Remembering the Individual

When we talk about HIV/AIDS, we do so rather epidemiologically and demographically.  We talk about percentages, about incentives, about behavior change on a larger scale.  These are all important and they are the basics of public health.  If one is going to really impact an epidemic or a pandemic, looking at statistics and general trends is important.  I just worry the individual is getting lost sometimes.

Working on HIV/AIDS anywhere is a challenge.  Trying to get people to change their eating habits is difficult--forget their sexual habits!  As we aren't fluent in Setswana, Peace Corps volunteers try to do what they can.  We show videos in schools to have kids discuss HIV-related topics, we organize educational events for the community, help organizations write proposals and request money...the list goes on.  What we don't do a lot of is counseling people.  We simply don't have the language to do it, and most of us don't have the necessary skills.  So even though we support HIV-positive people and see the lines of people waiting for their ARVs (anti-retroviral drugs) at the clinic, we don't always know if the people we are working with are HIV-positive or not.

Because HIV is talked about everywhere, is widespread in Botswana and it is obvious who is getting ARVs at the clinic, we oftentimes think that HIV is accepted, or somehow not a big deal to locals here.  I have heard some locals who dispense ARVs in clinics and hospitals say things like:

"Well, they just don't even care.  They flush the pills down the toilet.  They come late for their refills.  These people just don't care."

It is true that ARVs are an issue here.  They are given relatively free of charge to everyone who needs them.  These drugs cost thousands of dollars per month and the government is just giving them out.  So, looking at it in terms of incentivizing, as we often do, brings about conclusions that somehow the drugs aren't valued...or gives people the liberty to be careless with them.

But all of this ignores one thing: the human aspect.  When that woman comes in from the cattle post and pays money to hitch a ride to the clinic to refill her ARVs, she deserves to be treated with respect.  If she missed some pills, she may not want to tell you why.  Perhaps her husband wouldn't let her come back early enough to get them.  Perhaps her child was sick at home.  Assuming that people "just don't care" is hurtful.

HIV-positive people in Botswana are our friends and co-workers.  But what if one were your mother?  Your father?  Your husband or wife?  Your sister?  Your brother?  Would you feel differently about the woman waiting in line to get her ARVs?

What if it were you?  Would you feel that you have the right to have kids, even if you are HIV-positive?  And if you didn't have money for artificial insemination and sperm washing?  Would you have sex with the person you loved, risking spreading the virus, simply because you wanted a child?  Maybe you wouldn't.  But maybe you would.

And that's what I want us to remember.