Wednesday, December 1, 2010

Reflections on World Aids Day

Back in Zimbabwe behind my grandparents homestead in Chivi, in the Masvingo area, there is a sacred burial ground which is named the hero’s acre. I guess this is in reference to the National Heroe’s Acre in Warren Hills, Harare, where Zimbabwe’s national heroes are buried. I guess my grandfather thinks his children and grandchildren are heroes in their own right too.
 Anyhow, the hero’s acre in Chivi is strictly devoted to our family members who have died of HIV/AIDS. In 2006 there were 22 people ranging from ages 6 months to 49 years old. To put that number into some sort of perspective, I come from a huge family, some of whom were born after I left Zimbabwe. However 22 people in the space of 10 to 15 years is pretty sizeable for only one family. It is these deaths and the devastating effects that HIV/AIDS has had in Zimbabwe that I decided to specialize in HIV research when I first came to America. Initially I was interested in HIV vaccine development and so I enrolled as a doctoral student in the department of molecular biology and immunology at the Johns Hopkins Bloomberg School of public health. After completing the didactics I wrote a proposal for my research project which would see me in Hauna district in the Manicaland Province of Zimbabwe.
There I conducted an HIV prevalence survey with a sample size of five hundred. My analysis would later reveal a 25% prevalence rate in that particular region of the country which borders Mozambique and Malawi.
While all aspects of this project were important for my thesis, the part that touched me in a transformative way was the different groups of people I got to interact with and to talk with about their perceptions of HIV/AIDS. There was a lot of denial in Zimbabwe and early on in the epidemic the denial was institutional where hospitals did not give a diagnosis of HIV/AIDS. Rather they would write the secondary infection the patient had presented at the hospital or clinic with, such as Pneumonia, or tuberculosis or cancer. At the time I went to do my study, in early 2001, the situation had changed drastically, with the influx of international aid agencies and other nongovernmental organizations spearheading prevention and education campaigns.
I lived in Hauna very close to the hospital where most of my study sample came from. I also drove to outstation clinics to conduct my interviews and do HIV tests on those participants who consented.
I met a group of commercial sex workers (15 of them) at one of the outstations. They were part of a peer education group and wore T-shirts with slogans to encourage their fellow commercial sex workers to get tested. This was one of the most vibrant, generous and wonderful group of women I have ever had the privilege to work with. They were a lively bunch who danced for us  petted my protruding belly, massaged my swollen feet and brought me yams and avocados to “feed the baby”.  I drove out to where they were based in the foothills of the lush Katiyo tea Estates and listened to story after heart breaking story. One woman in particular spoke of how she had no choice but to become a commercial sex worker and risk getting infected with HIV because she had children to feed. The thought of watching her children starve to death is what kept her going in this trade, playing Russian roulette with her life. There was no negotiation of condom use in most cases.
Because of the main road that passed through Hauna to Mozambique, I had the opportunity to meet and chat with truck drivers who ploughed the cross border route, stopping at growth points for refreshments and “adult entertainment”. Hauna was one such growth point. They were rather amused to see a heavily pregnant woman who had the audacity to question them about their sexual behavior, which was still a very hush hush subject.
What I came away with from this experience was that while an HIV vaccine was definitely worth working towards, it would be a long time in coming. I also realized that I needed to be where the people were, to try to figure out why it was that, despite knowing about HIV/AIDS, knowing also that it could easily be prevented with condom use, people continued to engage in high risk sexual behaviors. There was a fatalism that frightened me as I listened to people say they would rather not know their status and some of this was due to the fact that people knew there was no cure. Therefore the knowledge that one was HIV positive was in essence a death sentence many people did not want to live under. Drugs were available but at such exorbitant prices that only the very wealthy could afford them and even they soon succumbed to full blown AIDS when their wealth was eroded by fantastic inflation rates. At that time there were very few government programs for HIV drugs and these were mainly in the urban centers.
Women whose husbands refused to use condoms yet went around philandering were the most vulnerable. We looked on helplessly as husbands would get sick and die. A few years later the widows would succumb to AIDS and die, leaving behind orphans in the care of grandparents or other family members. Not long after this the grandparents would die of old age or fatigue or both, leaving behind child headed households. The 10 or 12 year old would drop out of school in order to fend for his or her siblings. All this was unfolding and the AIDS epidemic was ravaging the country, which was also falling apart at the seams politically and economically.
 At the peak of the epidemic Zimbabwe was experiencing hyper inflation as never before seen in history. There was a mass exodus of doctors and nurses many of whom were fed up with working under frustrating conditions. There were no drugs to treat patients. Patients had to buy their own surgical paraphernalia (sutures, medication, antibiotics, gauze) and place a huge down payment before they could be attended to.  Public health became nonexistent and those with family members in the Diaspora fared better than the rest.
I will never forget the faces of my study participants who tested HIV positive and had opted that I tell them their results. I hated what I was doing because here I was delivering such news to someone and having absolutely nothing to offer them except, that hopefully my research would advance the quest for a vaccine, and a cup of Mazoe orange crush for their time.
Often I would go home in the evening with my nurse Memory, and I would ask her how she was so adept at leaving her work out in the field.
‘We are so used to this. We are at funerals every weekend and sometimes as they are lowering the coffin in one grave you are rushing off to another graveside for another relative. We have become accustomed to the walking dead among us. You can pick them out as you walk along the streets: pink lips with blood vessels almost bursting under thin membranous skin, the huge lymph nodes behind the ears, the dull ashy skin covered in a fine rash that refuses to heal, the thinness that does not respond to any amount of food and the babies that are born but never grow and mew like kittens. I guess after a while we have become numb, desensitized from living in this society. We don’t even cry at funerals anymore. It’s so sad because it is as though we have lost our souls and we can no longer mourn. Or maybe our grief is so huge that if we allow it expression, it will annihilate us.’
Many a night I cried myself to sleep, thinking of the young woman married to a soldier deployed in the Democratic Republic of Congo. She had come for a test, confident that she was HIV negative because she had recently delivered a healthy baby boy. She had emitted a dry hollow creepy laugh when I told her she was HIV positive. Then I saw the curtain of despair fall over her eyes. Later that week rumor circulated at the growth point that a young woman had been found hanging from a tree, behind her sleeping hut leaving a baby boy sleeping in there. Her mother in law had discovered her. Apparently her husband worked out of the country…
Today as I reflect on my own journey I realize that HIV/AIDS has touched my life and the lives of many people I know. As I write this post I am thinking of all my family members, who thanks to medication are alive today and living their lives to the fullest. I will continue my work in the field of HIV both In Zimbabwe and here in the United States where my research is within the African American community. This disease knows no borders and knows no barriers. It is no respector of persons, it is aggressive and  it will take a great deal of ingenuity, patience and great passion both in the primary prevention, the drug development field, and vaccine research to dominate it and hopefully render it a disease in our history (much like the plague), rather than in our present.

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