World AIDS Day

World AIDS Day is December 1st of each year. It seems like every cancer, disease or profession has a “day” assigned to it. Usually, those days are passed with little notice expect those who are affected or infected by the disease or profession.  I used to get flowers when I was an administrative assistance on administrative assistant day, celebrate the nurses I worked with on nurses day, do a walk for breast cancer and so forth.

World AIDS Day had a special meaning this year.

In America, HIV/AIDS is still primarily found in certain population groups. Injection drug users, men who have sex with other men and minorities are the affected groups. In most cases, clinicians don’t discuss HIV/AIDS with the “average” patient. The average patient being a straight man or women who  may or may not have behave in risky sexual behaviors. Since about 2008, I have volunteered with nonprofits who provide testing, counseling and case management services to HIV+ individuals. I have given HIV test and had to break the news (on more occasions than I would like to think about) that an individual is HIV+. Saying those words “you are HIV+” is one of the hardest things that I have ever had to say.

HIV in Africa is a different beast. HIV in Botswana is a different beast in comparison to the rest of Africa.  In Botswana, 25% of the adult population (18 and older) is known to have HIV or AIDS. Just over 2 million people live in Botswana and of that 2 million residents---33% are under the age of 14 and an additional 22% are between 15 and 24 years of age. If you do the math, having 25% of  the adult population infected with a disease is substantial.

Last week, just before school let out, we commemorated World AIDS Day. The student body led speeches, dramas and choirs unifying the student body. I was really quiet impressed. Shocked actually by the student bodies effort and commitment to carrying out the event.

The theme for this years AIDS Day in Botswana was around “zero new infections, zero discriminations by 2016” Truthfully, I wasn’t that impressed with the theme. So I modified it. I wanted my kids to think about what they can do, how they can be accountable. So I stressed the idea that “We are the Future” If I don’t get anything into my kids during the time that I am here-I want them to take away the idea that they and they along are responsible and accountable for their actions. So having changing the them to “we are the future” seemed appropriate. Our dramas and speeches were all centered around that ice of our personal accountability.

The equivalent to the student body president quoted JFK “ask not what your country can do for you, but what you can do for your country” Of course, he knows little of JFKs involvement in the Peace Corps and why I am in their lives….and as Americans do in touching moments I tear up (and the kids stare at me).

Botswana is fortunate. During the height of the AIDS pandemic the president made a call for action and implemented life saving programs such as free ARVs, currently if  your CD4 count is under 250, you qualify for free ARVs. Health care is universal, there is a plethora of aid being pushed into Botswana--PEPFAR, UNSAID, UNAIDS, ACHIP,  partnership programs from Harvard, UPenn to name a few. Botswana is also a country that isn’t plagued by corruption. Botswana is blessed with huge mineral wealth. Botswana has really made an attempt to half HIV in its tracks.

But for the amount of money and effort going into HIV/AIDS in Botswana, it isn’t enough. The reality is: people are still dying, condoms aren’t being distributed because the clinics are out, HIV tests aren’t being given because the clinics are out, Doctors can’t visit rural health posts due to transport. Patients don’t come to follow ups because there is no transport to the clinics. Stigmas still exist. People whisper if you are too thin, if you sweat too much or if you have cold sores. Transactional sex happens all the time, people have concurrent partners, myths surround condom use, women aren’t empowered enough to demand condom use. At times, it seems that people are almost apathetic about it. HIV/AIDS education is infused into every curriculum in school and is constantly being discussed on the news. Dare I say, that the familiarity of HIV/AIDS has taken the fear out of it.

I am not meaning to come across negatively. It breaks my heart to see my students being raised by their grannies because their parents are “late” (dead), it pains me to see students who I suspect have HIV. I breaks my heart that an entire generation is missing their parents due to a disease. A disease that is preventable, a disease that will forever be stigmatized because it is transmitted by sex (and sex is taboo).

I encourage you all to take a moment, the next time you are at the doctor to discuss HIV. Just because you are in America, doesn’t mean that you are not at risk.

Know your status, get tested. I do, I am HIV negative.