ART Clinic

I am running the ART clinic this week. No, I am not teaching remedial painting. ART stands for antiretroviral therapy. For three afternoons per week, patients with HIV come to the clinic for review and to get more medications or, for those who are newly diagnosed, to start ART. Being in a country with one of the highest HIV infection rates in the world, the clinic is always booked solid.

And so I sit behind the desk in the clinic with a nurse next to me to translate and to help me fill out the forms. One after another, the patients come in. I ask about their general health, check on their adherence on taking medication, any side effects experienced, check the last CD4 count, and examine any new complaints. The vast majority of them are in excellent health, with no signs of immunodeficiency or any opportunistic infections. It is heartening to see how well the drugs work at keeping their CD4 counts stable or preventing them from dropping further.

Unlike the rest of the world, HIV transmission in Africa is mainly through heterosexual sex and from mother to child. So the types of people who come to the clinic run the gamut: men, women, the young, the old, babies. One patient could be a school teacher, the next one could be a farmer from a far-away village, followed by a six-month-old baby whose mother was never tested but are now both in hospital for opportunistic infections. There are those who are open about their HIV status, while others have not completely accepted it and have not even told their spouses. The most frustrating ones are the women who are on ART, but their husbands flatly refuse to come in for testing or to use condoms. The power of denial, that most potent ingredient in the making of the next generation of multi-drug resistant strain of the virus, can never be underestimated.

The Zambian government has made a huge effort to rein in the spread of HIV. At the ART clinic, patients get their otherwise prohibitively expensive antiretroviral medications for free, which are from a combination of government funding, donations from NGOs and pharmaceutical companies. These medications, like almost every other drug used at the hospital, are manufactured in India. I remember hearing a couple of years back that NGOs like Doctors Without Borders were publicly calling pharmaceutical companies to make antiretroviral drugs available and affordable to sub-Saharan Africa. Maybe this is a result of that, or maybe India has always been the source of medication to third-world countries.

I have seen billboards that encourage people to go for HIV testing with the goal of having an “HIV-free generation” in Africa. The ART clinic gives me hope that, with the continuing sensible government health policy, availability of affordable medications, and campaigns to education people and dispel any myths related to HIV and AIDS, Zambia is taking small steps to reach that goal, which may be a lofty one, but not a pie in the sky.