Infectious and parasitic diseases are a major health threat, accounting for at least 50 percent of all deaths in Zaire. (The United States rate, by comparison, is 1.5 percent.) Malaria, trypanosomiasis (sleeping sickness), onchocerciasis (river blindness), and schistosomiasis are all endemic. Malaria, lonÍÍÍg a significant cause of illness and death, is increasingly menacing because of its growing resistance to antimalarial drugs. Cases of trypanosomiasis are increasing, primarily because of a reduction in the number of mobile teams engaged in controlling the spread of the vector, the tsetse fly. Diseases such as measles, diarrheal diseases, tetanus, diphtheria, pertussis, poliomyelitis, tuberculosis, and leprosy are preventable or curable given available technology unfortunately, only 30 to 40 percent of the population has access to such technology and services. The UN has estimated the immunization rate in the early 1990s to be only 38 percent for measles and 35 percent for diphtheria, pertussis, and tetanus. In addition, a majority of the population is infected with intestinal worms, including ascaris, hookworms, and ankylostomes the effect of these parasites is to further weaken a population already suffering from widespread malnutrition.

The disease burden has fallen particularly heavily on children under the age of five. They constitute roughly 20 percent of the population and account for 80 percent of all deaths. Malaria is the primary killer among infants, while measles, malaria, and diarrheal diseases are responsible for the bulk of deaths of children under five.

Acquired immune deficiency syndrome (AIDS) and other sexually transmitted diseases have been spreading rapidly. As of 1990, the number of reported cases in Zaire totaled 11,732, a 60 percent increase over 1989. In urban areas, the AIDS epidemic is the most threatening public-health problem facing the nation. Seropositivity statistics (the proportion of a population whose blood serum tests positive for the AIDS virus) in Kinshasa for the general population in 1987 were 6 to 8 percent among prostitutes the figure was as high as 30 percent. The scanty data from rural areas show a lower incidence, but the samples are too small to be statistically significant.

AIDS is regarded as a potentially even greater public-health hazard in the face of the virtual collapse of the state-run health care system. By most accounts, in 1993 the majority of blood banks had been closed, and blood screenings were rare.

AIDS transmission in Zaire occurs primarily through sexual, mostly heterosexual, intercourse (80 percent) infected blood transfusions and contaminated skin-piercing instruments account for 15 percent of cases, and transmission from infected mothers to their offspring for 5 percent. The significance of heterosexual intercourse in the spread of the disease is documented in the ratio of afflicted men to afflicted women in Zaire it is 1:1.4, while in the United States it is 13:1.

Initial public reaction to the early warnings sounded by the medical authorities tended to be skeptical. In a play on the French acrony 73d m for AIDDS, SIDA (syndrome immunité déficient acquis), Kinshasa street slang labeled the new disease the "syndrome inventé pour décourager les amoureux," or, crudely translated, "syndrome invented to discourage lovers." But as increasing numbers of well-known musicians and other public figures have contracted the disease and died, public attitudes have grown more sober. Public health authorities have attempted to promote safe-sex education in their health education programs. In addition, the United States Agency for International Development (AID) funded AIDS research programs and health education programs through Project SIDA, and the government used a US$500,000 grant from the World Health Organization, together with money from other international agencies, to establish a national AIDS control program. Thus far, however, success in slowing the spread of the epidemic remains elusive, and rates of prophylactic use remain low.

Data as of December 1993