On one of my trips to Nigeria, Doc and Samaila introduced me to a man named Ikenna, who ran a bar on the same military base where I happened to meet Elizabeth. He was small, with short arms protruding from the rolled sleeves of a blue, orange, and green dashiki. The fabric engulfed him so completely that his body wandered within it even as he sat perched on the edge of his plastic seat. I wiped my forehead and face repeatedly with a paper napkin that dissolved into bits that stuck to my sideburns and beard. He didn’t sweat, not a drop or even a shine on his forehead in the low lights as he sat across from me. He was extremely attentive, carefully monitoring and measuring the proximity of opportunity (a customer) or the velocity of danger (a drunk customer). He kept a steady watch over his bar girls, ready to berate them into skips and smiles as they suffered the indignities of heat, the buckets heavy with bottles of drink they carried, and the catcalls of intoxicated men. His eyes were pulled down into a tired, wary slant by a persistent frown. He had a potbelly that was visible when he stood momentarily to see what business, if any, needed attending to while we spoke.
That night, clouds intermittently obscured the moon, and in the low light, I watched soldiers milling about; even though drunk, they carefully avoided old divots filled with a collected mess of wash water and carelessly discarded drink. They shouted hearty greetings in the local Hausa language, “Sanu! Sanu!” or pidgin English, “How now!” with handshakes pulled into hugs, then released again into handshakes that ended in snaps. Colored lights played across the open courtyard and bounced to the rhythm of the music blasting through the loudspeakers: 2Face Idibia’s “African Queen”—“You are my African queen, the girl of my dreams”—was the popular song of the moment, and it seemed to play on repeat. Between the beer and Coke bottles, over the wood-smoked suya, peppered meat, which Ikenna and I jealously protected from persistent flies, we tossed some conversation starters back and forth—“Did you see the Super Eagles play? Why can’t our boys just play good football anymore?”—the neutral subjects you speak of when you know a person only so well and talk centers on common subjects: rainy season versus dry season, country calm versus city chaos.
“You’re welcome,” Ikenna said to me softly, without warmth, after the chitchat dissipated. I put my notebook on the table between us and he watched with interest as I leafed through to a blank page.
“So,” I said, bouncing my knees, “tell me about yourself.”
He settled into his seat for a moment, slid his traditional cap off his head into his lap, revealing a closely shaved head, hairline receded into a deep W, and sighed.
Ikenna was much older than he looked. Originally from the east, he was the son of a poor farmer. He was supposed to go to college, to lift his family from poverty with his education and perhaps a career in the civil service, business, or medicine, but his terrible exam results at the end of secondary school prevented that. Instead he got on a bus with his few possessions in a bag, his only guide the address of an older sister who had married a man from Kontangora, a small town near the military base, and began the journey north. His first job was managing bars, then he moved into brothels, and then after Sharia law became a problem for certain establishments, he moved into selling drinks on a military base. Twenty years later, he was still here, but at some point along the way, he had gotten HIV.
Every so often, Ikenna cocked his head to one side to better watch his serving girls walk to and from his stall. They stepped into the orange light and in one swift motion deftly swept one arm to their breasts to keep cleavage in place while quickly swapping empty beer bottles for cold full ones. Mist from the deep freezer where the drinks were stored engulfed them. Ikenna, it seems, was not a man who trusted easily.
“Can we talk about HIV?” I asked after a long pause.
“You’re welcome,” he said again.
Here? Now? In the open, where everyone’s conversation was common property and someone might overhear our discussion? I had whispered the word HIV, as people do when speaking the uncomfortable.
He read my face. It was late. He had to work. Maybe we could get together after his HIV/AIDS support-group meeting. He presented all of this calmly, as life’s simple and obvious routine.
I took his number.
“Can I come to the meeting?” I asked, my words faltering, almost dissipating in the distance between us.
He responded with a light shove of the table as he pushed his chair back and stood. The bottles lined up on its surface rattled. “Why not?”
The support group met at the local hospital, where large orange-tailed lizards scurried across courtyards of struggling crabgrass bobbing their heads at one another, tasting the air with their tongues. The Hausa men who worked as nurses wore white safari suits as uniforms. They slipped in and out of the wards and headed for the afternoon prayers toward a small mosque built on the hospital grounds. The support group’s meeting room was on one side of the hospital, near the recovery ward for men who had just had hernias repaired. They met in a small cube of a room with cracked plaster and a small window high in one wall that allowed a thin sheet of sunlight to catch dust particles stirred by a wobbling ceiling fan.
When all members had assembled, they mulled over a list of concerns and joys no different from those of average Nigerians: “I have no food for my family.” “I need school fees for my children.” “Money for housing.” “A job.” “My boy just finished his West African Examination Council exam.” “My sister needs to do a traditional wedding.” Then someone said, “My drugs have failed.” There was an audible gasp. Nobody said a word. The women tugged at their headscarves.
The voice belonged to a young man in a muscle shirt that showed off defined biceps and prominent veins. Someone put a hand on his back, rubbed, and mumbled, “It will be OK. What line of medication?”
“Second line. Kaletra,” the man said, taking his time so as to control an aggravated stutter.
“You don’t have to worry too much,” his comforter said, and then loudly for everyone else to hear, to relieve tension, ease away collective fear. “There is still third line, and in some cases you can even go back to first line. It will be OK.”
A heaviness had settled upon the room. I watched as Ikenna slipped outside. I followed.
“Can we talk?” I asked, finally relieved to have him alone and in a quiet space.
He nodded. “You want me to tell you what I know about the something?” Ikenna rasped. “In fact I never knew about the something the first time I was very seriously feeling sick. They took me to hospital. I got OK,” he continued as we walked away from the hospital buildings down a path trampled through the grass toward a road that looped around the hospital grounds. Gravel crunched beneath our sandals as we approached hazy shapes of bungalows set back from the road on long drives. “Within some weeks, it started again, and they say I should go for a test. They say it’s HIV. I say, ‘No, it can’t be. I have not been meddling with women for a long time.’ So I resisted. I say, ‘No! I have to move to Kaduna to do another test.’ When I got there, to one big military hospital, they tested me, and it’s the same thing. Since that time, I accepted it. It was the year 2000.”
As we walked on, chatting, I noticed that he had trouble breathing and would pull his air in sharply, in between the bits and pieces he told me about his life. I asked him a number of times if he wanted to stop, but he waved away my concern with a small hand. At one point, as the road looped back toward the hospital compound, taking us from the hot sun into the shade of large trees planted in perfect lines, I turned to him and asked, “Ikenna. Do you ever wish you didn’t have HIV?”
He answered very quickly. “No.” There was no equivocation in his voice, not even a hint of lamentation about the things that he might never know or see—his three children growing up and marrying. There was no hint of a fear of death.
“Tot! Nah God gets us? Once they tell you, you have to accept. It is their job. So they told me. I have to accept,” he said as we entered the hospital through the men’s hernia recovery ward. Around us, patients shifted in their beds, groaning, mumbling prayers, and straining against painful coughs. We moved quickly and quietly so as not to disturb them. “I thank God I’m still getting up to eat,” he whispered to me. “I feel fine, so I have no fear over it. There are some—you see the way they appear—you know that thing is worrying them. When it enters into them too much, it used to destroy body. You see some lean, looking like a broom. I thank God I’m not looking like them.”
We pledged to continue our conversation the next time I came to Kontangora. I didn’t know that that would be the first and last time I spoke with him. Two months later, as I sat at John F. Kennedy Airport in New York waiting to board a British Airways flight back to Nigeria, I received a short e-mail from Samaila.
“Your friend Ikenna is dead,” he wrote. “He died last week of a respiratory infection.”
I sat there staring out the window at the large body of the plane I was about to board, stunned. A living, breathing someone who was once here was now not. The connection that we had started to form—suddenly cut short. I stood there, mouth open, eyes wide, fully aware of the breath flowing in and then out of me, paralyzed by a profound sense of the incomplete, another death caused by HIV/AIDS.
From the moment of its first presentation, HIV/ AIDS has been intimately associated with death, and necessarily so. The first cases to appear in the United States were those people with advanced HIV infections, end-stage AIDS. No one knew the exact cause, but the effect was clear; without exception, these people died. Even after HIV was isolated as the cause of the constellation of symptoms that constitute AIDS, there were no effective drugs or vaccines to treat the virus, and people still died. Only in the mid-1990s, after the introduction of powerful antiviral drug cocktails and massive public education programs, did death as a result of HIV/AIDS become less immediate. Though the scope of the sub-Saharan African HIV/AIDS epidemic became clear after the introduction of lifesaving treatments in the West, this epidemic has followed a similar trajectory. An initial lack of access to treatment meant that the majority of people who contracted HIV/AIDS in sub-Saharan Africa would die. In recent years, as public health programs have become more effective in their outreach and access to treatment increases throughout the continent, things are changing. Still, first impressions are hard to shake. Over twenty years and many medical advancements later, people still believe, as one young man I met said, “What I know about the HIV problem is that HIV don’t have cure in life. If you have HIV, your world is gone. If you have something calling HIV, know that you will lose your life.”
When considering the sub-Saharan HIV/AIDS epidemic, many find it difficult not to adopt this attitude. The numbers alone make it hard to believe that this disease brings anything but death. In 2009, 1.3 million people in sub-Saharan Africa died from HIV/ AIDS. In Nigeria there were over two hundred thousand AIDS-related deaths that same year. But what does this all mean?
Development indicators have traditionally been one of the ways that we interpret the impact of mass casualties in this epidemic, and the impact is deep. To begin with, it’s not just that people die; it’s who dies that makes HIV/AIDS so powerful. Most diseases tend to cause death among the very old or the very young, but this epidemic is most deadly among the sexually active, those between the ages of fifteen and fifty, who also make up the majority of any given country’s working population. As a result, the mortality rate in a given population is increased when it should be at its lowest.
In addition, because the epidemic affects women more than men, a traditional pattern in mortality is changing. Normally the death rate among women is lower than among men, but with HIV/AIDS, women are dying at earlier ages and in greater numbers, because women are biologically and socially more vulnerable to HIV.
Finally, life expectancy has decreased as a result of the epidemic. The average life expectancy for a person from sub-Saharan Africa is now fourteen years less than it would be had HIV/AIDS never existed, dropping a life expectancy already much lower than in the rest of the world down to an astoundingly brief forty-five years. This loss of life exacts an economic cost, further exacerbating what I have heard some people in Nigeria jokingly call AIDS—African Inability-to-Develop Syndrome. Countries affected by HIV/AIDS deaths face a declining workforce, which can translate into a drastic drop in productive capacity. Household incomes drop dramatically when working members of a family die from HIV/ AIDS. Most alarmingly, when adults die from HIV/ AIDS, they leave behind children, orphans, who will likely have decreased access to nutrition, educational opportunities, and other economic advantages that would make them productive members of society. In general, the standard of living decreases and whole societies fall further behind. Death from HIV/AIDS comes to mean a loss of opportunity, not just for those who die, but for those they leave behind.
We often prefer these statistical interpretations and macroeconomic analyses of HIV/AIDS-related death, primarily because the numbers seem more tangible. Decreased economic output, reduced GDP, and a household that now lacks income are easily represented as the consequence of this epidemic. But I also wonder whether a focus on economic deprivation when considering HIV/AIDS-related death in Africa is ultimately reductive, casting Africans as an amalgam of physical needs and in the process overlooking the real sense of missing another person that humanizes the experience.
When I spoke with Fatimah, the banker, about her aunt who had died of HIV/AIDS, she said of her family’s experience, “Whenever we’re together, we can all feel her loss in the air. It’s there.” As she spoke, her voice softened until it was almost inaudible and her face relaxed into the contours of sadness.
“When it started she used to smoke, so she thought she had tuberculosis. The doctors told her she had tuberculosis. Finally after two years, she went to a hospital in Kano. They tested her and they told her she had HIV. Obviously they didn’t deliver the message well. You know Nigerian doctors, they just come out and say you have HIV. They don’t go through counseling and talking to you, making you understand this is something you can live with. They just tell you, ‘OK, you have HIV.’ She broke down. Everything happened in the span of two months. She took herself to the hospital, but she didn’t come out walking. They had to carry her out of the hospital and she was on bed rest—sick. Two months after, she passed.
“I was very close to her. She was actually my mom’s cousin, but they grew up together. Everything, they did together. I grew up with my cousin who was her daughter. We were just like one family. She was a mother to me. I didn’t see her as an aunt. I could go to her for anything. So losing her was … that was my first major loss.
“What was she like—your aunt?” I asked her.
“She was tall, really tall, like six one, and she had this beautiful shape, long hair, pretty smile, caramel skin. She was a great person. She laughed a lot. She was always laughing, and she laughed out loud. She was a storyteller. She was a mother. She had all the qualities of a mother, and she was nice to everyone, kind and giving.”
Fatimah stopped speaking for a moment and drew in a deep breath.
“I still miss her. I do. And when I see my cousin, I can see the tension. I think partly I’m over it; I’m able to deal with it now. I think her daughter is even stronger than I am when it comes to discussing her and her past.”
Fatimah’s experience with her aunt’s death reminds us that death is an individual emotional experience. Numbers alone do not make death meaningful. Rather, they create a spectacle that captures attention for a moment before alienating its beholder in a realm of fact. That a young woman must sit and consider all the emotions that arise in a life without her aunt makes us question how we would behave in the same situation and so deepens our understanding of her humanity.
This small globe of a virus with its sinister round spikes is by now a familiar picture for many people in the world. It has been a celebrity of sorts, even receiving its own magazine covers and spreads. So intense is this association of HIV/AIDS and death that the diagnosis of HIV is itself considered the end of life. As the former police officer and activist, Samaila, explained to me, “Immediately I realized I was HIV positive, certainly what came over my mind at that time is that I was going to die. I knew—or I thought—I was about to die, and I was sure of that. So the first thing I did was that I put in a retirement letter, a resignation letter, from the police force so that I would be able to take any gratuities that were due to me, build a house for my children, and then go ahead and die. It was as fatal as that.”
Even more devastating is the fact that the HIV-positive person loses his or her identity to the virus, becoming a form of death incarnate. The living human body becomes a visible reminder of the same decay that happens to a corpse. In the words of a man who described a woman he knew who died from HIV/AIDS, “How can one woman with hip like this, breast like this—full breast—just turn into nothing? Nothing? Her body change color—a yellow lady become a black. Her whole body just disappear and cover in rashes to the point where you cannot even look at her. You just cannot.”
We do not like to look at death. It has remained abstract primarily because we have separated ourselves from its physical form through ceremony and ritual designed to control or appease the violence it offers. Burial, cremation, and the ceremonies that surround them allow for an effective disposal of death in its physical form while providing a platform for the collective expression of the emotions death calls forth. HIV/AIDS flouts these culturally constructed barriers between the worlds of the living and the dead and in so doing disrupts the normal process of grieving.
Obong, the driver from Abuja, had lost seven friends to HIV/AIDS. He had even driven the coffins of his friends from Abuja to their villages and final resting places. Death from HIV/AIDS was not new to him, nor were the associated burials.
“Like in my place,” he said as we sat there, “if somebody die, if they have children, if they bury you, your family will not go to farm until seven days. That is the respect they will give to you because you are family man. Maybe they hear that this other village trespass, find trouble, kill our youth. If you see the kind [of] burial they will give to such person, you will now know that yes, you were a good person in society. When you die, if because of that HIV and AIDS, your burial will just be as if they bury dog. They will say, ‘What are they keeping you for? You were not responsible. You did not leave anything behind, no legacy. So there is no need of feeling pains.’ I’m telling you this. As far as youth just dig hole, they put you there; they cover. The next day, people go to their farm, continue their life. It’s just like this bird flu killing fowl. They will say the breeze have touched you, so they have to bury you according to the way you live your life.” He sat quietly after he finished speaking, and sighed heavily.
It appears that in Nigeria, death comes in flavors: good and bad. A good death is one that unites a community in its emotion and allows for public expression of grief. In a good death, the deceased is someone who in life strengthened the fabric of society by contributing and through death has the power to do the same by bringing people together. The death of an elderly person who leaves behind family and the death of a young person in the service of the community are life affirming. Death in these situations is seen as normal and reflective of good character. A bad death is one that divides a community and is either indicative of or results from bad character. Because HIV/AIDS confuses the lines between life and death, it turns death into an abnormal, unnatural process. This kind of death cannot be ceremonialized. There is no gathering of community, no expression of collective emotion. There is the sense of something incomplete.
“That is how life is,” Obong finally said. “There’s no two way about it. If you dance good, you dance to the end. But when you dance bad, you dance halfway.”
He readjusted his shades to fully cover his eyes with the shimmering blue lenses. He didn’t look at me.
The link between HIV/AIDS and death is especially hard to sever, but the way we think about HIV/AIDS and death is changing—primarily because so many people living with HIV/AIDS have fought to reimagine the perceived death the rest of the world assumes they live.
In Lagos, at their offices near a Julius Berger Construction Company staging ground by the lagoon, I met an HIV-positive woman who worked for the Nigerian Business Coalition Against AIDS (NIBUCAA), a foundation set up by a consortium of companies—Julius Berger included—addressing the issue of HIV/ AIDS in Nigeria. We spoke just outside the office, so as not to disturb her colleagues working inside. The air smelled of diesel and industrial products, and the landscape that stretched out before us was bleak. Crushed gravel, chain-link fences, scrap metal, rebar, and other building products, along with the constant churning noise of large trucks exiting and entering the premises, gave the setting a postapocalyptic feel. We stood in a corner of a carport freshly painted in white. An odd collection of black butterflies fluttered around a Mercedes parked in front of us.
“Like for me when I just tested, I’m used to wearing trousers and tops—small tops,” she said as we leaned against the wall. She had the slight frame of a fashion model, if a little short, with a delicate face framed by her relaxed hair. Her skirt suit was cut to just above her knees, and her smooth calves tapered into a pair of black dress shoes.
“And then all of a sudden I start wearing something long,” she continued. “I would cover my head. I won’t talk to people. I wanted to stop schooling. When after we knew it was HIV, my strength was very low, and at that stage I wished death could come. There was one day, two days I didn’t take my bath, but death didn’t come. Death didn’t come. Then I decided to take my bath. And despite the fact I used hot water, I was cold. I was shaking. And I prayed to God that if death did not take me now, then I should be able to live and live. After that night I was just praying that if death could not take me now, then I’m going to live long. Then one day I just said, It seems you’re hiding. Are you ashamed of yourself? Why are you ashamed? You still have a lot to live for. Your father and mother still believes in you. Your family still believes in you. You can still do something. I started my medication December 2004. Then I bounced back to life. I went back to school—although I had an extra semester because I missed all my exams. And I just moved on in life. Ever since then, I’ve always been on the move. I’m always on the move.”
I could believe it. As we talked, she constantly bounced her shoulder against the wall. She seemed so possessed of energy and motion that I wondered how she was able to work at a desk in an office.
“The next question I asked myself was, I have to learn about this disease that wants to kill me. I started going to the Net, go to the Web, start searching for ‘human immunodeficiency virus,’ the virus I believed would kill me. But eventually you find out more, that this virus does not eventually kill. Other opportunistic infection kills the person. And if the person is at the stage of denial, the person may end up dead. So that’s how I became open about my status. I learned more. I started going to workshops, trainings. Another thing I did was to join a support group, AIDS Alliance Nigeria. I remember the first time I went to support group. I saw more than two hundred. People that are older than me. People that are younger than me. I said, ‘Ah! So all these people are living with HIV.’ The thing that amazed me even was that they were quarreling about they were supposed to give them food. They were quarreling about it—transport allowance. I was like, ‘Ah-ah? These people are not even thinking at all about death.’ I was just amazed, and that inspired me like, if these people can live and still struggle like this, I can do more things.
“It’s not as if I’m really proud to be living with HIV, but I felt there’s a need for me to be doing something positively. And the way to affect people’s lives positively is to let people know that OK, the message is true—it’s a fact. Because a lot of people believe that AIDS is not real. And for me to do that, I have to become open about my status. I have to tell people. And after telling them the message that this person you’re seeing is really living with HIV, and she’s been coping, and if she can cope, you too can cope. And if she’s positive, then anybody can be positive as well. And if you’re negative, there are steps you can take to remain negative and live your life as well.”
In her essay “Beyond the Politics of Bare Life,” the anthropologist Jean Comaroff writes, “Claiming positive identity can be tantamount to a conversion experience: quite literally a path to salvation. ... Rebirth through the disease likewise involves standardized formulas of self-declaration, a passage to new ontological certainty and transparency that claims to reverse the deceptions of prejudice, secrecy, and untruth.” This is to say that there is life after perceived death, that it can be lived completely, fully, and with renewed purpose, that being positive, in both senses, can engender a new HIV/AIDS paradigm that emphasizes life. In the words of another activist I spoke with, an Igbo man who had been HIV positive for ten years, “Life begins when you know your status. If you don’t know your status, life has never begin. Like that 2001, I know my status, that is a new life I begin. ... It’s a new life.”
This new life begins only after an intense reckoning with HIV/AIDS-related death. It does not come by ignoring or denying the fact that HIV/AIDS can kill even under the best of circumstances—after all, Ikenna was compliant with his treatments and very active in his community of HIV-positive people—but by recognizing that each individual death is important, because it represents the loss of a human connection. Preserving and enhancing these connections in the face of the epidemic can serve as the motivation for further action.
In recent years, there has been a downward trend in the number of HIV/AIDS-related deaths in sub-Saharan Africa. In Nigeria, the number of reported deaths related to AIDS has stabilized and is no longer increasing. As fewer people die and the number of people living openly, positively, and productively increases, it becomes harder and harder to complete the equation HIV/AIDS equals death. And as these people live fuller, more visible lives, more accepted lives, their presence and vocality demand a discussion not only about what HIV/AIDS means in a community, but also about how that community can ensure that all people, positive or not, are positively influenced by the epidemic.