Lake Victoria Region
To start with a fact: HIV is not being treated on the islands of Lake Victoria, period. After 2 months of working in mobile clinics in this region with a 40% prevalence, we met one person receiveing ARVs (who had to travel at her own expense to a Doctors Without Borders center on the mainland). On the islands HIV is largely not spoken about, stigma is rampant, and there appears to be no easy solution on the horizon.
Our minds began to wander when contemplating the facts: 40% prevalence of an incurable chronic disease in an area with frequent promiscuous sexual practices. What will become of this area? Will it become extict? Abstinence is unrealistic, condoms are ineffective unless used correctly during every sexual encounter, and even ARVs don't provide a cure or definitive method to prevent transmission. What will these islands look like in 5, 10, 15 years?
The only service we could offer our patients was a government Volunteer Testing and Counseling Center (VCT) to find out their HIV status. At first we were shocked at the many emaciated, likely end-stage HIV patients we encountered that stated they had not been treated or tested and had no intention of doing so. We were frustrated by the sexually promisucous youths who outright told us, why would I get tested, it will only increase my stress?
But once we stopped and put ourselves in their situation for a moment, we began to understand their feelings of indifference and futility. Why would they go in to VCT to find they are HIV positive, receive negative stigma from the community, and be sent home to die with no ARVs available? Encouraging patients to go for VCT without having treatment available approaches unethical medical practice. It is comparable to conducting a clinical research study without having available treatments offered to participants.
Fortunately, we had the chance to work in another area on the mainland, which has access to ARVs as well as a well-run AIDS center. The situation is this area 3 years ago was quite similar to that in the Lake Victoria region. However when this program began administering ARVs, the community took notice of those that were once wasting away and now suddenly were growing stronger. Consequently people stopped viewing testing as something that just "increases stress", and instead realized that testing could lead to treatment and betterment of their health. We actually sat through several VCT counseling sessions where the patient was relieved to find out that they were HIV positive because now they had an explanation for why they were feeling ill, and could work towards improving their strength with ARVs.
In time, people in the Kendu Bay area began to attend VCT freely. In doing so, whether positive or negative they received the full hour-long counseling session explaining HIV, and its transmission, prevention, and treatment. The effect of this intervention rippled throughout the community. With education, the stigma of the disease began to break and support groups popped up amongst those receiving ARVs.
Kendu Bay taught us the epidemiologic utility of providing treatment, even if ARVs are not curative and do not completely prevent transmission. The availability of treatment attracts people to testing, with testing comes education, and with education comes a change in mindsets and actions with regards to abstitence, condoms, and stigma. Needless to say this community was not headed toward extinction and demonstrated to us the path that the Lake Victoria area could head down given the appropriate intervention.
The Future of Lake Victoria
After becoming very frustrated with "doing the best we can with what we have", we are now looking forward to improving what is available in the region so that we can do better. After seeing the effect of ARVs in the epidemiologic course of HIV in Kendu Bay, our goal is to help bring access to ARVs in addition to VCT to the Lake Victoria region through the IMC.
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