Triumph and tragedy on the frontlines of the war on HIV

“Have you ever been tested for HIV?” This question is one, which has the potential to strike terror into the hearts of many.

“Have you ever been tested for HIV?”

This question is one, which has the potential to strike terror into the hearts of many.

It’s also a question I ask people as part of my job.

I was going to tell you about last weekend, when I travelled to Kisoro and hiked Mount Sabinyo, one of the only mountains in the world where when (and if) you reach the top you can stand in three countries at once: Uganda, Rwanda and the Democratic Republic of the Congo.

It was beautiful, hard-going and scary, especially when our guides arrested a potential rebel at gunpoint.

I was also going to tell you a story about the next day, when we went to track the golden monkeys of Mgahinga National Park and one of our armed trackers got attacked by a buffalo.

Seeing as I’m leaving Uganda in a few weeks though, and as I haven’t really mentioned my, well, job … I figured I probably should.

I’d like to think that it’s kind of important.

As the HIV/AIDS health education officer for Lake Bunyonyi Development Company (and one of several for ACTS), I have a varied role.

Research, organization of presentations, mobilization of people willing to contribute their time and energy to fight misconceptions and stigma surrounding various diseases; these are all parts of my work.

I also give swimming lessons to some of the staff on Bushara Island, distribute goats (donated so generously by the people of Whitehorse) to HIV positive people, teach computer skills, watch Nigerian soap operas with the grounds crew … you probably get the idea.

Anyway, this particular story starts last year, on March 21st.

I had organized with the AIDS Information Centre to come to Bushara Island for an HIV testing day.

In a country where HIV prevalence hovers around eight per cent, testing is pretty important.

I had arranged for radio announcements to be broadcast over the local radio station, the counselors and lab technicians were booked, people from the local churches were notified, and I was terrified.

Given the Ugandan concept of time, the sudden weather changes and limits on people’s time I was not convinced at all that anyone would show up.

At around 10 in the morning, I canoed over to the neighbouring island to see if the high school students had heard about the testing day and to try and convince some of them to attend.

The high school on Bwama Island is much like a high school in Whitehorse, if you don’t take into account the lack of electricity, teaching aids, textbooks, rain-proof buildings and glass windows.

OK, so it’s not the same at all.

The school doesn’t have a lot of money, but the teachers do with what they have, as do the students.

I found the principal in his office (and I won’t even go into the differences between this office and a principal’s office in Canada) and explained about the testing organized for the next day.

He was enthusiastic, and then looked at me considerately.

“Why don’t we go to each classroom and you can explain what is going on? Then we can make a list of the students who would like to attend so that we will be able to give them written permission to leave the island and try to arrange for canoes to transport them to Bushara.”

Public speaking is not my particular forte, but I agreed, privately dreading the exercise. 

First we went to the S4 (approximately equivalent to Grade 11 at home, which is the highest grade at Bwama High School) classroom, where the teacher was explaining scribbles on the blackboard, which looked frighteningly like physics, another thing I dread.

As we entered, the room went completely silent.

The principal spoke mainly in Rukiga, introducing me, and then gently nudged me to the front of the class.

“Hello,” I said cheerily (in that embarrassing sing-song way one tends to use when speaking to people for whom English isn’t a first language).

“Hello,” they responded in unison.

“How are you?” I asked nervously.

“I am fine, Madam.” Their synchronicity was impressive.

Preliminaries out of the way, I went on to explain what was happening the next day, and invited everyone to attend. The principal then cut in to ask for a show of hands to indicate who would like to be tested.

Tentatively, one or two boys raised their hands. I then pointed to myself, smiling like a fool, and put up my own hand. Actually, I put up both of my hands and bounced around a bit in an encouraging sort of “Testing is fun! Let’s all know our HIV status! It’s super cool!” dance.

The tension in the room eased a bit and about a dozen or so more students raised their hands, laughing at my enthusiasm (or just at me, I’m not sure which).

Class after class, the routine was repeated. 

By my mental tally, around 80 students had expressed interest in coming to the testing day. How many would actually show up was an entirely different question.

I stayed awake most of the night worrying. 

Would the counselors show up? Would the students show up? Would anyone show up at all? Would this be the biggest flop of all time?

I woke up at 8 a.m., dressed up in my ‘appropriate’ clothing (long skirt, shirt covering the shoulders, high neckline, basically what you would wear to a conservative great-aunt’s 70th birthday party) and then went down to the dock to catch the boat to the mainland where I was meeting the AIC team.

The radio announcements had stated that the testing would start at 9 a.m., so I figured that by 11 a.m. some people would hopefully show up.

Down at the dock, I was shocked to see a group of half a dozen students milling around.

These were some teenagers I knew, having organized an HIV information workshop that they had attended a few weeks previously.

They were obviously nervous, speculating on how much the needle was going to hurt, and pantomiming the way that they might faint or scream. There was a lot of giggling at the same time.

I tried to reassure them as best I could (not speaking a whole lot of Rukiga it wasn’t the easiest task), and then hopped onto the boat, waving encouragingly at them and pointing to my watch to show that I’d be back soon.

I reached the mainland and began the wait for the AIC staff.

One thing I hope I’ve learned here is patience. I feel myself starting to get that thousand-yard stare, and suddenly find that an hour has gone by.

In this case, it had.

The team turned up around 10:15 a.m., armed with coolers full of supplies, props and papers. We quickly boarded the boat and made our way back to Bushara.

When we reached the conference centre, around 30 or so people were already there.  The team wasted no time in beginning. First were introductions, then came the “sensitization.”

It’s one of those buzz words that people in development love to use, which as far as I can tell means “information session.”

As they began to talk about HIV/AIDS, the causes, methods of transmission and prevention, students started to trickle in.

By the time they got to the interesting (the “how to put a condom on a wooden penis”) part, the conference centre was nearly full.

I counted around 80, mostly students ranging in age from 14 to 18. According to the show of hands, most had never seen a condom, nor had any but the vaguest clue of how to use one.

There was a lot of self-conscious giggling as participants were asked to come up and try their hand at the new skill.

It’s important to remember that Uganda is an extremely Christian country — around 90 per cent of the population is either Catholic or Protestant.

Things like pre-marital sex, safe sex, sexually transmitted diseases or even sex itself are not common topics of discussion.

Paradoxically, these are exactly the subjects that must be brought out into the open if HIV/AIDS is to be combated effectively.

You might argue that that’s only the opinion of one, but there are mountains of research to support this argument.

As soon as the sensitization talk was completed, the students and adults formed a line where they first registered, got a numbered card (to ensure anonymity  — results are never written next to names or recorded in a way that could lead to identification) and then went for a quick counselling session.

Next they joined the line to get their blood drawn by the lab technician.

I did the same, encouraged by the counsellors to queue jump so that the students could see me getting my blood taken so as to set an example.

There was a lot of laughter as I winced and pretended to cry, then grinned, shaking my head to show that the needle didn’t hurt at all.

Twenty minutes is all it takes for the results of the rapid tests, but with so many people there were inevitable delays.

I quickly went to rig up the satellite TV so that they could sit in the cool of the conference centre and watch Arnold Schwarzenegger blow things up while they waited for their results.

We were called by number, and went in one by one to learn our results. I was first, and the group laughed as I emerged, saying, “Yay! Testing is fun!! Let’s all know ourselves!!”

The flurry of activity seemed to last forever (and simultaneously no time at all). Then it was over. The kids, smiling broadly, waved goodbye and ran down to the canoes to paddle back to school, while the adults went their own ways home.

I went to speak with the AIC staff to learn the results.

“Great turnout,” the counsellor Israel commented. “And I think they really learned something from the sensitization.”

Smiling nervously, I agreed. “But, um, what, well … how many positive?” At this part my heart was absolutely pounding, having spent the day chatting with the students and secretly crossing my fingers for them.

“Only one.”

At first I was elated. All of those high school students, knowing themselves to be HIV negative and having had the information session, hopefully taking measures to protect themselves in the future … what could be better?

Then I thought of the one.

One person who may or may not have anticipated the results.

One person going home, probably devastated, trying not to let on to anyone else how he or she feels about the result, which can so easily be a very early death sentence in a developing country like Uganda.

On Friday March 22, 2007, there were 94 fantastically rewarding parts of my job, and one part which still makes me sad, hopeless, hopeful and angry all at the same time. 

Such is the nature of my job.

Christine Purves is a Yukoner now working in Africa.

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