Monday, December 01, 2014

World AIDS Day

Today is World AIDS Day, a day that I do not remember acknowledging after graduating from college over a decade ago. Now, however, living in Lesotho, it takes on new significance.

Lesotho has one of the highest HIV rates in the world. A year ago, as I was preparing to move here, it was the third highest rate. In my invitation to serve, Peace Corps stressed the realities this brings by noting that I would make friends and they would die during my two years of service.

Now, I am a few days from my six month mark and the real impact of living in a place with such a high HIV rate is still sinking in. In the meantime, the county has moved and now claims the second highest HIV rate in the world, having just surpassed Botswana.

What are the implications of nearly one in four people in a country being HIV positive? There are too many to list them all, however, here are a few:
-An unusually high number of orphaned children in a country without the resources to provide for them. According to UNICEF, 150,000 children are orphaned by AIDS. Keep in mind our population is under 2 million, so that is around 13% of the total population in Lesotho.
-A life expectancy of only 48.7 years.
-A high number of HIV positive children due to Mother to Child Transmission.
-People being afraid to get tested because of strong stigma associated with being HIV positive.
-Economic issues in a country that is already impoverished. Consider what it means when a large part of the population either has HIV or has a family member with HIV, they may be unable to work, tend their gardens for food, or otherwise help their family but they still need money for transportation to the clinic and good nutrition is even more critical than for someone who is HIV negative.

My Peace Corps program is called Healthy Youth. Designed with the Lesotho government, it has three main goals:
1-To help youth adopt healthy behaviors that will decrease the spread of HIV.
2-To help infected youth apply behaviors that mitigate the impact of HIV/AIDS and improve their quality of life.
3-To help youth in areas impacted by HIV (all of Lesotho) to be prepared for adulthood and the professional world.

It is my job to try and counteract some of the impacts of HIV in Lesotho. This includes educating people about how HIV is spread and how it is not spread (it is spread through blood, breast milk, semen, and vaginal fluids...not saliva, it cannot survive outside of the body for more than a few minutes, etc), stressing the importance of knowing one's status and taking ARVs (anti-retroviral medication) regularly if one is positive, and providing youth with the life skills to stand up for themselves in relationships so as to decrease their likelihood of getting HIV.

While this may sound easy while reading it on a computer in a country with a low HIV rate, think about how difficult it is to do something foryour own health even though you know for a fact the choice you are currently making will shorten your life. How was that fast food feast the other day? Are you still smoking, even if only occasionally? Did you do that workout yesterday or simply land on the couch for another NCIS marathon? Is your cholesterol high but the bacon too tasty to give up? More salt on that? The reality is, we all make small decisions every day that we know put us at risk of major health problems in the future, but the present is more enjoyable because of those decisions. We know what we should do, but it doesn't always happen.

And so, here in Lesotho, we educate, we support, we inform, and we try to gradually bring about behavior change. There are some rally neat ways to do this. Over the weekend my host brother and I attended a Grassroot Soccer training. We are now ready to teach teens more about protecting themselves and supporting one another through incredibly well developed games that serve as metaphors related to HIV/AIDS. Every month I help at a support group for HIV positive teens.

Lesotho and the international community have also been approaching it from the medical side. To fight Mother to Child Transmission, every pregnant women who goes for prenatal care if tested for HIV. If positive, she is prescribed ARVs. Her child is also then put on treatment after birth. HIV positive mothers are allowed to breastfeed but are told to stop as soon as solid food is introduced as this increases the likelihood of transmission. Eventually, if the child infant continues to test negative, they are taken off the medication. The mother should!d stay on it, as stopping ARV treatment usually results in a big drop in the person's CD4 count.

Another medical push going on right now is VMMC or Voluntary Male Medical Circumcision. Studies elsewhere in Africa have shown that being circumcised reduces a man's risk of contracting HIV by 60%. This is because the cells of the foreskin are more membraneous than the rest of the penis and therefore removing them significantly decreases the likelihood of contracting the virus. VMMC is available for free in all districts of Lesotho and also includes HIV testing and education about other ways to reduce risk such as abstinence, one mutually faithful partner, and using condoms correctly every time.

This year people around the world have been hyper-conscious about Ebola. Today, I want to challenge you to think about another virus, one that is impacting far more people, in far more places. While it may not kill with the same speed or media frenzy of Ebola, it deserves far more attention.

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You should choose as your life's work whatever feels the most like play.
-Harvey Oxenhorn