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!

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.