This is the second part of a true story told through a friend, a first person account of the life of Nhlanhla , a nurse in a Sub-Saharan country afflicted by HIV and AIDS (read part 1 here). Names, places and minor details have been changed to protect people’s privacy. It is a story of fear, stigma, discrimination but also of hope, the everyday story of a young woman whose life, on revealing to her family that she is HIV positive, spirals into hell and despair.

“A few days later I visited Nhlanhla at home. She had found a nice little home for her family, and I tried to say what an achievement that had been. But the house is a very long way off the main road and with no services around at all. There is no electricity or running water. They have to buy water and coal – but when I was there they had very little water and no money for coal so were cooking with wood. Her mum is a lot sicker than she had led me to believe and can hardly move – she sat vacant on a mat the entire time I was there. Her children were there when I visited but have since gone to two different relatives in order to access school – and I have no idea how Nhlanhla has managed the school fees for both but am guessing this is why she is so broke. Her sister is younger than her and obviously very submissive, and after meeting her I could better understand how the second suicide attempt happened at home as she really is not in a position to intervene (this is difficult to explain but she is like the house keeper who is completely financed by her older sister, so is not suppose to challenge her older sister, if that makes sense). I also met Nhlanhla’s aunty who lives elsewhere. Nhlanhla has only disclosed her HIV status to this auntie’s husband but he recommended her not to tell any of the other family members! This aunty is her late father’s sister – and it is her blood line relatives who threw her mother, sister and children out of the paternal homestead on accusations of witchcraft and threatened to burn them to break the spell – hence leading to the house in this area. So basically Nhlanhla really does not have any other family to go to and has no contact with any of her mothers kin at all.

When I was there Nhlanhla told me she had not taken her anti-depressants that day as she felt ‘too tired’. I again expressed the need to take them every day and each day I have spoken to her since she confirmed she had taken them. She went to a GP in town for pains in her back (not her own GP as she couldn’t get an appointment) and he gave her pain killers and sleeping tablets (she assured me she told him about the anti-depressants).

She had agreed to go to her own GP about starting ART treatment, and she did visit him. The back pain was still there so she had an X-ray which apparently identified a lung infection but she couldn’t tell me what type – so she is now on antibiotics as well. The GP wanted to admit her to hospital but she refused. The GP wanted to do another CD4 count before he started her on treatment (her last count was 167). Apparently her main concern about ARVs is a common side effect here of extended breasts and stomach. I have spoken to a friend of mine about this who works in the Department of Health services. He says this is mainly related to D4T in the first line regiment. She is completely refusing to go to the government services as she feels everyone knows her there. So we have advised her to speak to the GP about swapping D4T for AZT. In this way if her private health insurance through work runs out and she transfers to the DoH services then they will continue her on AZT and this will reduce the chance of the side effect she is most concerned about.

Nhlanhla is due to go back to the GP and I have asked one of our doctors to speak to her and offer to accompany her. She is officially back at work and her direct line manager at the clinic was the person who eventually found her after the first suicide attempt so knows about her situation – but she still refuses to disclose her status to her manager. She wants to be back at work to take her mind off other things and keep her busy. Her manager will keep a close eye on her at the clinic and I am hoping this will support our efforts to get her into regular psychological sessions.

As you can see this is not a simply case – she is obviously seriously depressed and the psychologist does not think that she is out of risk yet in terms of being about to make stable and rational decisions. I am also worried about her declining CD4 count – she had a number of quite extended illnesses. I really hope that she does start ARV treatment soon.

It is funny that in writing this down it almost feels like we are all too involved – but unfortunately this is the reality of this area in terms of the support that people need. It is all very time consuming and emotionally draining for all involved – but hopefully we will get her through! As usual the main people are offering all their support despite having their own challenges.

I am always reminded how lucky I was to just happen to be born in the UK!”

Nhlanhla’s mother died a few months ago.

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