Containing the Fire

The hospital holds HIV clinics three times a week. This afternoon I sit in on one of them.

One of the patients came in through the hospital’s outreach program. The program goes to villages in outlying areas and brings high-risk patients back to the hospital for HIV testing and, if found positive, offer them free counseling and antiretroviral therapy (ART). This patient, a woman in her late twenties, is thirty-two weeks pregnant and has just been tested positive for HIV. Although looking quite well, she, with a CD4 count of only 22, is likely to have been HIV positive for many years (by definition, a person has AIDS when her CD4 count is below 200). Not understanding the gravity of the situation, regarding both herself and her unborn child, she just wants to go home. It takes much convincing for her to agree to stay in hospital for two weeks while getting started on ART. The next hurdle comes when she is asked about whether she plans to breastfeed her baby. Although breastfeeding increases the chance for her baby to be infected with HIV, she has no other choice. Buying baby formulas is out of the question; they are prohibitively expensive for the average Zambian. The doctor sighs resignedly and hands the woman the admissions form.

Venting her frustrations, the doctor conducting the clinic tells me that although designated as the district hospital, Lubwe Hospital is affiliated with the Catholic Church and contraceptives are not allowed to be distributed through programs run by it. They can only tell people about the use of contraceptives like condoms for the prevention of sexually transmitted diseases and the pill or depot injections for contraception; the people would have to go to government-run clinics to access them. As is the rule with people living in extreme poverty in rural areas, going to see a doctor or to the hospital is something they do only after a long period of illness that does not resolve; preventive health is negligibly low on their priority list. Hence HIV, among other sexually transmitted diseases, spreads like southern California wildfires fanned by the Santa Ana wind. The high rate of vertical transmission, from mother to child, ensures that the burden of disease weighs heavily on the family and, by extension, the nation, forever enslaving them to poverty and condemning them to the misery of a Hobbesian life – poor, brutish, and short.

But all hope is not lost. Despite the enormous stigma still attached to HIV/AIDS, campaigns run by the government have made some inroads in educating the people about the disease and getting people to get tested. Although most of the testing are still done at the urging of health care professionals, a few have already come in on their own to get tested. With the hospital’s efforts to ensure patients’ confidentiality and the government’s policy of providing free ART, as well as the education programs that help to allay the fears and misconceptions about the disease, there is a glimmer of hope for Zambians. Is this a light drizzle on the raging wildfire that will eventually become a downpour or is it merely a bucket of water thrown in the general direction of the conflagration? I hope it is the former.