to remember about me? What would I prefer to have suppressed? Do I have a number of secrets that I shall take with me to the grave? How can I shape other people's recollections of me?

It is an impossible task. I can hardly control what anyone else chooses to remember about me. I can only have a vague idea of what sort of an impression I have made. To some extent I can anticipate reactions to what I have written, what I have done in the theatre. But what about the memory of me as an individual? The child who was born in St Göran's Hospital in Stockholm at four o'clock in the morning of February 3, 1948?

I can guess that people's memories will vary. Some will remember me as a rather gloomy, possibly even melancholy person who needs to be left in peace and who can flare up if he's disturbed. Others will remember me as the opposite, a decent, cheerful person who will hardly be the last name to spring to mind when drawing up a guest list for a party.

I don't know what people will remember. Nor for how long. Memories are always finite. Memories of me will last for a number of years, but the day will come when they no longer survive. It is given to very few to live on beyond the memories of their grandchildren. After a hundred years most of us are one of the anonymous grey shadows in the blackness that surrounds us all.

But I also turn the question round: what do I remember about others?

26

That evening in Kampala I lay in the darkness and thought about my own parents. That was only natural. Obviously, they were important to me when I was growing up. But in quite different ways. My father was the one I lived with. Without his ability to notice me, listen, be positive, I don't know how I would have turned out. He more than made up for the fact that my mother was present only through her absence. She didn't exist except as a figure in photographs that were hidden away and kept from me. My mother was a strange shadow when I was little. I can't remember how old I was when it finally dawned on me that there was something peculiar about my mother. But I remember asking my paternal grandmother, who lived with us, why I didn't have a mother. I don't recall her answer, but it was evasive, I did notice that. That is something children learn at an early age – how to interpret the way adults answer questions. They soon learn how to tune their antennae to distinguish between the truth and a lie, what is a clear answer and what is evasive.

Then, when I was six, I started searching in secret for traces of this mother of mine who had disappeared. I found several photographs. Including one of me sitting on her knee. They were taken in a photographer's studio on my first birthday. I can still remember my heart pounding when I saw my mother's face for the first time. She had disappeared at such an early stage that I had no memory of her. Now I could see what she looked like. I was surprised that she was so unlike my father. Didn't people who had children have to look like each other? Then it struck me that in the photograph she was looking at me as if I were a child she didn't know. A changeling or something the fairies had brought.

I don't know that I thought that at the time, of course, or that it was so well formulated. But I doubtless realised that there was something funny about it. She was holding me as if I were a burden she would like to put down as swiftly as possible.

In Kampala that night I thought about her and my father, both of them now long since dead. I had difficulty in conjuring up their faces in the darkness. That was a shocking moment. I had forgotten what my parents looked like. It had been a long time since I had seen them, of course: my father died in April 1972 and my mother a couple of years later. There was a no-man's-land of thirty years between the faces I had seen and those I could no longer remember.

On the other hand I could quite distinctly recall the smell of my father's hair and his suits. My mother's face was blurred, but I could remember the sound of her voice, the way she spoke, the unmistakable traces of the Örebro dialect that she had spoken as a child.

In my mind I wrote a few memory books about my parents. And of course it was possible to do that. The memories of a smell and a voice meant that the faces came slowly out of the darkness. Now I could see my parents again. The memories behind those smells and sounds opened up many other avenues of memory. I recalled events, conversations, images, both in close-up and long shots.

It is true that neither words nor photographic images are necessary for memories. That is precisely why the examples of memory books that I saw in Uganda were so remarkable. I thumbed through the little exercise books. They contained pressed flowers, insects, one including a butterfly whose wings gleamed in an unusual shade of blue. Somebody had Sellotaped in grains of sand. There were also drawings: matchstick men, landscapes, animals, as if the pages were ancient cave paintings.

I saw stories without words, without pictures. There was joy and clarity in these stories. But, inevitably, mainly despair and worry: what will happen to my children when I have gone? All those I spoke to, all the people who had overcome their uncertainties and produced memory books for their children were pleased they had done so. I talked to men and women, all of whom had made nine or ten stories, one for each of their children, told in different ways because the children were of different ages.

Stories are bridges. Nobody regrets the building of a bridge.

Needless to say, that was the most moving and at the same time the most poignant aspect of these slim little memory books. They were farewells, inexorable farewell letters. All the stories ended up in an infinite emptiness, they were about lives that would end far too soon.

Christine said as much very clearly in reply to one of my questions: "When does death come too soon?"

She thought for a long time before answering.

"When does a person die too soon? There are lots of different answers to that. One answer that is always true is: when a parent, usually a mother, is forced to leave her children when they are too small to take care of themselves. And when she cannot be sure that someone else can be counted upon to take care of her children when she has gone."

Suddenly she realised that some of her children were listening. She fell silent immediately.

"Do you think they can hear what we're talking about?"

"I don't know."

Then she burst out laughing.

"It doesn't matter. Why should I try to fool myself or my children or my friends? Everybody knows my time is limited."

Later, our last day together, she returned to the question:

"Death always makes a mess of things, no matter when it comes."

27

I've experienced this before.

People who are shortly going to die want to know that they are still alive. Often with a desperate and at times ferocious intensity.

Once I had a friend who had bone cancer. He suppressed to the very end the fact that he was in great pain and had only months to live. He wouldn't even reach forty. We had known each other for a long time. The sad thing was, he had always imagined that when he retired, he would sail round the world. One day when I went to see him he insisted on examining his face in a mirror and then asked me if I thought his face had grown more mature-looking in recent years. I agreed with him, naturally. Now, many years after he died, I can't remember talking about anything else on that occasion, just that his face had grown more mature and signalled a man on his way to his prime. That's how it was too with the people with Aids that I met in the villages north of Kampala. They showed me things all the time. Photographs, a newly painted room, a knitted sweater. Everything was significant because they thought it confirmed their existence, was a sign that they were still alive. They were somehow protected by these objects. Despite the fact that many of them were already so acutely ill that they would very soon die, the objects gave them the illusion of being a safe distance away from cold death.

28

During my visit to Uganda I spoke to a lot of sick people, but I spoke most to three: Christine, Gladys and Moses. And there was also Aida, the girl who wasn't ill, the girl who wasn't going to die but instead would have to take on huge responsibilities.

The girl who was nurturing a mango plant.

I have already written about Christine. A few miles from her house lived Moses. I had made a few notes on the overnight flight from London, but when I looked at them later, the questions I had written seemed idiotic. The most idiotic of all was: "When did you start being afraid?"

It was the most obvious question, of course. Fear, open or concealed, affects everybody suffering from a fatal disease. You keep waiting for test results that can turn out to be a death sentence.

A young man who tested positive for HIV in Gothenburg at the end of the 1980s told me how the doctor who had to inform him of the positive result burst into tears. He was nineteen when he discovered that he was infected. Instead of trying to cope with his own fear, he found himself having to console the weeping doctor.

When did you start being afraid?

When had I been afraid?

During the night I spent on the flight from London to Entebbe, I thought a lot about the occasions in my life when I had been paralysed with fear. I could recall three situations in particular, one of them was when I was waiting for news from a doctor.

I was in Mozambique, it was autumn, the days were hot. I was working on the production of a play, but started to feel unwell. I suspected it was influenza, possibly malaria, or it could simply be exhaustion. As usual, I had been working far too long hours. The tiredness wouldn't go away. I dragged myself as far as my Renault 4 in the mornings and sat there, having long, silent conversations with myself before making up my mind to try to work one more day.

But then one morning, when I reached the theatre and had parked the car, I stayed behind the wheel. It was obvious that there was something badly wrong with me. I was seriously ill, something nasty had found its way into my body and was threatening my life. I drove home again, but stopped on the way to buy some food. As I went up the steps I bumped into Christer, a Swedish dentist and aid worker.

"You're completely yellow," he said.

I went to my doctor, who sent me to a clinic for tests, and I returned with liver readings that were nothing short of catastrophic. I was sent at once to South Africa. I remember nothing of the journey. But it was an aggressive form of jaundice. (I suspect it was caused by a dirty salad at a restaurant in Pemba in northern Mozambique.)

But it wasn't only jaundice. One morning a doctor came to see me. He was obese and was wearing a Jewish skull-cap. I remember my messengers over the years very clearly, all the people who have passed on to me vital information.

I did not know his name, but I remember there was sweat on his forehead as he told me, without beating about the bush, that they had found a patch in one of my lungs. It could be ominous. It would take several days for all the test results to come through. Then he went away. I don't think he had looked me in the eye once during the brief time he was in my room.

I remember the feeling of paralysis that gripped me. Panic was a sharp hook stabbing into my consciousness and immediately sending signals to all parts of my body. Fear makes itself felt in the stomach as well as in the brain. It was like a frantic telegram being rattled out by a machine inside me.

Lung cancer. I hadn't avoided it.

I smoked my first cigarette at Spencer's cafe in Borås, in Allégatan. It must have been one of the last days in August, 1963. I had just started secondary school. One of my classmates, a girl called Hedelin I think it was, offered me a cigarette. A Prince. I had never smoked before, apart from a couple of furtive puffs on stumps of cigars in Sveg. But now I felt obliged to accept the cigarette. From then on I was a smoker. Although I had long since stopped smoking by the time that Jewish doctor came into my room, all those packets of cigarettes had caught up with me. Followed me all the way down to southern Africa. I had stopped smoking too late. Lung cancer was going to kill me. I could envisage my lungs covered in lumps of tar. In desperation, trying as far as possible to keep the panic under control, I tried to convince myself that I might be able to live for a few more years. Not more than a few, probably, but long enough to have a chance of completing some of the things I had planned. Not ten books, but maybe two. And a play, if I really worked hard.

There followed a few days of extreme panic. I lay in my sickroom, sometimes listening to the sound of gunfire in the unsettled Johannesburg night; the fear came and went in waves. I don't recall ever starting to cry, though. I stopped short of that. It would be a defeat already if I went to pieces. In that case the illness would be let loose and finish me off immediately. I tried to imagine the number of days in which I would be able to lead a normal life in spite of everything. I tried to convince myself that the cancer had been discovered very early and hence I would have a considerable way to go before my last journey.

I lay awake at night, hoping the whole thing might be a mistake. A technical fault in the X-ray machine, a piece of dust on the plate.

One morning the obese doctor with the skull-cap came back. I gripped the bed frame tightly and prepared to listen to my death sentence. But he informed me that it was an accumulation of fluid in one of my lungs. Nothing dangerous, not cancer, nothing to worry about. Then he was gone.

I wonder what he knew about people's fear. Perhaps it was beneath his dignity to worry about such lowly human emotional reactions? I thought afterwards and I still feel that I hate that man for his inability to recognise my fear. But what about me? Do I see the fear of others when it ought to be obvious?

Both my other two moments of well-founded terror are associated with incidents in Africa. Late one night in Lusaka I was attacked as I parked the car outside the house where I lived. I was dragged out of the car by a man with blood-shot, drug-crazed eyes. He held a pistol to my head. I still don't know how long it was there. I have tried to reconstruct how long it would have taken the bandits to pull me from the car. Thirty seconds? More? Less? I don't know. But I was quite certain that I was about to die. Most often in Zambia in the 1980s the car hijackers did shoot. They had nothing to lose. If anyone used a gun in the course of a robbery, it was a hanging offence. And hanged they were. Absurdly enough, the hangman in Zambia was called White, as I recall it. Anyway, it was usual practice for the hijackers to shoot. I remember the cold terror, as if somebody was slowly filling my veins with liquid ice. I was sure that I was about to die, and that I didn't want to die in this stupid, barbaric way. Then the revolver was taken away, I was kicked to the ground, and as the car drove off with a racing start it came to me that I was still alive.

The third moment was the worst. It might seem exotic, almost comical, but it was the most dangerous thing to have happened to me in my life. (Nobody knows, of course, how close one might have been to a plane crash or a road accident.)

It was on one of the little tributaries of the River Kabompo in Zambia, still in the 1980s. There were several of us on a fishing trip. We cruised up the river, switched off the engine and started fishing as we drifted. We knew that there was a colony of hippos just past a point where the river split into two branches, some way downstream in the direction we were drifting towards. In good time before we reached there, we would start the engine again and turn off along the other branch. Hippos are extremely dangerous if they think their calves are under threat. And these hippos had young. Some distance before we reached the colony, one of us pulled at the cord to start the outboard motor. Nothing happened. At first there was no panic. The man in the stern kept pulling, adjusted the choke, tried again. No ignition. By now we could see the heads of the hippos. We didn't need to say anything, but we all knew that if the engine didn't start, we wouldn't stand a chance. The hippos would attack the boat, overturn it and then hack us to pieces with their enormous jaws. There would be no point in diving into the river and swimming for it. Not one of us would reach the bank – the river was teeming with crocodiles.

At the last possible moment the engine gave a cough and started. There must have been an angel in the carburettor.

What I remember now, so many years later, is the relief I felt as the boat moved away. We never referred to the incident afterwards. If I remember aright, we carried on fishing.

29

But there was also the time I took an HIV test. It was in the mid-1980s, when everybody still felt insecure. Despite all the assurances about how the virus was passed on, was there a possibility that it could infect people in some other way? Nobody could be certain, and opinions were divided on whether kisses could be infectious or not. In other words, there was a grey area around the assertion that HIV was a weak virus, could survive only for about twenty minutes at room temperature, and therefore that it was not so easy to become infected, one could avoid it by simple precautionary measures.

I took a test at the hospital in Ystad. The doctor asked me why I was doing this and I said I had no reason to believe that I had been infected, but that I was doing it "for safety's sake". He had no objection. I suspected that he had probably undergone tests himself, just "for safety's sake".

Afterwards, when I had had my blood sample taken and registered, when I was on my way home in the car, I suddenly felt scared. I was so shaken that I had to pull up. It was a wet day in the autumn. I got out of the car and felt quite certain that the result of the test would be positive. Nobody, least of all me, would ever be able to explain how it had happened. Perhaps I would be the first one to demonstrate that there really was a very large grey area blurring the convictions of medical science regarding how the disease was passed on.

The three days that followed were pure nightmare. Common sense told me that I had nothing to worry about. But I gave a start every time the telephone rang. I woke up each night and stared into the darkness.

The nurse duly phoned on the third day. A shiver ran down my spine when she said who she was. But, predictably, I was not summoned back to the hospital. She simply told me, with no appearance of feeling, that the test result was negative. I thanked her for informing me, perfectly calmly, with no trace of stress, and replaced the receiver.

Then I went out into the rain and fell to my knees in the mud. I stayed like that for a long time before going back indoors. My relief had been manically exaggerated. Not joy, just relief. I can still remember the mud sticking to my trouser legs.

I had been afraid for no reason. What must it be like for those who take the test and know that there really is a risk that he or she has been infected?

30

Moses was the only man with whom I had real conversations during my stay in Uganda. Beatrice, who worked with people with HIV, told me that men seldom write memory books. Nor were they so willing to talk about their fate, whereas women were always prepared to talk openly about their lives. But there were exceptions, and Moses was only one of many, even though for various reasons he was the only one I ended up talking to.

The last time I spoke to him somebody took a couple of photographs with a polaroid camera that I had with me. Moses and I are sitting on a couple of wooden stools in the shade of a tree. He kept one of the pictures, I kept the other. Whenever I look at it I wonder how he is, if he's still alive, if he's in pain. And I think that the picture shows him exactly as I remember him. A face radiating great dignity. A man who has accepted that life can suddenly change course, and nothing will ever be the same again.

Moses lived not far from Christine. He had a large family, several of his children had families of their own and some lived in the same house as he did. He sat in the shade, pointing out all his grandchildren and telling me their names, their ages; and he characterised their "lust for life" in various ways. One of them, a girl, delighted in kicking a home-made football around their yard. A boy, aged about ten, could climb any tree that stood in his path. He could climb as high as you like, as quick as a flash. That was the way he liked to characterise his grandchildren, and he would keep laughing out loud. But much of the time he was melancholy.

He had written about fifteen memory books, one for each of his children and some for the older ones among his grandchildren. He didn't tell me how he had caught the virus; but his two wives were dead, no doubt he had infected them, and they had both died before him. I thought several times that I ought to ask him. But I never managed to overcome my hesitation. And now it's too late.

I asked him about the memory books.

"Somebody told me about them. Beatrice. At first I thought they weren't for me, but I couldn't get them out of my mind. One day I went to that centre where people who have the disease can go for help and advice. I spoke to another man who was also ill. He showed me a memory book he had written for one of his daughters. That made me think I ought to do the same. Even if I'm not very good at writing. I thought I could tell the tale, and one of my grandchildren could write it down. All of them can read and write. So that's what I did."

We leafed through one of the memory books he'd written. All the text was in rounded, childish letters. Everything except his signature and an admonition to "always live honourably and work hard".

He noticed that I could see the text had been written by various hands.

"I thought that even handwriting is a memory of a person. My handwriting is poor, the letters jump all over the place, but it's my handwriting. When I'm gone, my grandchildren can remember that this is how their grandfather used to write."

Then he started talking about how the fatal disease that had taken possession of his body had crept up on him.

"It came in the night. Illness never strikes when the sun is shining. Diseases, especially those that are serious and kill or blind or deform people, always creep up on you during the night."

I asked him what he meant by that.

"The mosquitoes start whining at night. They only suck your blood from sundown until the sun starts rising again. Mosquitoes carry death, malaria. Snakes and predators also roam in the hours of darkness, even if we haven't had any lions or leopards in these parts for the last ten or even fifteen years. We are convinced that disease strikes you during the night."

"A bite in the neck from a leopard can hardly be called a disease!"

"Everything that kills, be it visible or invisible, is a disease as far as I'm concerned. I know that you Europeans talk about something you call 'death from natural causes'. For us Africans that is a very peculiar way of looking at what happens in the dark."

But then he suddenly seemed to have lost interest in discussing his view that the night is the realm of death and illness. Instead he started talking about when he first realised that there was a new disease that was dangerous and invisible.

He had just started talking when the heavens opened. We took cover and sat in a part of the large house that he had to himself. One of his daughters, Laurentina, was very fat but moved gracefully and quickly despite her huge body. When we came in, she disappeared behind a curtain made from cut-up, old skirts. It was dim inside the room. Moses sat down in a sagging armchair from which he could keep an eye on what was happening outside while he spoke.

He said: "I was still very young. It was 1974, the year before Amin came to power and ruined our country. My father used to go often to Kampala to buy cheap clothes with factory faults that he put right and then cycled round the villages and sold them. One day he came home and told us about one of the young men he used to do business with in the city: he was now ill. My father said he had grown very thin in a very short space of time. He had lost his appetite, the glands under his arms had swollen up and were very tender, and now he was getting sores all over his body. He had been to the doctor, who had been unable to tell him what he was suffering from, nor could he give him any effective medicine. My father was quite sure about what he was saying. He had a keen eye, a good memory, and he often was quite certain about things before anybody else realised that something had happened. That was exactly what he said: 'Something has happened'. His business contact, Lukas was his name, was suffering from a disease that my father was convinced was something quite new. 'It has crept up in the night,' my father said. Lukas died, and his two wives also fell ill and had the same mysterious sores and one after the other they too died. Every time my father came back from Kampala, he told us about other people who had died from this same disease. Soon, so many had fallen victim to the disease that everybody was talking about why people all of a sudden became very tired and very thin and then died. But nobody knew what it was. I think that was the situation until the 1980s – in any case Amin was no longer around when the disease was finally given a name and it was understood how the infection could be spread. I was no longer so young by then. My father lived to be very old, and of course he was not surprised to find that he had eventually been proved right. What his friend Lukas had died of was a new disease that had crept up on us during the night. He had noticed it before anybody else."

Moses fell silent. Then he shouted something to his daughter. She came in with a bottle of water and two glasses. Moses poured, and assured me that the water had been boiled.

"It is a terrible plague," he said after a while. "In the night, in the darkness, when men and women come together, the disease wanders from person to person. There have been other diseases in the past that have infected people in the same way. But nothing as dangerous as this, nothing as painful. I have seen how people suffer before they die. I have listened to people in houses a long way away from here, screaming in agony before everything goes quiet, and they fade away into the other darkness, the one that never quite dissipates when the sun rises again. The land of death is a land without sun, that is the nature of it and we are all frightened of being forced to go there before we have lived for so long that we don't really care any more. Now I have the disease myself, and every day I look for signs to show that I am on the way to being overcome by this thing inside me, and every time I think about that day my father came home and was worried as he told us about his friend Lukas."

Moses stared at his hands.

"I didn't want to write these memory books. Not for a very long time. It was as if the moment I picked up my pen or started telling my story for my grandchildren to write it down, I was giving up all hope of not having to die as a result of this disease. Obviously, I don't have any hope. Everybody who catches this disease dies of it. But deep down there is another kind of hope, something you have no control over. It's as if there is an unknown being inside my body that is hoping on my behalf. I don't know how to explain it any better than that. But once I'd started to write those books, it was as if I'd accepted the fact that I was going to die. I dreamt about my father the night before I started preparing to write the memory books. He was coming back from the city on foot, just as I remembered it as a child. He always walked quickly, carrying a bale of clothes on his head. Now he was old and didn't have anything on his head. The worst thing was that he didn't stop. He didn't turn off the road and come back here. He just kept on walking until I could no longer see him. When I woke up the next morning and remembered the dream, it seemed as if he had instructed me to accept my fate. That was the day I started preparing the books."

Moses had finished his tale, abruptly, as if he'd told me too big a secret. Then he said with a smile that he was tired, and needed to rest.

We said our goodbyes, and I left. I didn't know if I would ever meet him again.

31

Lots of people have jokes to tell about the Aids crisis on the African continent. Some even try to use various anecdotes in order to prove that the basic problem is the inability of Africans to take in information. Many ignore the fact that the real problem is illiteracy. Instead, these unpleasant joke-smiths conjure up an image of stupidity, a peculiar lack of intelligence when faced with facts and arguments. The stories and the conclusions are downright racist. The implication is that it is the natives' own fault that so many Africans are HIV-positive. They ought to know better than to indulge in extra-marital affairs or to lead polygamous lives. If they are infected, there is not much that can be done about it. Let them die.

This is not said in so many words, of course. But I have heard the joke, told by a Scandinavian aid worker, about the European nurse who travelled to a remote African village to address them on the subject of Aids. She talked about condoms. To demonstrate how they should be used she stuck up two fingers and slid the condom over them. Whereupon all the men present, according to the Scandinavian teller of the tale, went home and applied a condom to their fingers before mating with their wives.

It is easy to make fun, racist fun, of African people. But misunderstandings about safe sex are not a result of stupidity. They are a relic of the tradition and heritage that Europeans have forced upon Africa. They have to do with the only golden rule that mattered during the four centuries of colonialism. Europe said: don't think, do!

Unsurprisingly, this attitude lingers on. It is neither stupidity nor cowardice. It is a continuation of European pressure. Moreover, teaching people how to protect themselves is a very sensitive matter. In many African cultures you simply do not talk to strangers about your intimate sex life. It is completely inappropriate for a clumsy European to march up and gather villagers together, then make threatening gestures with his or her fingers and slide a condom over them. Being illiterate is not the same thing as being devoid of dignity.

I have met vast numbers of poor, ignorant Africans whose dignity far exceeds anything I have come across in the West. This is not a tendentious or far-fetched claim. Human dignity does not go arm in arm with material well-being or a high degree of knowledge. Human dignity is an automatic reaction in poor people who have understood why they are weighed down by poverty.

Informing people about how the infection is passed on is crucial, obviously, but the teaching has to be adapted to those who are to be taught. Those whose mission it is to impart this information must first learn to listen, and not seek to impose the solutions and rules of conduct that various Western experts and bureaucrats have decided are correct.

Thousands of people are dying of Aids today because of wrong, often downright arrogant methods of trying to make them realise how HIV is passed on. There is no doubt that one essential tool in the effort to reduce the rate of infection whether in young or rather older people would be the taking of steps to ensure that everybody has access to an ABC-book. For instance.

The statistics paint a complex picture, but they tell the same story. It is a lack of basic education that makes people more vulnerable to HIV infection.

32

There was one question which I put to everybody I talked to in Uganda. A question I had also asked people earlier in Mozambique, people suffering from full-blown Aids, or people who had just been infected and told that they were carrying HIV.

I asked them where they thought the virus had come from.

Replies varied. Astonishingly, many thought that it could very well be a disease the West had introduced secretly into Africa, and was making sure that it spread everywhere in order to reduce the number of poor people there. In other words, the disease was a subtle way of committing mass murder. The invisible gas chambers of a new age, a microscopic virus that could send people to their graves in a "natural" way. The people who believed this to be the origin of the HIV epidemic often replied very emphatically. They were absolutely convinced that the death they were facing had been deliberately planned. The whole of the West was made up of witches or medicine men bent on genocide.

There were some who introduced a religious dimension into their fate. Abandoned gods were spreading death and destruction all over an Africa that already seemed to be ripe for extinction. Famine, civil war, expanding deserts, malaria parasites and diarrhoea. And now Aids. There was a self-disgust about these people that doubled their suffering. They were often the ones who lived for the shortest time. Their immune system was unable to cope with the double pressure of the ravages caused by the virus, and their mental collapse.

These people gave the impression of using the virus as a means of committing suicide.

Most others knew nothing more than what the doctors had told them. A virus – whatever that is. Something that resulted from making love, from blood transfusions or from using dirty syringe needles.

Everybody seemed to agree that the suffering was hitting the African continent especially hard.

Christine said: "It's as if there's no end to it. I read about our continent. It is as if we Africans are concerned only with dying, not with living. But it's not like that, of course. Even if all these diseases hit us especially hard."

Of course there were many people who also maintained that the West was conspiring in some remarkable way with various gods. The overworld and the underworld had combined to destroy the African people with the help of this virus.

Christine again: "I've heard that some people think the disease originated in animals, especially the apes, and that we got the disease inside us when we ate meat from apes. But couldn't it just as well be that we have always carried the disease inside us? Maybe it has always been inside, us but it is only now that it has been given a name."

What did Moses think? He shrugged.

"Is it important? I can't tell you the answer, nobody can. Why should I spend my time worrying about that? My time is already limited. Death is wherever there is life. Death sometimes wears visible clothing, sometimes he makes himself invisible."

I spoke to everybody, including Gladys and Beatrice. The answers varied, but were always evasive.

33

In the end I spoke to Aida as well. We were in among the banana trees, but not to look at her mango plant: we were trying to find one of the black piglets that had decided to run away. Aida found it and pounced on it before it had a chance to escape her grasp. We carried it back to the pen. Then Aida went to wash her hands.

It was she who asked the question: "Where does it come from, this disease that Mum has?"

"I don't know. Different people think different things. But it's a virus, a so-called micro-organism."

"Why is it only people here who get it?"

"It isn't only here. People get infected just the same in the country I come from."

Aida thought about that.

"Where did it start? In your country or here in ours?"

"Probably here, but nobody knows for certain."

Aida seemed depressed. We walked back to the houses and the courtyard where a cockerel with an injured leg was limping about.

"I think the disease comes from somebody who wants to harm us," Aida suddenly said.

"Who would that be?"

"I don't know."

"Diseases don't come from 'somebody'. Diseases are there all the time. They develop and change. Eventually people start to die of them. It has always been like that."

Aida said nothing more. As we walked towards the raffia mat where Christine sat cleaning a wound on Aida's youngest sister's foot, she aimed a kick at the cockerel who fluttered away, cackling angrily.

Aida could get at the cockerel, but not at the 'somebody' she thought had inflicted the disease on her mother.

But I can't be certain what Aida believed or didn't believe.

34

There are many fallacies about Aids. Not least with regard to what happens in the critical stages that lead to death, what is known as "full-blown" Aids. One of the fallacies is that the really horrific aspect of the disease is the way it strikes in haphazard fashion, and often affects very young people. What creates angst in a person is the psychological torment of knowing that you are going to die early from a disease that you could have avoided. The physical symptoms, as the disease takes hold, are that you lose a lot of weight, grow very tired, might have a lot of sores, and then die of something like pneumonia when your immune system can no longer cope. There is rarely any mention of the fact that Aids can lead to a mental deterioration that causes suffering worse than practically anything else.

The people I spoke to in Uganda seemed to be aware of this, however. They didn't hide behind fallacies even if the illusion might have been a temporary consolation. It seemed to me that Moses, Christine, Gladys and all the rest approached what was in store for them with their eyes wide open. It was a duel they had already lost. Once again it was that dignity that I couldn't help but notice everywhere, and that I think of now above all else as I write these words. The dignity that was so important to all those who had been infected with the disease.

On one occasion we met, I told Christine a story. It was about something I experienced in the early 1990s in northern Mozambique. A few days later when I went back to her house, she asked me to tell her the story again. This time Aida was there too.

It was a story about dignity.

During the long and difficult civil war that ravaged Mozambique – from the early 1980s until 1992 – I made a journey to the Cabo Delgado province in the north. One day in November 1990, I was in a place just south of the border with Tanzania. The area had been badly affected by the war. Many people had been killed or crippled, and starvation was widespread since most of the crops had been burnt. It was like entering an Inferno where misery rose like smoke all along the dusty roads.

One day I took a path that led to a tiny village. A young man came walking towards me. It seemed as if he was walking out of the sun. His clothes were in tatters. He could have been nineteen, maybe twenty. When he came closer, I noticed his feet. I saw something I shall never forget as long as I live. I can see it before my very eyes as I am telling this tale now. Rarely does a day pass when I don't think about this boy who was coming towards me as if from out of the sun. What did I see? His feet. He had painted shoes on to his feet. He had mixed paint from the soil and preserved his dignity for as long as possible. He had no boots, no shoes, nothing, not even a pair of sandals made from the remains of a car tyre. As he had no shoes, he had to make some himself, so he painted a pair of shoes on to his feet, and in doing so he boosted his awareness that, despite all his misery and destitution, he was a human being with dignity.

I thought at the time and I still think now that of all the strangers I have met in my life, this meeting may have been the most important of all. For what he told me with his feet was that human dignity can be preserved and maintained when all else seems lost. I learned that we should all be aware that there could come a day when we too will have to paint shoes on to our feet. And when that day comes, it is important that we know that we possess that ability. I don't know what his name was. He couldn't speak Portuguese and I didn't understand his language. I have often wondered what became of him. He is most probably dead, though I have no way of knowing for sure. But the image of his feet will always be with me.

It was like telling a fairy story, I thought. But Christine knew it was true. She turned to Aida.

"Do you understand what he is talking about?" she asked.

Aida nodded. But she didn't say anything. And Christine didn't push her to provide an answer, like the sensible mother she was.

35

I've seen it once. A person's face just after being told that she has tested positive. But I didn't see it just in her face. The pain and the shock was all over her body. Her feet were screaming, her arms were flailing desperately so as not to go berserk, despite the fact that they were hanging down by her sides.

It was a woman, and she can't have been more than twenty. It was in Maputo, in a private clinic of the simpler kind. I was there to check my blood pressure. I waited outside the closed door to the doctor's consulting room. It opened and the woman emerged. I knew immediately even though I didn't know: this young African woman had just been told that she was HIV-positive. She was just setting out on life, but had found that her time had been brutally cut short. Her life was coming to an end almost before it had started.

She walked away down the corridor. When they measured my blood pressure it was extremely high. The doctor frowned. But I told him it was only temporary. Something had happened shortly before I entered his room that had forced up my blood pressure. Now it was on its way down again.

I keep some people very close at hand, easily accessible in my memory. Aida is one, that nameless woman is another. I wonder very often what became of her, whether she is still alive.

36

There was once a famous library in Alexandria. It contained the sum of human wisdom, or as much of it as was recorded, on its shelves. Then it burnt down. Now, a few months before I go to Uganda, I pay a visit to the newly opened library in Alexandria. Architecturally, it is a remarkable creation. More of a cultural centre than a straightforward library. At the time of my visit an Austrian symphony orchestra is rehearsing in one of the halls.

While I am in Uganda it occurs to me that if all the memory books that are now being written could be gathered together, they might fill the library in Alexandria. There are so many memories to be written down, so many million little books will be left behind after the people who will shortly die from Aids. The vast majority of these millions of people will die too young. Most of their lives will be cut unjustly short. Many of their children, who are going to receive these books and are the reason why they are being written, will have been made homeless and will end up wandering aimlessly from continent to continent.

Then I have a vision: empty, abandoned libraries, and the great collections of books find themselves with no readers.

It is not a totally outrageous thought. Many a plot could be composed that would be just the thing for a science-fiction movie. There is already research which predicts that certain countries or regions in Africa south of the Sahara will be ruined if Aids continues to spread at the rate it is today. What they say should be taken seriously. The social fabric will be altered. A large percentage of the workforce will be wiped out, making society increasingly dependent on child labour. To make things yet worse, the whole existing intellectual heritage will be in danger of dying out because young people who are infected will not be able to raise the motivation for studies.

Wilderness, child labour, silence. Many people refuse to believe that this could happen. Or at least, think it is a threat that won't concern us for a very long time to come. But it takes only about nine hours to fly from the heart of Europe to the heart of Africa. In other words, a good night's sleep or a somewhat extended working day, and you are in the centre of what is threatening to become a wasteland, a return to the most primitive circumstances for work and property.

Some are already commenting on this in their memory books. There are people who are about to die, but who do nevertheless try to see into the future. They can comprehend the consequences of their own death, magnified and on a global scale. If there is one thing that is certain when it comes to Aids in Africa, it is that you will not die alone. Also it is true that your death will have very far-reaching consequences.

I read about this in several of the memory books. The fear of impoverishment, the fear that children will be left to their own devices, the fear that all knowledge will be forgotten, rot away like the dead body of a human being.

Aids has to do with many kinds of death. Hence also with many kinds of life. Obviously, life can be assessed and interpreted in the number of books that are written and the books that are read.

In 1343, Petrarch found a voluminous manuscript in Verona containing Cicero 's letters to his son Atticus: for many years the boy was an idle and unenthusiastic student in Athens. Those letters had been lost since Cicero 's time, since the beginning of our chronology. After thirteen hundred years they suddenly reappeared.

Is this what will happen to all the memory books that are being written today? It seems hardly credible that in our day and age it would be possible to bury the written word in archives, even as we bury nuclear waste in caverns deep inside mountains. But you never know.

There was once a great library in Alexandria. It contained all of human knowledge until it burnt down. Now it has been rebuilt.

Perhaps that library ought to be a centre for all the memory books that are being written today. Perhaps at least copies ought to be kept there, for the future.

37

In the diary I kept during my visit to Uganda there is a stray sentence scribbled down on the inside back cover.

The pain can be seen in their smiles.

Strangely enough, I have to admit that I can't remember when I wrote that. Who had I met? Whose smiles was I referring to? It seems to me odd that I can't remember. I would hardly have made a note like that without good reason.

I scour my memory, but I cannot find the occasion or the cause.

How can I remember a smile without remembering the face?

38

It wasn't until my last visit to Gladys that I realised that there was a link between her and Christine which I had not known about. Gladys told me when I first visited her that when she heard she had tested HIV-positive, she sat down and stayed sitting down for several years, doing nothing, only waiting to die. On that occasion, I overlooked the obvious question: what shook you out of that apathy?

It was Christine who persuaded her to abandon her apathetic wait for death.

Gladys and Christine knew each other only slightly, but Christine had heard that Gladys was sitting in her dark room as if paralysed. She never went out, hardly spoke to her children. She just sat there motionless, waiting for the cold breeze on the back of her neck.

One day Christine went to see her. She knocked on the open door and went in. Gladys' house has three rooms. In the first one, which was used as the best room, there were two armchairs with white embroidered throws over their backs. It was in one of those chairs that Gladys was waiting for death to call. She had been sitting there for more than three years. Every morning was a long wait for the evening. A wait for death. Christine entered the room and sat down in the other chair. She began by telling Gladys that she too was HIV-positive, but that she was unwilling to sit down and wait to die. Gladys didn't say much, so Christine talked all the more. She spoke about all Gladys' children, and her own children. Christine said that between them, they had a responsibility for seventeen children. They simply had to live for as long as possible, and never forget that despite everything, there could always be room for a smile on their faces. They had no right to sit down and wait for death. He would call when the time came, in any case.

Christine kept going back, day after day. I don't know how long she spent trying to persuade Gladys, but the fact is that one day, Gladys left her chair and abandoned her unending wait for night to fall. Christine had succeeded. I asked Gladys what would have happened if Christine hadn't knocked on her door.

"I'd have still been sitting there, waiting to die."

And Christine?

"I knew that Gladys had many children. I heard that she was just sitting there in the darkness. I couldn't bear the thought of that. I thought that I might be able to talk her into making an effort to live longer."

Gladys also said: "I feel infinitely grateful to Christine. But for her, I'd have withered away. When she first came, I didn't want to listen to her. But she wouldn't give up. I thank her for that every morning when I wake up."

And Christine?

"I don't think I did anything out of the ordinary. It was just that I couldn't bear to walk past her house knowing that she was there, inside in the darkness, doing nothing, with no will to live. That was all. Nothing else."

39

In all I read some thirty memory books while I was in Uganda. Not all of them were complete, some had been interrupted by the death of the author and would never be more than fragments of stories. Some were written by people no longer with us, others had authors who were still alive.

Some were brief, laconic. That could be due to the style or the contents. There were some authors who knew practically nothing about their own ancestors, about the earlier generations of their families. They had left the "my family" pages blank. Other authors seemed to be overwhelmed by the feeling that they had "nothing to say". They thought they led humdrum lives. It had never occurred to them that they would leave any impression behind them apart from the houses they had built, the land they had cultivated, the children they had had. But even if some of the documents were thin, all of them were full of life, and often extremely expressive. Everything in them, whether written, drawn, pressed in the form of flowers or butterflies – everything was about life and death. Literally.

Most moving, of course, were the memory books written by sick parents of children who were still very small, in many cases infants. They would inherit these slim little books without having any memories whatsoever of the parent who had written this last will and testament bequeathing no money, no property. Nothing but a memory.

There were also memory books written by two parents together. They might not be married, but they have children together. Infidelity is a vague concept in cultures where polygamy has to do with traditions rather than a matter of morality. The infected parents sit together and write these memory books.

These suffering couples. It was as if they were sitting side by side, asking: Who are you? Who am I? Who are we? And so their memory books were created.

Needless to say, I also saw unwritten memory books. The pages remained blank. Not because the people concerned had no memories. Not because they had no desire, no intention of writing. They were blank memory books that bore witness to the overwhelming angst that induces paralysis in the face of disease, pain and death.

These empty memory books were almost always symptomatic of people who didn't dare start to write, as that was tantamount to accepting that death really was close at hand.

It is with Aids as it is with all other chronic diseases. Many of those infected will refuse to accept that they are ill until the bitter end. It starts much earlier, of course. When many people refuse to undergo tests. Some fall ill and will die with every symptom you can think of. But they insist that they are suffering from something else.

This disease is shameful, burdened with guilt. Whole villages, whole generations are riddled with guilt and shame in the shadow of Aids. Not everybody is affected in this way, not people like Gladys, Christine or Moses. But far too many are.

All those who refuse to accept that they are ill believe that they alone will survive. At least, as long as they refuse to start recording their memories in little exercise books made up of a few pages of grey paper.

40

One day my stay in Uganda comes to an end. In the evening I drive from Kampala to the airport in Entebbe. There is traffic chaos as usual, with frequent gridlocks: cars, overcrowded buses, lorries with lefhally packed loads. The only ones who get to where they want to go are those on cycles or mopeds, or on foot. It is Saturday evening, the jams are especially chronic. But eventually traffic starts moving again, and we get to the airport in time. The flight departs late at night and I head for Europe, and before long I shall be dreaming about the people in the coniferous forest.

Those faces projecting from the tree trunks, their frozen faces, their wordless horror. The coniferous forest crammed with the dying, and the already dead.

I must be honest. It was a relief to get away. So much death and suffering in a few intensive weeks is more than enough. I shall never forget the people I met. Nor shall I ever cease to be angry over the fact that so much of this suffering is unnecessary.

Christine again: the medication she needed cost twice her monthly wage as a teacher. She earned the equivalent of US$55 a month (£30). The drugs, in their simplest form, cost US$110. Approximately US$1300 (£720) per year. That's US$1300 for Christine, US$1300 for Moses, and another US$1300 for Gladys.

But they shouldn't really need to pay anything at all. When the history of this epidemic is eventually written, a chapter will be devoted to the gigantic pharmaceutical monopolies and the actions of their shareholders and executive boards during the years when Aids ravaged the world. No courts will be able to bring the owners of those companies to justice.

But the greed and inhumanity tells the story of our age. What we allowed to happen. We will never know how many people died before the drugs companies permitted or were forced to permit medicines to be manufactured in places and at prices that made the drugs accessible to the poorest people of the world.

The scale of this crisis is unique. The greed today concerning drug licensing, the ruthless exploitation of the weak economies, the increasing but nevertheless inadequate resources made available to combat Aids are another scandal. No wonder many Africans believe that the West has no objection to large numbers of poverty-stricken Africans being killed off so as to "ease the burden".

I think about this as I fly to London. It strikes me that these giant aircraft travelling through the night skies are the modern equivalent of sailing ships. In olden days they would ply the seas to Africa at a stately pace.

Nowadays, everything goes much faster. But the distances are no shorter. They are still vast. They are kept vast. They are not distances to be bridged. They are chasms to be left in place. Or patrolled.

The truth about Aids is of course a general truth about what the world is like today. In other words: what we allow the world to look like.

41

It is like one of those awful, cruel fairy tales by Hans Christian Andersen or the brothers Grimm. It deals with one of the most frequently recurring themes in literature. The possible variations are limitless. Two people, brother and sister, brother and brother, twins, or two people not known to each other at all, are born at the same time. If they are twins, they might become separated only to meet again later without knowing who the other is. As I say, there are endless variations.

Here is one: in November 1989 a good friend of mine, a stage designer, was told that he was HIV-positive. When his male partner underwent tests and was found also to be infected, they were soon able to work out what had happened. They were frank with each other and with their friends. The stage designer's partner had visited New York in the spring of 1988. He had been careless one night and invited a man he'd met in a bar to his hotel room. There was no other possible source of infection. A one-night stand, death the outcome. Despite the fact that one of them was clearly guilty of making them both carriers of the disease, they never – as far as I know – uttered a single angry word to each other. They both knew the risks. One of them had taken a chance. At that time, in the late 1980s, there were no ARVs. There was no hope at all, in fact. Death would ensue. Soon.

They began to make preparations. Or rather: they decided to live life to the full, to do everything they had planned to do, to cut out everything that was unnecessary. They moved from the town where they lived, settled in the country, and lived a quiet but intense life. I don't know much about their nights and their dawns: they must have been suffused with fear. Then they died, one of them in 1996, the other a year later.

A few years earlier, a woman friend of mine in Mozambique told me that she had Aids. Well, she didn't actually tell me at first, but I had started to suspect as much when she suddenly started losing weight, acquired a nasty cough, and lost a lot of her good humour. We knew each other well enough for me to ask her outright: had she tested positive? She confirmed my suspicions. When we went on to talk about it, she admitted that she had started living on borrowed time. She learned for certain that she had the disease in the spring of 1988.

She didn't last long after she told me that she was ill. Although I was able to help her financially, the resources available in Mozambique were inadequate to ease her suffering. Her death was dreadful. Unlike the friends I had in Sweden who were able to die without needless pain, one of them in an ordinary hospital, the other in a hospice.

All three died on the wrong side of the border, as it were. Before this happened, there were virtually no ARVs: afterwards, the new medication could give hope to the sufferers. The researchers and doctors had almost reached the first of the finishing lines. Only a year or so later it began to be possible, in the West, to slow down the progress of the disease. Nowadays, people with Aids live comparatively normal lives. A lot manage to die of other illnesses, or simply of old age.

But this development would have made a difference only to my two Swedish friends who died. The ARVs would not have been available to my friend in Mozambique. At least, not unless I had paid for them.

That makes me angry. A desire to overturn the injustice must survive the death of its victims.

42

In the early 1990s, at the theatre where I work in Maputo, we staged a production of We Can't Pay? We Won't Pay!, a play by Dario Fo that has been performed successfully all over the world. In it, a coffin is used to smuggle sacks of flour past a number of watchful police officers. The old carpenter, Mestre Afonse, made the coffin we used from thin plywood. Heaven alone knows where he managed to find this relatively rare but very useful material in Maputo. Anyway, we performed the play many times and then put the production in mothballs as we intended to include it in the repertoire at some future date.

And that is precisely what we did. Two years after the premiere our theatre manager, Manuela Soeiro, decided that it was time to give the Fo play another run of about a month. He spoke to me and we arranged times for rehearsals and reallocated one of the parts, since one of the actresses was much too pregnant to manage her part.

The day before we were due to rehearse the scene which involved the coffin I was approached by Alfredo, the stage manager, who asked for a word in private. He was very worried, and stared at his feet. I had great difficulty making out what he was muttering. In the end, the penny dropped.

"Are you saying that the coffin has disappeared?"

"Disappeared."

"How is that possible? It was agreed from the word go that this production would have a second run."

Alfredo stammered and mumbled away. I started getting impatient.

"For Christ's sake, that coffin can't simply have disappeared, can it?"

"It has been used."

"Used? What do you mean, used? What for?"

"For a funeral."

I stared at Alfredo for quite a while. Then we sat down in the front row of the stalls. I asked him to tell me the full story. A girl who used occasionally to hang around outside the theatre had died. She was seventeen or so and used to beg for food. She had died of Aids, Alfredo knew that for sure. He also assured me that although the girl probably worked as a prostitute, none of the theatre workers had been with her in that capacity.

But it was all to do with the burial. The girl did not have any relatives. She had run the risk of being tipped into one of the paupers' graves in the city. They were filled once a week with dead bodies. Then the stage technicians at the theatre had remembered the coffin that had been used in the Dario Fo play. It might only be a stage prop, a cheap plywood box, but it was better than nothing. So the coffin had been retrieved from the stores and the girl had been buried in a dignified way, though her coffin was only a prop from a play written by an Italian master of farce.

When Alfredo had finished his story, we sat there for ages, neither of us saying a word. I felt sick. It was as if reality had placed its heavy, gnarled hand over the theatre.

But the queasiness passed. I told Alfredo that I thought they had done the right thing. No doubt it would be possible to build another coffin.

"Mestre Afonse says he has no more plywood."

"Then he'll have to use something else."

"He has only solid wooden planks."

"Then he'll have to use those."

"They are thick planks. The coffin will be very heavy."

"Then the actors who carry the coffin will have to get used to that."

About a year later, Alfredo and I were both present at a burial service in the big cemetery outside Maputo, by the side of the road leading to Xai-Xai. Afterwards, as we were walking towards the gate, Alfredo pointed towards a corner of the cemetery. There were several mounds with no crosses.

I understood without him needing to say anything.

That was where she was buried, in a stage coffin made of plywood which had been used in a theatre production.

I've often thought that I ought to write to Dario Fo and tell him this story. I'm sure he would have liked it. I'm certain he would have been moved.

43

It is impossible of course not to feel angry about the Aids epidemic that is ravaging our world. The number of unrecorded cases is astronomical and terrifying. For the majority of those affected, death is inevitable. Only a limited number of those with the disease have access to effective ARVs and the full resources that can more or less control the virus.

The virus can infect anybody at all who is careless, unaware or irresponsible. But depending on where you were born or who your parents were, the implications are different. The virus will also infect those who, through poverty, are forced into situations where they are exposed to it. This in itself is enough to arouse and justify anger. This is what our world is like, a twilight zone for poor people in the so-called developing countries. At the same time it is an illusory paradise for those who live in the rich ghettos surrounded by palisades that are growing higher and higher. Death has become an economic question. Solidarity with our fellow men and women is being made more and more difficult.

A growing number of people are forced to accept that their lives are going to be unexpectedly short. They will not be able to watch their children grow up, grow to be in a position to look after themselves. That is why they write their memory books, so that they do not completely disappear from the memories of their children.

In the midst of all this I see Aida and her mango plant. I never saw any trace of her anger, but I am convinced that it exists. Why should her mother have to die when she herself is still so young? Why should Aida have to shoulder responsibilities that are much too great for her to bear? She finds herself in a situation in which she has no choice. The only thing she can do is to protest, and she does that by tending her mango plant, watching it live even as she herself is surrounded by death and more death.

This is the point of what I am writing. We must hope that Aida will not need to write a memory book about her own life for her own children. She is aware that the disease exists, she knows how she can avoid catching it, and she will make demands of the man she meets one day.

Memory Books are important for Aida's sake.

It will be best if her own is never written.

44

What did Aida say when she took me to see the mango plant that she had hidden among the banana trees? As she was very shy, she didn't say much at all.

I think she felt an affinity with that plant. It was young, as she was. I think she wanted to show that she was able to nurture a piece of life, to make something grow and survive; that she had drawn up her own line of defence, there in among the banana trees. Surrounded by death and fear she had planted her little tree as a protection for the living, for things that grow.

But I do remember one thing we spoke about. What mangoes taste like. We were in complete agreement: if you eat one mango, you want to eat another one. Mangoes always make you want more. I asked her how long it would be before her plant was big enough to bear fruit. She didn't know, but she promised to write and tell me.

Now, several months after I met her, as I am writing this, I can't help but think about her name. Aida. One letter makes it different from the name of the disease. Just as one hair's breadth separates life and death.

45

I shall end as I began. One night in June, in 2003, I dream about dead people in a coniferous forest. Everything in the dream is very clear. The smell of moss, the steam rising after autumn rain. Fungi around the roots of the trees, unseen birds taking off from branches that are still shaking. The faces of the dead are inlaid in the tree trunks. It is like wandering through a gallery with an exhibition of unfinished wooden sculptures. Or a studio that has been hurriedly abandoned by the artist.

The faces are contorted. No cries come from their half-open mouths, only silence.

In many ways the dream fills me with unanswered questions. But I know the important thing is that death has a name: Aids.

If I look carefully enough, at the periphery of the dream, I can see a young and still very fragile mango plant, hidden under layers of twigs that protect it.

And close by, a half-rotted plywood coffin that once was used on a theatre stage, but then was spirited out into dark and horrific reality.

We are the ones who decide, nobody else. About what will happen in the trial of strength between the mango plant and the coffin of rotting, black-painted plywood.

Nothing is inevitable.

Nor is anything too late.

Afterword

The people I have written about here exist in the real world. But their words are not only theirs, the words are also mine. What I have written is a record of what I heard them say and to an equal extent my interpretation of what they didn't say out loud.

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

Twenty Years of Denial

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.

I met Bohmwick ten years later. We had both left the Red Cross by then. I asked him if he remembered our conversation from 1987. He smiled in embarrassment and admitted that he had made an error of judgment. Today, it is estimated that India has nearly five million citizens who have tested positive for HIV. The infection is spreading rapidly, especially in the big cities. It transpires that Hindu men in general visit prostitutes at least as frequently as men in Europe and the USA.

The HIV epidemic has also reached China. For a long time the authorities refused to acknowledge the problem, but in recent years they have turned officially to WHO and UNAIDS for help. What is extremely tragic in the case of China is that a lot of the spread of the infection is due to flagrant negligence in the health service. Hundreds of thousands of poor people in rural areas were infected when they gave blood. Just as in India, promiscuity is relatively widespread, and in the longer term an extremely serious situation is in prospect.

What is now happening in India and China is very ominous. If the epidemic develops in a similar way to what we have seen in many African countries – and the risk of this cannot be ruled out – it would mean that several hundred millions of Indians and Chinese would be affected. The human catastrophe would be scarcely imaginable in its proportions. It would also have a very serious detrimental effect on the economy of the two countries, and hence also on the world economy in general.

Another region where the disease is spreading rapidly at the moment is eastern Europe. Authorities there are also very badly prepared when it comes to prevention programmes and direct nursing care for the afflicted.

The HIV epidemic is a security problem

During the first decades of the epidemic it was considered to be primarily a health problem in most countries. International meetings to discuss the implications were organised by WHO in the early days, and thereafter by UNAIDS. Those who attended were mainly health ministers and their colleagues. There was nothing wrong with that, of course, but as the epidemic spread it became obvious that more was being affected than merely health. For a number of countries in Africa, what is at stake is their survival as a nation. Decades of development aid are at risk. Whole sectors, such as agriculture and education, are facing more or less total collapse in some countries.

For Africa as a region, the epidemic is also a security problem. How will certain countries be able to function, how will law and order be maintained, if the disease is not brought under control in the near future? This was the theme of a conference organised by the UN Security Council a few years ago. The initiator was the then American Ambassador to the UN, Richard Holbroke. As far as I am aware, it was the first time the Security Council had taken up a theme of this kind for detailed analysis.

We shall be condemned by future generations if this kind of passivity is allowed to continue.

With hindsight it is relatively easy to say what ought to have been done in the way of preventative measures at the end of the 1980s. There was already enough knowledge and experience to organise an effective prevention programme, but this experience did not lead to the action we now know should have been taken. Governments ducked the issue and the international community failed.

A few countries have managed to buck the trend. This is true of Uganda and Senegal in Africa. It also applies to Thailand, and to some extent Brazil. The common denominator in these countries is very active government involvement. President Museveni has played a pivotal role in Uganda. All taboos have been stood on end. Ministers and other opinion formers have actively and systematically preached "safe sex". The distribution of condoms was a matter of course. But serious attention has also been paid to questions of abstinence before marriage and faithfulness within a relationship. These countries could serve as models for others.

There is no contradiction when it comes to putting resources into prevention, and also providing support and assistance to people who have already been infected and/or fallen ill. Prevention and nursing care must go hand in hand. What is the point of undergoing tests if there is no care available if you turn out to be carrying the virus? In this respect an individual firm can play an important part. Many companies, especially in South Africa, have become actively involved in preventative work and also help to pay for and distribute ARVs among their employees.

What we must now work to achieve is co-operation between all countries of the world in a long-term and systematic campaign to slow down and eventually stop the advance of the HIV epidemic. We must not allow the worst-case scenario to become reality, and must prevent the epidemic continuing to spread for another 60 years.

What is needed first and foremost is total frankness about the disease and the ways in which it is passed on. A stop must be put to all those who continue to agitate against sex education and the use of condoms, and who think, like some parts of the Bush administration, that the disease can be controlled simply by preaching sexual abstinence.

Just as important is to mobilise sufficient funds to pay for preventative measures and the care of those who have the disease. We have a special responsibility for the welfare of the millions of orphans that the epidemic has already left in its wake.

We must think big. Even if the USA and the EU have increased their contributions significantly, it is not nearly enough. We must work towards a tripling or quadrupling of the current levels of funding. At the same time the countries at the receiving end must revise their budget priorities and make health care their number one concern.

Special efforts must be made in funding research to produce a vaccine, and to develop better and cheaper drugs. In this respect the US government has a major responsibility. Hitherto it has turned a blind eye to the activities of the giant pharmaceutical companies instead of making clear the self-evident fact that drugs must be distributed at the lowest possible prices in the poorest countries, and that the only alternative is the imposition of a compulsory licence for countries where Aids is widespread.

Finally, it is important to do everything possible to prevent the spread of the epidemic in countries like China and India. It is estimated that so far only 0.5 per cent of their population has been infected. It should still be possible to prevent a catastrophe of the kind that has befallen a large number of African countries. In order to achieve this, everything possible must be set in motion now. In a few years it will be too late.

Anders Wijkman, 2003

Member of the European Parliament,

formerly Assistant Secretary General of the UN,

member of the board of Plan Sweden

Life in the Time of HIV

"Through my photos, I wanted to make people more aware of Aids, to show the consequences of the disease and to give advice. But I also wanted to demonstrate the hope that I still have in life, despite my illness"

Julie, former photographer

Fondation Femme Plus, Democratic Republic of Congo

In 2000, Christian Aid, one of the UK's leading aid and development agencies, gave cameras and photographic training to HIV-positive women working with the Kinshasa-based women's organisation Fondation Femme Plus so that they could record images from their own lives – create their own testimony of life in the time of HIV.

Fifteen women documented their day-to-day lives with families and friends, and doctors and hospitals, and their vision of the social tragedy caused by HIV. The result, the exhibition Positive Negatives, which opened in London and Kinshasa before touring the UK and Ireland, was a unique and powerful record for their children and future generations.

Julie, who was once married, lived for a time on the streets of Kinshasa and later in churches after her husband and baby daughter died and she discovered that she was HIV-positive. Like many other women, she was ostracised and faced a life of destitution.

She began to work in the restaurant run by Fondation Femme Plus, a women's group founded in 1994, and visited the centre where FFP's 1200 members gather for social support, training and financial help. She was selected to join the small group of women being trained to use a camera. As a photographer, her images, like those of the other women, show a sometimes shocking and harsh reality. All the images are a powerful record for the women's families of their own feelings about living with HIV.

"Now I know how to take photos and I know how to describe the meaning behind a photograph," said Marie-Jeanne, another photographer. "Through the photos, we have shown different ways in which people suffer with HIV/Aids such as the thinness. We have also shown how women cope. I feel proud of what I've achieved. I've done something that I never thought I could do."

Several of the women photographers are still working, appearing at government functions in Kinshasa to be the official "snappers". Others are no longer alive. But they have left behind a memory – images – of their lives with HIV.

Some of the women made up family albums of photographs for their children. One of the captions from Julie, who has since passed away, reads: "The photograph was taken for a family album, which will be passed on to my children as a lasting reminder of my life."

Memories

It is this sort of work that is an increasingly powerful element of support for people who are dying and for their surviving family members, especially children, "Memory work" since the early 1990s has evolved as a vital element for people living with HIV and Aids.

The long interval between infection and becoming ill and then dying that is experienced by many people gives them time to contemplate their last months or years, answer their children's questions about their illness, and make plans for their children and other dependants.

"I miss my mother's smile"

Many young orphans are sent to live with distant relatives, foster parents, in institutions or on their own, and the risk of losing their personal history is high. These children often grow up without a clear sense of their identity, their family traditions or their roots. The sense of loss is enormous.

"I miss most of all the good times with my mother, laughing with her," remembered nine-year-old Emmanuel Kalunga, speaking to Christian Aid in his grandmother's home. "I miss my mother's smile most of all."

Memory work encourages a process of reflection and discussion that allows people living with HIV to come to terms with the practical and emotional implications of their illness. It can motivate parents to acquire the knowledge and skills to make their children's futures secure, and it provides the opportunity for dialogue and a resolution to difficult topics about guardianship and inheritance with both extended family members and children.

For children uncertain of their future without parents, memories – in the form of a book or an image – can provide a basis for a more secure future.

Memory work can give children a link to their past and help them to build a "portable" identity, understand the loss of their loved ones and develop more self-confidence, resilience and hope for the future. Memory books, boxes and baskets have been created to provide a place for the tangible pieces of a person's life. Through the collection and discussion of the stories, photos, drawings, souvenirs, body maps, family trees and other mementoes, these memory stores help families address and cope with disease, death and grief, document prematurely shortened family life, plan for children's futures, and reduce the fear that many children have as they consider life without their parents.

The increased availability of drugs, and the resultant prolonging of life, may reduce the urgency of memory work as death ceases to be the most pressing concern of people living with HIV. But work with memories will undoubtedly remain a unique way of confronting difficult issues and creating links with the past for children living in uncertain times.

Today's emergency

Today there are more than 40 million people living with HIV. In 2003, an estimated five million people became infected. Three million people died. These days, 95 per cent of people living with HIV live in developing countries. Almost three-quarters of them live in Africa.

HIV is often linked to poverty. It is a vicious circle: poor people are often more vulnerable to HIV; HIV makes formerly productive individuals and families poor. On a national scale, HIV has a devastating effect on the economies of highly affected countries. By the end of 2004, it is estimated, HIV will cut GDP by a quarter in many southern African countries.

The recent food crisis in sub-Saharan Africa was due in part to HIV. HIV has eroded agricultural productivity as men and women of working age die. People who are living with HIV are also more vulnerable during food shortages. James Morris, executive director of the UN World Food Programme, summarised the situation: "The issue of HIV/Aids is so overwhelming that it will change this part of the world [sub-Saharan Africa] for a long time to come – its impact on women and children; its impact on the labour force, on the local public and private economies. The Aids crisis in Africa will ultimately have more impact on food supplies than recurrent droughts."

The effect of HIV does not stop there. School enrolment is falling in many parts of Africa. In Swaziland, the number of children in school has fallen by a fifth. Girls, in particular, are more likely to be deprived of education as they are taken out of school to earn money or to care for sick parents and relatives.

All walks of life

HIV affects everybody, in every walk of life. Deaths among educated groups of people – teachers, health workers, key community members including priests – have led to a huge skills shortage. In Zambia and Malawi health workers have suffered a five- to six-fold increase in illness and death. The deaths of so many health professionals add to the difficulty of delivering health care in an already overburdened system.

The widespread effects of HIV are not confined to Africa. Eastern Europe and the former Soviet Union are seeing the rapid emergence of epidemics, and HIV prevalence is continuing to rise in Latin America and the Caribbean. In Haiti, six per cent of the adult population aged 15-49 is infected with HIV. In Asia, an estimated six million people live with HIV. Many are in the poorest and most vulnerable communities.

In UK and the United States, HIV prevalence rates continue to rise, too. But as treatment is widely available, the visible consequences of young adult illness and death have almost disappeared.

Some successes

The history of HIV has been marked by some successes – and many failures. Some countries, where there has been strong political leadership, have shown that HIV can be prevented and the crisis turned around. But elsewhere, political and religious leaders are turning a blind eye with terrible and fatal consequences. The opportunities offered by new drugs and the hugely energetic and committed efforts of local community groups are being ignored at the cost of lives.

Mother-to-child transmission

One notable success has been the prevention of transmission of HIV from mothers to children during birth and early infancy.

The Atlanta-based Center for Disease Control and Prevention reported its first case of possible mother-to-child transmission in 1982, and in 1985 HIV transmission through breastfeeding was described. Without interventions, mothers infected with HIV have about a one-in-three risk of passing the virus to their babies. In 1994, a study showed that the antiretroviral drug AZT could halve the rate of transmission. This landmark discovery was followed by a further trial in Thailand, which showed that another regimen – cheaper and easier for patients to take – could also halve transmission, even in poor communities.

In 1998 prevention of mother-to-child transmission became even simpler and cheaper. A single dose of the antiretroviral nevirapine given to the mother during labour and a single dose to the newborn baby was found to be effective in preventing HIV. The drug company Boehringer Ingelheim which made nevirapine then offered the drug free to developing countries with programmes to prevent maternal transmission. Today, in industrialised countries, mothers with HIV can take combination antiretroviral therapy, have routine caesarean sections and offer their infants breast-milk substitutes. This has reduced the risk of transmission from mother to baby to just one per cent.

With cheap and easy interventions available, prevention of mother-to-child transmission is becoming more widely possible – in theory at least – in poor countries. However, in developing countries, where the vast majority of HIV-positive mothers live, very few currently have access to HIV testing. Therefore they cannot benefit from nevirapine.

As with everything in the story of HIV, nothing is easy, simple or inexpensive. The issue of infant feeding, for instance, offers both possibilities and risks. In the UK, every woman with HIV is advised to use infant formula to feed her child, to avoid transmitting HIV through breast milk. In developing countries, however, those few pregnant women who do have access to testing, and subsequent access to nevirapine, are faced with difficult infant-feeding choices. Even if baby milk is available, it can be expensive. Access to clean water is essential, as is fuel to prepare feeds. There are also social obstacles; sometimes feeding newborn babies with infant formula is tantamount to declaring oneself HIV positive.

Coming to life: drug treatment

In the 19 years since AZT was identified, there has been remarkable progress in drug treatment for people with HIV. In 1995, a new class of HIV drugs, called protease inhibitors, was discovered. These, usually combined with two other anti-retrovirals, have proved to be highly effective at preventing HIV replication and thereby reversing the suppression of the immune system caused by HIV. Combination therapy converts fatal HIV into a chronic manageable condition such as diabetes.

By 1997, for the first time since the outbreak of the HIV epidemic, the number of HIV deaths in the US had dropped dramatically. The death rate in the UK also fell, and places like the London Lighthouse hospice closed residential units once used to care for those who were terminally ill with HIV.

Early HIV regimens were complex and often unpleasant. It was not uncommon for patients to take up to 20 tablets a day, often with different food restrictions, and the drugs sometimes had adverse effects and serious interactions. Today modifications of the earlier drugs have made them less toxic and combining drugs has made it possible to treat HIV with a single daily combination tablet. Although laboratory monitoring is preferred, lack of access to laboratory facilities – the norm in many parts of the world – is no longer seen as a barrier to using antiretroviral therapy.

The price of life

The other major development in the antiretroviral story is more recent and has to do with price. In 1989, the cost of AZT was US$7000 per year. When combination therapy became available in the UK after 1995, the cost of a year's treatment was often in excess of £12,000 (roughly US$18,000). With annual per capita health spending in many of the most-affected countries of less than £10 (around US$15), it was hardly surprising that virtually no-one in developing countries could afford treatment.

In response, Aids activists in both the industrialised and the developing world mounted intense campaigns. They lobbied governments to allow parallel importation of generic drugs avoiding patents, and they demanded that drug companies cease what they called "price gouging" and "profiteering" and reduce their prices significantly.

These campaigns have been highly successful. Generic combination therapy is now imported into countries such as Zambia, where it is available at less than £20 (US$30) per month. Although even these reduced prices keep the drugs out of the reach of the majority of people, many of my former colleagues and friends in Zambia – doctors, nurses, teachers and priests – can afford them and are today, five years since I left Zambia, still alive.

A global health emergency

This price reduction has also led world leaders and international donors to support efforts to increase access to treatment. Worldwide, of the five to six million people in need, only 300,000 are on antiretroviral therapy. In sub-Saharan Africa, only 50,000 people – out of the 4.1 million who require therapy – have access to drugs.

The failure to deliver antiretroviral therapy to the millions of people who need it is now seen as a global health emergency. To address this emergency, WHO has committed itself to achieving the "3 by 5" target – getting three million people on antiretroviral therapy by the end of 2005. It is up to the governments of the rich countries to find the money to do this.

A community response

Another success has been the increased role of nongovernmental and local community organisations in leading the response to HIV. Whether in churches or campaigning groups, community-based HIV work is a response to the witnessing, by community workers, of the tragedy they see unfolding around them. While governments remain the crucial element in helping to turn around the trajectory of the virus – only governments have the power and funding to create a national response to the crisis – local organisations have the sensitivity to, and knowledge of, local communities which makes them especially effective.

Many failures

Yet as significant as these successes are, the deaths and new infections go on.

Effective HIV prevention is needed everywhere. There are no easy solutions. Condoms prevent sexual transmission. Clean needles prevent transmission in health settings and among drug users. But lack of funding and inadequate basic infrastructure for. health and education have prevented programmes from being effective – or even, particularly in post-conflict nations such as Sierra Leone or Angola, from reaching people.

Social barriers to changing sexual behaviour are often complex and little understood, and current ways of promoting safe behaviour are not effective. Even in the UK, with universal access to sophisticated health care and education, rates of sexually transmitted disease are alarmingly high among young people and rates of HIV infection continue to rise – particularly among vulnerable groups. If highly populated nations such as India, China and Nigeria – which until now have had relatively low prevalence rates – do not mount effective HIV prevention measures, the global toll of HIV infections will be even more enormous.

Stigma and positive leadership

A unique feature of HIV is the overwhelming nature of the stigma. No other infectious disease has been so demonised. Stigma and denial are the greatest barriers to HIV prevention. On World Aids Day in 1995, Nelson Mandela called on all South Africans to "speak out against the stigma, blame, shame and denial that has thus far been associated with this epidemic". Three years later, neighbours beat to death the South African Aids activist Gugu Dlamini after she revealed her HIV positive status on television.

In countries such as Uganda that have been successful in reversing HIV rates, efforts to challenge stigma have been key. This has been achieved by involving people living with HIV in the development and the implementation of HIV programmes. HIV-positive priests and religious leaders, politicians and members of the armed forces, pop stars and sports personalities can all be open about their status. They can effectively challenge stigma and denial, and promote compassion and understanding in their communities. But where stigma is not addressed – in the majority of countries – HIV is spreading virtually unchecked.

Orphans

A tragic consequence of the HIV epidemic is the rapid rise in the number of orphans, and the consequent rise in the number of households headed by children and grandparents. By the end of 2003, more than 14 million children had been orphaned by HIV/Aids. It is estimated that in some countries in sub-Saharan Africa, poor households have an average of four additional dependants to care for. UNAIDS reports that 40 million children in developing countries will lose one or both their parents to HIV by 2010.

"Every day there are more and more children on the street," reports Pascal Rukengwa, director of Humanité Nouvelle, another organisation supported by Christian Aid in Kinshasa. "Among these are more and more children whose parents have died of Aids." His organisation now runs a theatre group and a day centre for these children and helps them develop skills such as shoe-shining so that they can work rather than beg and steal for a living.

Creating memories

HIV has changed the way we look at public and private memories. Last century, millions of young men were killed in two world wars. Public memorials were dedicated in their honour. In contrast, the flu epidemic in 1918-1919 left somewhere between 20 and 40 million people dead. There are very few commemorations in their memory. But the gay community, affected first by HIV, needed to make its own statement in response to this tragedy. HIV was killing young, articulate, creative gay men in their prime, and their community was determined not to forget.

In 1987, a gay-rights activist named Cleve Jones made the first panel for the Aids memorial quilt, in memory of his friend Marvin Feldman. This was the start of the "Names Project", a global initiative in which friends and families remember loved ones lost to HIV by creating a quilt panel representing the life of that person. The project provides a creative means for remembrance and healing. In addition, it has illustrated the enormity of the epidemic, increased the general public's awareness of HIV and Aids, assisted with HIV prevention education activities and helped raise funds for community-based Aids service organisations. Today, there are Names Projects in 43 countries, and 44,000 quilts have been made to commemorate loved ones who have died from HIV.

In 1988, WHO designated December 1 World Aids Day. HIV is remembered publicly in many ways, in many cities – especially in Africa – on World Aids Day. Unlikely partners such as the Mothers' Union and Aids activists march arm in arm, displaying banners demanding access to treatment or promoting love and support for people living with AIDS. Candlelight vigils bring communities together to demonstrate remembrance and hope. Church services on World Aids Day provide a spiritual context which allows people to grieve for dead friends and relatives and renew their commitment to fight stigma, discrimination and HIV itself.

In 1991 the red-ribbon symbol was introduced as a way for people to promote awareness about HIV, to show their solidarity in caring about people who are infected with and affected by HIV and Aids, and to express their support for action against the epidemic.

Marie-Jeanne, a photographer with FFP, expressed what many people feel: "I want to live. I want to work. When we are given a chance we can achieve things. It's all a matter of will. If we want to do it, we will. However, it's very difficult in this country. We don't have many opportunities to expand our horizons."

Dr Rachel Baggaley

Head of Christian Aid's HIV Unit

Honorary research fellow at the London School

of Hygiene and Tropical Medicine

For more information on memory work and related resources see

www.ifrc.org

www.plan-international.org

http://web.uct.ac.za/depts/cssr/asru.html

For more information about Christian Aid and its work with HIV/Aids, see www.christianaid.org.uk or telephone +44 20 7523 2172.

Worldwide Organisations Working to Fight HIV/Aids

PLAN

PLAN has several projects in progress all round the world to assist and support children affected by the HIV/Aids epidemic. Uganda is the African country which has best succeeded in turning the epidemic around, but despite this, the country still has a large number of orphans. In Uganda, PLAN is working to provide vocational training for young people who have been forced to leave school when their parents died. Single mothers with HIV/Aids are provided with nursing care and help in finding new ways of earning a living. PLAN was instrumental in initiating the Memory Books project, which is aimed at helping parents with Aids to prepare their children for the fact that they may soon be orphaned. The books help parents to express their feelings, thoughts, experiences and hopes for their children's futures.

Burkina Faso

Association Solidarité et Entraide Mutuelle au Sahel (SEMUS)

SEMUS works in a region where few other organisations address HIV/Aids. It provides a range of integrated development activities including income generation; food security; education; health care through provision of drugs at low prices from its pharmacy, and provision of drugs and medical equipment to a local health centre.

Burma (Burma/Thai border)

EMPOWER (Education Means Protection of Women Engaged in Recreation)

Established in 1984, EMPOWER aims to provide migrant sex-workers with access to education and information in order that they are better informed and better able to protect themselves from abuse and health risks, including HIV.

Activities include typing and computer classes, counselling, health and safer-sex workshops, distribution of condoms.

Democratic Republic of Congo

Fondation Femme Plus (FFP)

FFP is an association of women living with HIV/Aids. It specialises in psychological, social and medical support to more than 2000 women in the DRC, including counselling, medical treatment, support for small businesses and practical support such as food and help so that children can attend school. "When my husband died, I didn't want to be open with anyone. I felt as though I had died with him. But thanks to FFP, I feel like I am a worthwhile person, and I can go on living," Mama Dedy, mother of two, told Christian Aid.

India

Arogya Agam

Arogya Agam, based in Tamil Nadhu in south-east India, is related to the Women's Development Programme, promoting women's empowerment socially, economically and politically, and increased understanding of and access to health, with a strong focus on an HIV/Aids programme.

It gives support and training to village health guides and community health committees to lobby for and monitor government health services and demand community rights to access health services. It also refers patients with sexually transmitted infections for health care and provides counselling. Arogya Agam mobilises villages to distribute condoms and raises awareness of HIV/Aids, particularly among young people.

Jamaica

Jamaica Aids Support

Founded in 1991, JAS has 30 staff and 150 volunteers in three main offices. JAS provides services for over 10,000 clients, including a "friends" network offering practical and emotional support to people living with or affected by HIV. After training, volunteers are assigned to a client/family member or care-giver. It also organises educational outreach, care programmes and promotes human rights for people living with HIV in a climate of stigma. Its "living quilt", to which artists contribute each year, includes the names of people with whom it has worked.

For more information, see www.jamaicaaidssupport.com

Kenya

BIDII

Bidii is the Swahili word for "effort". BIDII is a Christian-inspired NGO that provides community development services in two districts of Ukambani. It combines training in sustainable agriculture and improved farming methods and protection of water sources with a programme of primary health care and HIV/Aids awareness in communities along the main Nairobi-to-Mombasa highway.

Zambia

Archdiocese of Lusaka, community home-based care programme

A network of 52 home-based care projects in and around Lusaka, supported by more than 1700 community volunteers who provide patients with nursing and medical care, counselling and pastoral support. Some projects support surviving families and orphans with material assistance or capital for small-business start-ups.

Copperbelt Health Education Project (CHEP)

Established in 1988 to address the deteriorating health standards in Zambia 's second city, Kitwe, in the Copperbelt. CHEP aims to change people's behaviour through the education of children, youth and adults. It helps people infected with and affected by HIV. Last year it opened a training centre to teach community organisations how to tackle HIV.

Kara Counselling and Training Trust (KCTT) and the Positive and Living Squad (PALS)

Kara was the first HIV service organisation in Zambia. It provides a wide range of services for people living with HIV and voluntary counselling and testing. The PALS are advocates for people living with HIV and have developed a programme of HIV education for workplaces and schools.

Appendix

This Memory Book

is for

…

and has been written by

…

– Information About Your Mother -

Family Name…

First Names…

Nicknames…

Date of Birth…

Place of Birth…

Your Mother's Story

(in brief, more details are included in the following pages)

– Our Family Home -

– Important Friends -

– Special Memories -

Information

– About Your Relatives -

Family Traditions

– And Special Events -

– Special To Me -

Thoughts On Life

– And Things I Believe In -

– My Likes & Dislikes -

– Special Interests/Talents -

– What I Do In My Free Time -

– My Health -

– My Working Life -

– My Education -

About My Childhood And

– Where I Grew Up -

– Information About Your Father -

– People Who Are Special To You -

– My Hopes For Your Future -

– My Favourite Memories Of You -

– Your Likes & Dislikes -

– Your Interests -

Henning Mankell

***