The Scrapbook: Outposts

It’s the sort of stuff you read about in the news, and see photos on TV, so I’m not sure that I can reverse any desensitization that many of us feel when we see stories about HIV/AIDS but this particular day changed it for me .

We pulled into a grassy compound with a number of small cottages filled with villagers awaiting treatment for HIV. The patients ranged in age from babies to what we would call middle aged, what Ugandans would call old, about 50. I have only seen two elderly women and one elderly man in my time here, life expectancy hovers around 59. The patients had undergone their various treatments, including the relatively recent addition of anti-retro viral (AVR) drugs, and were waiting for speak to us and help us learn about their lives.

I spent most of my time with a group of teenagers. They were solemnly seated on a bench and appeared deep in thought, their minds, most definitely, somewhere else than here. These kids ranging in age from 13-18 are all HIV positive, all had lost their parents to AIDS, some could not remember when.
Meet John Bosco, Alphanti Kigemuzi and Abdul Kareem

15 year old Alphanti Kigemuzi, in 2nd grade told me in his soft spoken way he would like to be an engineer in the future, he then stopped and amended gently, “if life allows me to”.

Both of his parents are dead. His father died in 1998 and his mother died in 1999. He doesn’t have any brothers or sisters so he lives with an uncle. In his soft spoken way Alphanti told me he doesn’t remember when he became ill or when his parents died. His case is typical. John and Abdul have similar stories.

John, a shy young man, is 18 and only in 2nd grade due to his illness.

Abdul Kareem is 16 lives with a grandfather and doesn’t remember when he became sick although it was quite a long time ago.

These kids at least have an adult caring for them. This area became famous for child-headed families where a child as young as 9 could be raising the children that were orphaned due to AIDS.

It really hit home that these teenagers know their fate is uncertain and in fact the doctors are not sure how their illness will progress or how long they will live. Although they feel less sick now with the medication and say they have no problem taking the drugs, the depression that surrounded the kids was striking. That’s when it changed for me. It’s not often that you have a group of teenagers hanging out together but they didn’t interact with one another, they didn’t exude any of the usual energy that teens are supposed to have.

It’s obvious, even to an outside a non-medical observer like me, that these kids are sick, some of them very sick. I should mention that speaking with the doctors that treat these kids, they are not only hopeful but really proud to share what they have accomplished for these kids primarily with funds from PEPFAR. I asked whether they had many journalists visiting, the doctors found my question really amusing, and laughed out loud, a group of journalists hearing their stories, was an unexpected though much appreciated novelty.

So if you read the previous post, you heard about the Rakai Health Sciences Program, a leader in HIV/ AIDS research that I visited yesterday. And you’ve probably heard about the ABC of HIV prevention: Abstinence, Be Faithful, and Consistently and Correctly use Condoms.

Condoms have been controversial of late, as in order to receive funding from PEPFAR (the President’s Emergency Plan for AIDS relief), the ABC program must comply with the regulations of promoting abstinence over condom education.

Well there’s a new C in town, or to be accurate, there is now ABCC…

What’s the new C? Men, cross your legs, it’s male circumcision.

In 2005, a trial at the Rakai clinic saw a decrease of 51% in HIV infection in circumcised men. This was so significant a number that they stopped the trial 6 months earlier than planned and began rolling out a comprehensive circumcision program, which is now underway.

OK, the skinny on foreskins… Here’s a box of them at the clinic about to be sent off for testing… eek.

Globally, 30% of the men are circumcised. Usually it’s done for religious or cultural reasons. It’s probably the oldest and most common form of surgery. So why does cutting off the foreskin better protect a person from HIV? Scientists suggest it’s effective because cells inside the foreskin are an ideal breeding ground for the virus and allow it be passed on during sexual intercourse. Cut them out, and the breeding ground is gone. And, apparently size does matter; they have figured out that the larger the foreskin, the easier it is to be infected with HIV.

Next, I went to the circumcision surgery waiting room. A group of men from aged 15 to 61 were waiting in line to get circumcised. I tried talking to some of them about what led to their decision, but the uncontrollable giggling that erupted from the group led me to believe they were never going to talk about that decision with me (yes, I’m female). They didn’t mind my taking their picture, though.

Here are the issues:

Currently men from age 15 on are getting circumcised. What’s the right age for circumcision to be performed? Babies, teens, adults? All of the above?

Who should consent for the children? There are a heartbreaking number of families without adults in this district due to parents who died from AIDS. More about those children later.

The doctor-to-patient ratio is overwhelming: 1 doctor to every 18,000 patients. Currently doctors perform the surgery, but that’s probably not sustainable. Who, then, should perform the surgeries?

Should antibiotics be used, or could they create antibiotic resistance within the community?

How do you do appropriate follow up with a remote rural population?

Rakai is trying to answer those questions. And while we are on questions, here’s a rhetorical one: Did you know, on average, it takes 1,000 unprotected sex acts with an infected partner to contract the HIV virus?

Would you like to read more on this circumcision study?

Our guide Sam Nabaasa brought us to see the source of the Nile today. It’s not every day you can say that. And you know what? There were no tourists. Apparently white-water rafting is much more popular as a tourist destination in Uganda. Wonder what it’s like? Check out my very short video with Sam as our guide.
Do I have to specify that the video it’s about the Nile and not white-water rafting? Oh..whatever…..

In the afternoon we had lunch and a very lively discussion with 20 students from law and public administration from Uganda Christian University in Mukono.

The students were passionate about the US presidential primary. They were eager to know how the next president of the US would work with Africa. Senator Barack Obama was the clear favorite with the students; they cited change and racial harmony as reasons. A discussion on HIV/AIDS led to another discussion. A number of students, male and female, didn’t believe that equality between men and women could happen in Uganda. More on that and their thoughts on President Bush and President Museveni later.