I didn't think much about AIDS before I moved to Kenya.
It was the stuff Lifetime Teen Choice Movies and board questions were made of.
There was the occasional patient - referred to the infectious disease specialist.
Now, I think about it every day. I have to. On any given day, I typically have one or more patients on the ward with HIV. Sometimes they are pregnant, sometimes not. Sometimes on meds, sometimes not. Sometimes its a new diagnosis......are they in PEPFAR...are they breastfeeding.....
So, in response, I have found myself reading more and more about HIV.
· Africa accounts for 14% of the population of the world
· Sub-Saharan Africa accounts for 68% of all HIV infected adults, 90% of HIV infected children and 76% of AIDS deaths.
· Southern Africa (Botswana, Lesothu, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe) has the highest prevalence of HIV; Swaziland being the greatest at 26% of the adult population (age 15-49 years).
· Proposed reasons why Southern and East Africa have higher HIV than other regions: lower rates of circumcision, greater gender inequality and regular concurrent sexual partners. (**Notice I did NOT list promiscuity, more sexual partners, the unavailability of condoms or lack of religion.)
From Manson's Tropical Diseases, 22nd Edition
And I'm finding the best reading isn't in the textbooks. I am becoming fascinated with the
culture and
fight against and how much medical school
did not teach me. In her book,
The Invisible Cure, public health specialist/molecular biologist,
Helen Epstein disspells some of the myths regarding AIDS in Africa. Epstein became involved in AIDS research when she was commissioned to Uganda to help with research for a potential AIDS vaccine. Her observations and research is not only a good read, with lots of I-know-that-feeling! moments for anyone who has ever tried to do anything in a third world country, but it has also started to make me realize that maybe that there are a lot more layers of complexity to treating AIDS in Africa than I ever imagined.
I am including some of my favorite quotes below - at the risk of pulling a Jim Carrey movie trailer trick and revealing all the good parts - I assure you that this book is worth the time to read it! Oh, and the sarcastic, not very useful comments in parenthesis are just mine....
From Helen Epstein's,
The Invisible Cure: Africa, the West and the Fight Against AIDS
…I learned early on that the most successful AIDS projects tended to be conceived and run by Africans themselves or by missionaries and aid workers with long experience in Africa – in other words, by people who really knew the culture. (American paternalism, exit stage left, thank you very much!)
There would be power cuts and water shortages and broken toilets and stuck doors and cars that started only when you kicked them. Most of the time, someone would find a way of rigging things to avert disaster.
I began to feel as though I had landed in a fairy tale where everyone is evasive and ignores appointments. (HA HA HA)
Much of the stigma and confusion surrounding AIDS has to do with its common association with perceived “irresponsible” or “immoral” sexual behavior.” (This is an obvious statement - but it has far-reaching implications: denial of diagnosis, delay of testing, even not the reluctance to reveal test results on the part of both patient and caregiver alike. And many times, the patients I see, are not "high risk" - they have had one or two sexial partners, no history of drug use or transfusion, and they are pregnant.)
Urging African people to abstain or be faithful has its limitations too, because most people are faithful already, if not to one person, then to two or three.
The greatest error the researchers made was to assume that any poor person can just go out and start a business. Many of them just can’t do it on their own.
Distributing even relatively simple drug regimens on a large scale basis in Africa poses formidable obstacles. Many African health facilities lack trained and motivated staff,adequate management and administrative capacity, and sufficient supply of medicines, vehicles, refrigerators, lab reagents, and other basic equipment. Some lack water, electricity and even intact buildings.
…20 percent of African women who tested positive for HIV experienced some sort of negative outcome if their husband or boyfriend found out.
