It Could Have Been Me: World AIDS Day

Happy World AIDS Day!

24.9% of Lesotho’s population currently is infected with HIV. Think about that for a moment.

It is absolutely mind blowing to look around yourself at a meeting, party, football match, or funeral and think that statistically one-quarter of the people you are looking at have HIV.

Somehow, as I consider this, it does not shock me then that in one of my four years in Lesotho I had a possible HIV exposure.

Within minutes of my potential exposure to HIV, I was desperately trying to control the runaway adrenaline in my body as it caused my legs to twitch while rationally reminding myself through Google and memories from Peace Corps trainings that I still had ways to protect myself from the virus.

As I researched PEP-Post Exposure Prophylaxis, I struggled to contain my panic. Everything I read warned that PEP is difficult and has many side effects. There were many reports noting permanent liver or kidney damage. There were even more highlighting that patients were unable to complete PEP due to side effects and therefore would still end up HIV positive. Reading these reports, I was terrified and furious at the series of events that put me in this position.

PEP is actually one of two options available to prevent HIV infection. PEP typically consists of taking Antiretroviral (ART) medications for 28-30 days, depending on the type of medications taken, after a single incident of possible exposure.  The simplest explanation of how it works is that the ART medications prevent HIV replication in the body until all cells that may have been exposed die off.

The alternate option is for people at consistently high-risk exposure to HIV. This is called PrEP or Pre-Exposure Prophylaxis and consists of ART taken throughout the period of high-risk (e.g. having a long-term sexual partner who is HIV-positive). Scientifically, it works the same way that PEP does, however, the person must continue to take it correctly until a month after exposure risk ends.

World AIDS Day

Happy World AIDS Day!

I remember living in America, being blissfully ignorant about the vital importance of this day and continued work in HIV care and treatment. My how things change!

Now, I live in Lesotho, surrounded by the second highest HIV rate in the world. When people die from illness, it is almost always HIV-related. When people die from illness, HIV is almost never mentioned.

Just as it does in America, HIV in Lesotho continues to carry an incredible stigma and huge amounts of discrimination. It seems that in America, because it can be transmitted through sexual activity and intravenous drug use, it is seen as scary and the repercussions of someone’s sins. The reality is, however, that here in Lesotho, the people most likely to contract HIV are young women ages 15-24. Many contract HIV through unprotected sex with their husband or an older partner. Many do not feel empowered to say no to sex or to insist upon condom usage in their relationship. Many have had only one partner.

Dribbling around risks
in life is an important
skill.

It is time for us as a world to look past the fallacy that someone did something wrong to contract HIV and to instead move toward helping to limit the scope of this disease.

Thanks to Anti-retroviral therapies, a person with HIV can live a long and productive life through maintenance medication, just as a person with diabetes, high blood pressure, and any number of other chronic conditions can. Additionally, an HIV positive person who religiously takes their medications can decrease their viral load so profoundly that the risk of them passing it to a sexual partner or to a child through birth or breast milk is incredibly reduced. There is simply no reason to stigmatize this disease!

A participant does push ups after hitting the "cone" for
risk of multiple partners during Risk Field.

For World AIDS Day here in Lesotho, my awesome counterparts and I added to the PC Skillz Grassroot Soccer Intervention we were already doing. Our practices today playing a game called Risk Field which uses risks like older partners, multiple partners, not using condoms, and combing alcohol and sex to show how HIV impacts not only the infected person but their family and friends and their entire community. We also played a game called Fact or Nonsense, which let us decide whether statements were true or not before learning more about the real facts. 

We finished up the day with empowerment. Since the theme of this year's World AIDS Day is "The Time to Act is Now," everyone came up with something they can do to help stop the impact of HIV/AIDS. Here is what they shared: 

Fact: Abstinence is the most effective way to avoid HIV.

Fact: The older your sexual partner, the more likely you are to get HIV.

"I will advise them [infected persons] to go to the health center for ARVs"

"I will tell them to abstain from sex..."

"I will form a social group"

"I will advise people to use condoms when having sex."

"I will tell them to go to the hospital.
I will tell them to have one boyfriend or girlfriend."

"I will tell them to have protected sex."

"I will abstain."

I will use condoms every time I have sex."

 How will you help reduce the impact of HIV/AIDS?
The time to act is now!

PC Skillz Intervention!

The coaches and certificate earning team members at our graduation.

For most of the last three weeks, my days have centered around studying ways to talk about relationships and HIV in Sesotho and playing with village youth.

 I have been doing a PC Skillz Intervention camp. PC Skillz is a joint venture between Peace Corps and Grassroot Soccer. It uses soccer-based games to teach life skills, positive living, and HIV/AIDS awareness. 

Although practices supposed to last for only an hour, most days I was playing with, talking to, or working with youth for 3-4 hours as practices usually took us between 90-120 minutes and the village kids would start arriving as much as two hours early and stay as long as possible to play with the "indestructible" One World Futbol. Add to that coach's meetings, making supplies, and translating pieces of the program with my brother and my entire universe has only been PC Skillz. 

The PC Skillz curriculum is a pretty fantastic experiential education curriculum. It reminded me of my favorite teaching moments in the US over the last decade.  

Over the eleven practices, we covered important topics like stigma and discrimination, abstinence, how HIV and ARVs affect the body, and how to avoid the riskiest behaviors for contracting HIV: unprotected sex, multiple partners, older partners, and combining sex and alcohol. Most practices we had 30-40 village youth from 9-19 despite having said the program was for 10-15 year old youth. In total, over 50 individuals attended at least one practice with more than half attended at least half of the practices. The Peace Corps Skillz program requires participants to attend at least eight practices to earn a certificate of completion, so only 18 received certificates. The others can come again next time we do the program to earn a coveted certificate. 

The coaching team after graduation:
Abuti Thabo, me, Abuti Ts'epo, and Ausi Mareisi

My co-coaches were absolutely amazing. While I was living, breathing, and sleeping PC Skillz, they were coaching with me a few hours a day and also working 6-9 hours in the fields! Every time they arrived, often just as we were starting practice, they were rushing back from the fields, but they always brought enthusiasm and a willingness to help. Prior to attending the PC Skillz training at the end of November, I worried about bringing my brother to the training as my counterpart. My brother is fantastic, but he is barely nineteen and still in high school. I worried that I was asking too much of him to coach his peers and younger teens in the village when talking about sensitive issues like HIV transmission, voluntary male medical circumcision, and sex. He was absolutely incredible though, both as my Sesotho back up-he seemed to know when to help and when to let me work out what I needed to say-and as a coach in his right. 

The youth were amazing too. Sometimes I wondered how much of the message was getting through between my poorly accented Sesotho and their reticence to speak up during Q&A and discussions. But at our graduation ceremony yesterday, it was obvious they knew their stuff. 

"Coach" Bolokang

For the graduation, in addition to bestowing certificates and taking over 100 photos (no really...the kids love having their picture taken, over and over again!), we ran through one of our earlier practices with some of the participants acting as coaches. When asked by their peers, the participants had every single answer they had hesitated to give over the last few weeks. It was wonderful!  

Coach Thabo telling a "Coach's Story."

I think my favorite thing about this particular intervention is that it really helped me get to know the youth in the village-their names, their personalities, etc. And it helped them get to know me and my personality, seeing me as a friend and mentor instead of just the smiling American who always says hello! 

"Patient Zero: The Origin of Aids"

My role in Lesotho will be as a Healthy Youth Advisor. Part of my volunteer work will include HIV/AIDS education, as Lesotho has the third highest HIV rate in the world. The current HIV positive rate ranges between 24% and 28%, which is literally stunning.

So, with this in mind, I share Radiolab's free podcast Patient Zero: The Origins of Aids. Most surprising factoid: the disease has been identified in a Bantu man who died in 1908. We do not think of this as a century old disease, but science has shown otherwise.

I really encourage you to take the half hour to learn a bit more about this disease. You might learn something...