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Death Row

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On Nairobi's dusty and tattered Kenyatta Avenue, street kids sniff glue and huddle together under plastic bags to sleep. A parking attendant saunters along the potholed sidewalk to ask a motorist for a little extra to park. A bus speeds by belching diesel fumes. Office workers scurry to pay bills or buy a few groceries during their lunch break, while groups of unemployed men gather on corners or loll on park benches, looking on at the wage earners with envy and an occasional glimmer of malice. Take a walk down Main Street Africa and the signs of economic decay — poverty, corruption, crime and hopelessness — are all too obvious.

But perhaps the greatest single threat to Africa's rickety economies remains largely hidden. To catch a glimpse of it you have to prod people to talk about things they would rather hide. It emerges slowly in strained conversations and snippets of statistics. "You will find it difficult to know the truth," says one civil servant loitering in the corridors of the dimly lit Nyayo House, which towers over Kenyatta Avenue and houses many of Kenya's government departments. "You will get a list of dead but no one will tell you why they are dying." Even he did not like to say its name.

Twenty-four million people in sub-Saharan Africa are hiv-positive, 70% of the world total. Thirteen million Africans have already died of aids and 10 million more are expected to die within five years. In Kenya, where one in seven people is hiv-positive, the list of dead grows 500 names longer every day. In Botswana, the rate of infection is one in four people; in Zimbabwe, it is heading toward one in three. The World Bank estimates that aids could shrink some African economies by up to 25% over the next 15 years. America's Central Intelligence Agency recently called the spread of aids in Asia, the former Soviet Union and particularly Africa a threat to U.S. national security and said that it could trigger ethnic wars and genocide and undermine democratic governments.

Despite such dire predictions, little is understood about the economic impact of the disease. But the anecdotal evidence collected along Kenyatta Avenue indicates that aids is already ravaging sections of the economy, and that, unchecked, it threatens the continent's entire economic future. "The way in which we deal with aids will to a large extent determine whether we remain a poor continent or whether we grow," says Kwame Owino, a research officer with Kenya's Institute of Economic Affairs.

The biggest immediate worry is the loss of skilled staff, especially in the public sector. Two policemen die of aids in Kenya every week. In Tanzania, some ministries are losing up to 20 employees a month. aids is the leading cause of death for teachers in the Central African Republic, leading to the closure of more than 100 primary schools there between 1996 and 1998. More than 30% of soldiers in many African armies are hiv-positive.

"Our revenue officers train over many years," says Kennedy Onyonyi, public relations manager at the Kenya Revenue Authority, at the western end of Kenyatta Avenue. "When we lose someone it takes some time to fill that gap." Onyonyi estimates that 40 of the department's 4,200 employees died of aids-related causes last year, including some of its brightest young graduates: "Our workforce is aging because we're losing a generation of professionals." Stung by what they have seen happen to their own staff, kra managers will soon begin a study into the disease's effect on Kenya's tax base. "The fear is there that aids could eat quite a big proportion of our revenue," says Onyonyi.

At a construction site a few blocks away, site manager Paresh Shah has no such staffing problems, or none that he notices — yet. The building company he works for, Laxmanbhai Construction, employs most of its staff on a casual basis. With near 50% unemployment in Kenya, "there's no shortage of men to choose from," says Shah, over the noise of hammering one floor up. "If there is an increase in sick people, we wouldn't really notice it. The man would just go home and tomorrow there would be someone to take his place." But at a sugar factory in western Kenya that supplies many of Kenyatta Avenue's supermarkets and restaurants, the spread of aids is obvious. In 1988, just two of Sony Sugar's 1,700 workers died of aids. Now more than 40 die a year. "It's just a straight line up," says company doctor Gordon Ambayo. "There's a lot of extramarital sex here as well as wife inheritance. We try to educate the workers about the dangers, but they're not getting the message."

Companies use a variety of ways to avoid losing workers — and in so doing distort employment patterns further. "In spite of the fact that younger people are better-educated we prefer to employ older men," says one petrol station manager who did not want to be named. "Older people don't fool around so much. We know we're not going to lose them." Many companies in Kenya, and elsewhere in Africa, require new employees to have a blood test, especially if health cover is on offer. Mandatory testing is illegal in Kenya, but few job seekers refuse. Once they've got a job, though, many discover that promotion is conditional on regular testing. Fearing the results, some workers prefer to stick in the same job, stifling growth and productivity. "I could have been a manager by now but I didn't want the stress of going for that test," says one Kenyatta Avenue accountant who refused to give his name. "You might find out something you don't want to know."

The cost of testing, health care and recruitment, as well as productivity losses due to sick leave and even days lost when staff attend funerals, has begun eating into profits. Kenya's National aids Control Council estimates that the annual per-employee cost of the disease to Kenyan businesses will increase by 160% between 1997 and 2005. The Kenyan government reckons that aids has already cost the country $10 billion in lost productivity and that the daily economic loss is now running at $2.7 million, though some analysts say it's less than that. In any case, says Minister of Health Sam Ongeri, "the economy is being decimated."

Figuring that the best way to avoid a blow-out in expenses is to keep their employees healthy, a few companies, mostly big banks and multinationals, offer booklets and training courses on how to avoid contracting hiv. Susan Muguro, external affairs manager in Kenya for Standard Chartered Bank, which operates in 12 African countries and occupies one of the oldest buildings on Kenyatta Avenue, says the most important thing is to get people talking. "Silence is possibly why our figures [in Kenya] are so high," she says. To get staff used to talking about aids, safe sex and condoms, trainers made them sit together and call out the names of body parts like penis and vagina. "At first people were giggling and blushing, but then you realize they're just words," says Muguro. "Africans find it hard to talk about this stuff. Typhoid wastes us, malaria wastes us, but this disease is one that touches the core of humanity — our sexuality."

Other companies simply get rid of the problem. John Shiverenje, human resources manager at popular Kenyatta Avenue fast-food joint Simmers, says if his workers are regularly sick they are forced to resign. "When they become weak you have to start paying benefits and we can't be happy with that. They might be infected." Felix Kikwawi, a manager at supermarket chain Nakumatt, says he doesn't know if any of his staff are hiv-positive "because it's something you don't talk about." But staff at Nakumatt's two Kenyatta Avenue stores say that they were recently required to have a blood test and that staff are sometimes "chased away because they keep getting sick." Kikwawi says the tests were for typhoid and were conducted by the Nairobi City Council. Whatever the case, because a typical breadwinner in Africa feeds at least six people, a lost job means an entire family suffers.

With so many other hurdles to business in Kenya — corruption, crumbling infrastructure, poverty — it's difficult to distinguish the effect of aids on a company's customer base. Health clinics and pharmacies report extra business because of aids — "vitamin preparations are selling out at the moment," says one Kenyatta Avenue pharmacist — while other sectors, like finance and banking, have been hurt by the spread of the disease. Any Kenyan applying for a mortgage, for instance, must answer questions like, "Have you ever had unexplained, recurrent or persistent fever or skin disorder?" or "Have you ever had unexplained weight loss?" They must then have a blood test, the results of which go to the insurance company underwriting the loan. "Sometimes people are reluctant to go through all that," says James Osumo, a manager at Kabage and Mwirigi Insurance Brokers, which underwrites loans from Kenya's biggest mortgage company. "Obviously it has serious financial and moral implications for our industry."

And so the noose pulls tighter. Families with even one hiv-positive member often withdraw children from school, sell assets and spend savings on health care. As consumer spending drops, layoffs follow. As well, and in contrast to the West, aids in Africa is largely a heterosexual disease, striking women just as often as — and in some cases more often than — men. Birthrates are subsequently dropping, but so too are average life expectancies — in some cases by as much as 15 years. The end result of the economic crunch: street kids like seven-year-old Michael Mwungi, whose father died of aids three years ago and whose mother is too poor to feed him. Crouching in the gutter along Kenyatta Avenue, his grubby and torn blue nylon jacket hanging from his tiny frame, Michael counts his day's takings: 30 shillings, or 40ข. "aids is a disease that makes you grow thin and not eat," he says, "and then you die." Unless more is done to stop the disease, Africa's economies will go the same way.
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