peripheries

Once in Africa, an HIV Story (Pt. 2)

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.

Once in Africa, an HIV Story (Pt. 1)

This is 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. 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.

“Over the year, Nhlanhla has faced many challenges in finding out she was HIV positive, receiving a terrible response from her church members when she tried to disclose her status, so withdrawing again, getting herself in terrible debt with shop cards on the basis that she expected to die, her family being chased away from their home by her late fathers relatives on the accusation of witchcraft, her mum ending up in hospital seriously ill, and her holding the sole responsibility for supporting her mother, sister and her own children. This was confounded when we identified that her CD4 count had dropped below 200 and she was ready for treatment. Given the experience of the previous year the doctors and I knew that this would be a difficult step for her to take.

Then, Nhlanhla attempted suicide. Thankfully we had been reading the signs and as soon as we got an indication that she had committed to the attempt we were able to intervene. It was a very stressful time for all the staff involved who were frantically trying to find her after she had taken the overdose. After a few days in hospital she was discharged but unfortunately tried again the following day.”

In preparation of her being discharged a second time “the team had really pulled together to try to support Nhlanhla and we have had amazing support from a psychologist. He had established a support structure for her that includes her family, her team members involved with the case, a doctor at the hospital and himself.

Nhlanhla was discharged from hospital and collected by one of our staff. The plan was for her to be taken directly to the psychologists private practice in town who, as a favour to me, had offered to provide a planning session with Nhlanhla and her sister. Nhlanhla waited until the psychologist came out and then she left. Unfortunately the psychologist had to return to his office and by the time he came back out to the waiting room Nhlanhla had left on her own claiming she was too tired and had to go home. Even in the psychologists office she did not even introduce her sister and neither was she greeted by her. In my book these are all really bad signs that Nhlanhla is not acknowledging that she has ongoing psychological problems she needs to deal with, and she certainly does not appear to have the support from her sister.

Nhlanhla obviously has a number of problems that need to be addressed, but a very clear stress trigger for her is that when her family were chased away from their home, she was forced to buy a basic home in this area for her family. She has managed to clear a lot of the cost of the house, but she still owes quite a lot of money. She is now overdue on her payment since a few month and the landlord is threatening eviction.”

A collection was organised amongst friends as officially giving loans to staff was not allowed. No return was expected “but the reality of people’s lives is such that it is impossible to ignore the hardship. I just thought that instead of us all waiting for someone to die before we contribute, this time our contributions may actually reduce the risk of her attempting suicide again and hopefully give us more time to encourage her to start treatment.”

To be continued…

South Africa: HIV officially causes AIDS

During the opening ceremony of the 2008 AIDS Vaccine Conference in Cape Town, Barbara Hogan who was recently appointed Minister of Health following the demise of Dr Beetroot, said “We know that HIV causes Aids”.

It was a “breath of fresh air” reacted Alan Berstein, executive director of the Global HIV Vaccine Enterprise.

Unfortunately I missed this historic moment but the Cape Times reports that Mrs Hogan is confident that a reform of the health system is possible and will scale up treatment to prevent mother-to-child transmission. She also challenged scientists and researchers to work harder and faster to develop an HIV vaccine in the coming years.

Twenty five years into the epidemic, South Africa has the highest number of people living with HIV, more than 5.5 millions.

[email_link]

South Africa Appoints New Health Minister

Kgalema Motlanthe sworn in as South Africa’s president replacing Thabo Mbeki has appointed Ms Barbara Hogan as Minister of Health and Dr Molefi Sefularo as the Deputy Minister of Health.

Barbara Hogan who was pushed out of Parliament in 2003 in part for her refusal to accept Mbeki’s denialist stance on AIDS, is taking over Manto Tshabalala-Msimang more commonly known as “Dr Betroot” for promoting the value of lemons, garlic and betroot instead of antiretroviral medicines to combat the spread of AIDS.

In a statement, the Treatment Action Group (TAC) said Barbara Hogan “has a reputation for being hard-working, competent and principled. Hogan has a long record of struggle for human rights. Twenty-seven years ago, she was detained and tortured by the apartheid security Police. She was tried for treason as an ANC member and spent eight years in prison” (Interview of B. Hogan before her appointment).

TAC recalls that 300,000 AIDS-deahts could have been avoided if Mbeki and Msimang had not pursued “a policy of politically supported AIDS denialism and undermined the scientific governance of medicine“.

There is now hope and great expectations that the period of politically supported AIDS denialism has ended in South Africa.

[email_link]

Global vs. targetted HIV prevention: Building on sound ground

It is revelation’s time for AIDS Inc. Two months ago Kevin de Cock, the epidemiologist heading the HIV-AIDS program with the World Health Organisation, briefly acknowledged, before recanting, that the threat of an heterosexual AIDS pandemic outside of Africa had disappeared and this month at the XVII International AIDS conference in Mexico, it was finally recognised that “a giant wave of infections moved like a tsunami through communities of gay men in Asia, Africa and Latin America” as The Sidney Morning Herald puts it.

“Men who have sex with men are now nearly 20 times more likely to be infected with HIV than the general population, yet they often receive as little as 1 per cent of global funding.”

Quoting Kevin Frost, the chief executive of the American Foundation for AIDS Research (amfAR), The SMH adds that “The story is one of abject failure on the part of the institutions that have been charged with leading the response to HIV/AIDS at local, national and international levels” and that “Men who have sex with men continue to have little or no access to HIV services of any kind and as a result are plagued by high rates of infection.”

A giant step towards a better understanding of the HIV epidemic but still a small step towards long-awaited programmes targeted at Men who have Sex with Men, and this for many reasons. One being that most countries where the HIV epidemic is moving like a giant Tsunami wave are still in complete cultural denial of the existence of MSM, from government to civil society and to MSM themselves. The other being that there is no such thing as an MSM community at least in the sense we understand it in the West.

This really is big problem that has yet to be recognized because throwing money in the air hoping the wind will blow in the right direction won’t be very much effective. Indeed there is no “Castro” in Bangkok where HIV prevalence amongst MSM recruited in MSM venues is over 30%. There is no “Soho” in Kuala Lumpur, no “Marais” in Phnom Penh. No Pink Paper in Singapore, no Gay Times in Shanghai. No Elton John in Luang Prabang. In short, there are not many “Gay lighthouses” in the East, not as we can identify them in the West.

Instead, as reported in 2003 in a review of knowledge about the sexual networks and behaviours of men who have sex with men in Asia by Dowsett, Grierson and McNally from Latrobe Uiiversity,

“The literature reveals that there are no socially or self-defined groups of men that fit into an overarching category of MSM. What the review shows is that there are just men!! Fishermen, students, factory workers, military recruits, truck drivers, and men who sell sex, and so on: all these categories of men are to be found in the studies and programmes reviewed.”

There were no similar traits in all of the MSM population studied other than them being males, and engaging in sex with other men.

In other words, for those familiar with the London scene: MSM in Asia don’t go for a drink in Soho reading QX before going for a meal in Balans and clubbing in G.A.Y or Vauxhall or to see Kilye in concert. Not all Gay men in London (here we can use Gay instead of MSM) have this lifestyle but many had or will and were or will be accessible at this point in there life.

The question and the challenge is “How does one design programmes specifically targeting or aimed at MSM in Asia when they don’t exist only as such?” Could it be that general prevention could be more efficient? The jury is not out yet because there is little to judge on. But the coming years will be crucial.

[email_link]