Today is World AIDS day. I spent this particular Monday the
way I will spend two Mondays a month for the next two years: working in the
clinic on ARV day. With a room packed full of HIV patients waiting to see the
nurses, the importance of having World AIDS day could not be more clear. I
spend these days filling up charts and looking for patient folders. I will
spend hours later inputting the results of CD4 counts and viral load blood work
once it’s all processed by the lab. And I will occasionally help the clinic’s
pharmacist organize the huge piles of pill bottles that keep people alive.
I haven’t been here long enough to know everything about how
the process works, but I can write about what I do know. Botswana has one of
the highest HIV infection rates in the world. In 2002, the government purchased
the three-drug combinations of ARV knows as HAART (highly active antiretroviral
treatment) and started training physicians and nurses to treat HIV patients.
Today, Botswana provides free testing and treatment to all of its citizens.
When I talk to people about what it was like in Botswana in
the 1990s, I am always told the same thing – terrible. People don’t like to
talk about it much, since virtually everyone lost friends and family to AIDS,
but when they do, you get a window into the sense of the fear, uncertainty, and
loss that was experienced at the time. People talk about the overwhelming
number of funerals the most.
To commemorate this day, I started reading Saturday is for Funerals by Unity Dow
and Max Essex. The book is made up of short stories of the lives of people who
were affected by HIV in Botswana. Each story is then accompanied by a
scientific explanation of different facets of the epidemic. The back cover of
the book reads, “In the year 2000, the World Health Organization (WHO)
estimated that 85% of fifteen-year olds in Botswana would eventually die of
AIDS. In Saturday is for Funerals we
learn why that won’t happen”. That statistic is devastating and terrifying, but
it also makes the progress Botswana has made even more astounding. People can
now have healthy, full lives while living with HIV. That fact was unimaginable
in the 90s.
There are still countless challenges to dealing with HIV.
There are issues with adherence, side effects to medication, non-concurrent
partners, and convincing people to get tested and use condoms, to name a few.
At the clinic I also see some of the pressing logistical issues that come with
treatment. People show up at 7:30 in the morning at the clinic, and then wait for
hours and hours until they can see a doctor. The doctor for our clinic can only
come twice a month for ARV day since he works at many clinics in the region,
but sometimes he gets pulled away for conference, and the nurses are left with
frustrated patients. Despite all the progress that has been made, there is
still stigma and shame associated with acquiring HIV. Furthermore, Botswana has an indirect culture
when it comes to addressing sexuality, which can make it more difficult or
awkward to discuss health issues like STIs or safe male circumcision. For
example, the word for condom in Setswana is sekausu, which means sock and the
phrase used for sexual intercourse translates to ‘sharing a blanket with
someone’. Finally, many parents simply do not feel comfortable discussing safe
sex with their children.
Anyway, this morning I read an article on al-jazeera stating
that the world may have reached a turning point in the fight against AIDS.
According to the article, “the number of people newly infected with HIV over
the last year was lower than the number of HIV-positive people who joined those
getting access to the medicines they need to take for life to keep AIDS at
bay”. I felt like my heart was going to burst with joy. The article went on to
state that back in 2010 only 5 million people were receiving treatment
globally. This year 13.6 million people are getting their pills.
But the fight is nowhere near over, and the global response
needs to stay aggressive and fully funded. I was reading some speeches by Paul
Farmer the other day and he strongly criticized the lack of imagination
exhibited when it comes fighting global epidemics. He also consistently fights
back against arguments of cost-effectiveness that are used as excuses not to
support global health initiatives. When treatments for HIV were just starting
to be produced, a study found that it would be ‘28 times more cost-effect to
prevent new HIV infections than to treat people who already have AIDS’. Despite the horrifying implications of that
sentence, dedicated public health practitioners fought and won to have HIV
treatment more available around the world. And it turns out that AIDS
medication costs have decreased to a fraction of their original prices. Not
only are they affordable, but it also turns out that ARV reduces transmission
to other people by 96 percent. Proper treatment is part of today’s prevention
and it would not have been possible without the rollout of generic ARV drugs. The
world is facing a new health crisis as well with the ebola outbreak in West
Africa that has already killed over 7,000 people. The international response
and support has been slow to say the least. I can only hope that dedicated organizations
like Doctors Without Borders get the support they need to help get the outbreak
under control.
I never know how to end my blog posts, but I’ll say thank
you to anyone who stuck with it and read to the end and I do hope that anyone
who reads this chooses to stay informed and supports global health initiatives.
That’s all for now!
Sources:
Saturday is for
Funerals by United Dow and Max Essex
To Repair the World:
Paul Farmer Speaks to the Next Generation by Paul Farmer
Al-jazeera news online
