World AIDS Day

This is my first World AIDS Day (http://www.worldaidsday.org) away from home, and I know my classmates at Loyola are undoubtedly doing a fantastic job raising awareness at our medical school.

At the Infectious Disease Institute (IDI) at Mulago Hospital (http://www.idi.ac.ug/index.php), a coop sold handmade AIDS pins for all to wear. Lectures took places as well, covering topics such as HIV-related cervical cancer secondary to human papilloma virus (HPV) infection (a huge cancer killer of women in low-income countries, especially in southern African nations).

Unfortunately, I was not able to attend any of the lectures, but I worked in the IDI HIV urgent care clinic in the afternoon. The physician I worked with, who we call Dr. Glen, is a top-tier teacher from Canada, who has been teaching me avidly (avidly requiring me to study again clinically!). We saw three patients with varied and complex symptomatologies today, including one woman with a hemoglobin of 3 (EXTREMELY low) and advanced cervical cancer. On exam, she had bloody vaginal discharge, an ominous sign of cervical cancer. There were probable masses in her abdomen as well and she had urinary blockage which could have been due to an obstruction of the ureters which connect to the bladder to the kidneys or urethra. She was about to start blood transfusions when I left for my weekly investigator’s meeting on Mondays. Her story is all too familiar here.

I think another man’s story typifies and captures HIV’s relation to poverty in many parts of the world. The first day I started shadowing Dr. Glen in the HIV IDI urgent care clinic in October, the first patient I saw with him was a man who very recently found out he had HIV. He was training to be a mercenary in Iraq, which pays very well compared to most jobs in Uganda. (You may recall from a previous post that the gentleman who washes my clothes was also on the mercenary career path at one point). The man (patient)said that he was hoping that he didn’t have an HIV diagnosis. We asked why. He said something to the effect of, “Because they won’t let me be a mercenary if I’m positive, and I need the money.” One would think he wouldn’t want HIV for the health reasons, but in this case HIV was a threat to employment first and foremost. The intervening desperation could not have been more apparent. His story resonates with the stories of many in Kenya my colleagues and I found in surveying in 2006, i.e., the most important concern in a community with notable HIV prevalence per our research was unemployment/lack of jobs.

Here are some Uganda HIV/AIDS statistics:

-A 2004-2005 report cited in a UNAIDS document (http://data.unaids.org/pub/Report/2008/uganda_2008_country_progress_report_en.pdf) states a prevalence of HIV at 6.3% in the population aged 15-49. The percentage is higher in Kampala (10.1%) and some rural areas and lower in other rural areas (average 5.7%). The prevalence rate in women is 7.5% and 5.0% in men.

-Although there is still more work to be done, prevention of mother to child transmission of HIV (PMTCT) continues to improve with less HIV+ being born.

– The percentage of children who are orphans and vulnerable was 20.7%. The percentage of children with one or both parents dead is 14.9% while those who live in a household where at least one adult has been very sick for at least 3 months in the past 12 months is 4.7%. The percentage of children who have lost both parents is 3.1%. The percentage of orphans attending schools is 81.9%; while those who have shoes, two sets of un-torn clothes and a blanket are 24.8%.

It is perhaps really easy to paint a bleak picture on World AIDS Day. I don’t think good news diminishes needs or the focus that should be paid attention to HIV, at least it should not do so; many good things are happening that must be said in order to continue good work and call for more, especially regarding access to medication and economic empowerment. Hope needs to continue to be promoted and collectively we can all give substance to such hope. 

The U.S. President’s Emergency Plan for AIDS Relief (PEPfAR: http://www.pepfar.gov) is one of those good things that has changed lives, here in particular. Programs such as this one need our continued support and scrutiny. HIV is health issue, a human rights issues, an international security issue, a poverty issue, an economic issue, a religious issue, a complex issue encompassing choice, lack of choices, violence (rape), responsibility, vulnerability, and an issue like so many others that gives rise for each of us at the individual or societal level to ask, how shall I treat my neighbor? Care, hope, empowerment.

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