BUKAVU, Congo -- The health care workers told the group of 30 teenage boys to put down their guns. They asked the boys to sit in a circle. They warned them against raping women. They showed them some unnerving photographs of young people withered and feverish from HIV-AIDS. And they told them if they were going to have sex that they should use a condom.

Then the lesson was over.

The workers with the aid group Population Services International, recounting the session held last summer, said they knew they didn't have a particularly attentive audience. They assumed many were HIV-positive.

"It's hard to convince an unpaid fighter to wear a condom knowing they are going to go out and rape someone. It's hard to change that sort of mind-set," said Dieudonne Zirirane of the Bukavu-based aid group. "But this is war. What else can we do?"

The men from the Congolese Rally for Democracy, the country's largest rebel group, went back to their posts in the dense jungle, where they were fighting other rebel groups. And this fall, the reports kept coming in -- from hospitals, from church health clinics and from the tin-roof shacks of traditional healers. A great many women were being raped by fighters.

Of those who came to hospitals for treatment, about half were HIV-positive, health workers said. In rural areas, tests are unavailable, so by the time women fall ill with AIDS, most unknowingly have transmitted the disease to their husbands and babies. Before the war, about 5 percent of the population was infected with HIV. In the eastern parts of the country that have suffered the most during the fighting, 20 percent of the population is estimated to be infected, according to the U.N. AIDS program in Kinshasa and the government's Health Ministry.

In Africa, the cycle of war is spreading HIV. In countries such as Liberia, Sierra Leone, Congo and Sudan, where war has been more common than peace in recent decades, HIV rates have ballooned during times of conflict.

In Liberia, less than 1 percent of the population suffered from HIV before war broke out in 1989; 10 years later, around 8 percent of the population was infected. After this summer's fighting, nearly 16 percent of the population had the virus, according to the U.S. Agency for International Development.

Estimates of HIV among the military in Angola range between 40 percent and 60 percent, while 3 percent of the general population is infected, according to the U. N. AIDS program. In Zimbabwe, 50 percent of the military is HIV-positive, while 25 percent of the general population suffers from the virus. Eritrea's HIV rates also rose after its war with Ethiopia.

Levels are astronomical in the military for reasons other than rape. Prostitutes are often drawn to soldiers to make money in desperately poor war economies, and casual liaisons are common among soldiers away from home for lengthy periods, several reports have shown. Congo's war has been particularly conducive to the spread of AIDS. At times, more than five neighboring armies were drawn in. The fighters brought soaring rates of HIV along with their weapons. Nearly a quarter of Ugandan soldiers who invaded Congo 41/2 years ago and backed rebel proxy groups tested positive for HIV, another USAID study said.

The war is officially over, with a fragile peace plan and a transitional government in place under the leadership of Joseph Kabila. But in the eastern reaches of the country, pockets of fighting continue, along with kidnapping and rape.

"My body became cold after I was raped," said Fabina Malibilo, 21, who was suffering from pneumonia at a hospital in Kalima, in the heart of the eastern Congo. "My husband tried to take care of me, but later on he got sick, too."

Malibilo is a friendly, even magnanimous woman, considering what she has lived through. Seven rebels from the Mai Mai group kidnapped her in September and held her for three months. Today, she doesn't know if she has AIDS, although she suspects she does. Her doctors say quietly that they are sure she does. They won't tell her though, because they have no treatment, anyway.

"I know I am very sick," she said, softly twisting her braids as she breast-fed her baby. "I am feeling very tired. All I am thinking about is how to prepare for my baby when I am not alive."

To be HIV-positive in Africa is often a slow, hopeless struggle to stay alive through better nutrition and good treatment for other infections. Sometimes, for the lucky or the rich, there is access to the life-saving drugs that are widely available and affordable in the West.

But to contract HIV during war in Africa is tantamount to a death sentence.

"We have big illness here. But we only have rubbing alcohol to treat it," said Bisimwa Gaspard, a nurse at a fetid military hospital in Bukavu, where bullet-ridden metal tables served as beds. "We know it's spreading. To be very honest, it's very much out of control now."

A bucket of dirty water was being used to towel off the perspiring head of a patient who might have been suffering from AIDS. Gaspard shrugged and turned away. "What can we do? We don't even have AIDS tests," he said. The patient was too sick to be interviewed.

In eastern Congo, no residents had received the life-saving AIDS drugs until Doctors Without Borders, a French medical aid group, began treating 10 patients in Bukavu last month. Without a functioning government in the country, the organization was able to bring in low-cost generic drugs that many African governments have rejected. The initiative is the first time that an aid group has tried to give antiretroviral treatments in Congo, where the fighting has not stopped.

"Africans know how to die with AIDS," said Carlos Cordero, who is helping to run the program in Bukavu. "But they don't know how to live with it. This is a moment in history for eastern Congo. It's an incredible opportunity."

The group hopes to have 150 patients in treatment by January 2005. For the treatments to work, however, patients must show up for medicine and appointments. If there is fighting again, they should not flee, as many do when shots are fired, Cordero said.

In that case, they will face a tough choice: run from war and possibly die from AIDS, or stay and be treated and possibly die from war.

"It's a horrible choice," said Francois Mutela, who works in Bukavu with the Catholic Church in the program with Doctors Without Borders. "I think that about sums up our dilemma. But, right now, it's the best choice we have."