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I visited a Christian care facility in Johannesburg for those in the advanced stages of AIDS, and I saw children with matchstick arms and vacant eyes who lie in beds all day awaiting the next seizure. Volunteer "mothers" visit to hold and rock them. New advances in treatment offer hope for some children, but meanwhile many are dying. One nearby community used to average two funerals per week; it now has 75. A Christian center in Cape Town that teaches young people printing skills used to specialize in wedding invitations; it now supports itself by selling funeral programs.

But who wants to hear about AIDS in Africa? Relief agencies such as World Vision and World Concern face that question while trying to raise funds to fight this world health catastrophe. Americans, overwhelmed by the magnitude of problems in Africa, wonder if anything can help. Though they may not say so directly, many American Christians also can't help thinking, "They deserve it." After all, doesn't AIDS in Africa spread mainly through sexual promiscuity?

Indeed, the visitor to Africa finds a different sexual landscape. In some countries, adolescent boys celebrate their rite of passage into adulthood with a public circumcision ceremony and afterward may mark their adult status with sexual exploits. The continent has a long history of polygamy, and in places like South Africa, the practice of separating male workers from their families further broke down marital ties.

No one is exempt: in confidential surveys by World Vision, 72 percent of South African pastors admit to extramarital affairs, with an average of three to four partners each. Muslims proudly point out that in Africa, the great frontier between Islam and Christianity, Islam is gaining momentum, in large part because the Christians in sub-Saharan Africa are dying at a faster rate, whereas strict Shari'ah law keeps down promiscuity, and hence the HIV rate, in Muslim areas.

Yet a finger-wagging approach does little to help the problem. Bruce Wilkinson stirred up a hornets' nest when he lectured African church leaders about the sinful aspects of the AIDS epidemic. In Uganda, some evangelical churches require HIV testing and will not marry a couple unless both test negative for the virus—thus driving young couples away from the church.

Nor does denial help. In South Africa, which has the world's largest number of people living with HIV/AIDS, President Thabo Mbeki has openly questioned the link between AIDS and HIV. Recently he declared that he personally knew of no one who had died of AIDS. That may be technically true (AIDS lowers the body's resistance to other diseases that do the killing), but his attitude has set back the work of AIDS educators who are trying to alert Africans to the urgency of the crisis.

By any measure, AIDS workers face a Herculean task. In parts of Africa, life expectancy has sunk from 65 to 37, a level not seen since the 19th century. Researchers predict that in some countries half the people under 15 will die within ten years. Imagine a teacher walking into a classroom and looking at the eager young faces, knowing that half will soon be dead.

World Vision workers in southern Africa told me that self-stigma, which keeps infected people from getting tested or seeking treatment, is their biggest obstacle. When Botswana (with a 38 percent HIV infection rate, the world's highest) offered free medication for those with AIDS, only 1 percent of the population responded, due to the stigma.

An HIV-infected worker who got the virus through a blood transfusion told me, "To those who lack compassion for Africans because 'they deserve it,' I remind them that half the infections come about when a promiscuous partner infects someone 'innocent' and unsuspecting." All too often, HIV gets passed on to a newly conceived child as well, or else a child becomes one of the millions of AIDS orphans who are now growing up in Africa.

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March 2004, Vol. 48, No. 3