HIV

As you know HIV/AIDS has had a devastating effect on this continent. The prevalence is high. A huge proportion of Mukinge's hospitalized patients are HIV positive. ARV's (antiretroviral drugs) have been readily available for several years and are having a huge positive impact in decreasing the human suffering related to this disease. Unfortunately, when people see the positive impact in others, it lessens the sense of dread and motivation to prevent the disease (no sex outside of marriage). There is a risk of an even more casual attitude with regard to sex.

There is significant fractionating of care with regard to treatment. The government has established a system of clinics for aids testing, counseling and treatment. These are run by clinical officers and there is one at Mukinge. If we want to start someone on ARV's we send them to the HAART clinic (highly active antiretroviral treatment - usually a cocktail of several drugs). The CO's will then start them on the drugs and do the cd4 testing, etc. Unfortunately there is no effective communication back about what they are on and what their cd4 counts are, etc. Again causing us to be "shooting in the dark" (somewhat unnecessarily in this situation).

If HIV testing is desired, we send them for ctc (counseling, testing and care). If they chose to have the testing done the result is sent back to the chart in the form of an even number (positive) or an odd number (negative). They go to great ends to protect privacy and you will not see the acronym HIV on any chart - they talk about people being "retroviral disease" positive or negative (rvd+ or rvd-). It is all a little odd since they have simply created another word which patients will soon understand to mean HIV.

There are some interesting cultural /societal issues around HIV too. When I was here 20 years ago the whole AIDS thing was attributed to a myth perpetuated by america (I saw some graffiti back then that said American Idea to Discourage Sex (AIDS)). Initially the government buried their head in the sand. In the last decade or more though there has been an active education program and in the last several years the ARV treatment is widely available.

One other odd cultural idea is that you can rid yourself of AIDS if you sleep with a virgin. Unfortunately young girls have been sexually abused because of this myth and bear the psychological and medical consequences.