12/22

I encountered many barriers and challenges today in counseling patients with HIV/AIDS.

For one, most are aware of their HIV status. It is not uncommon to ask someone "are you HIV positive or negative," nor is it considered impolite. People often go with their parents or other elders in their family to get tested. The flipside to this transparency-laden coin is that cliques form based on HIV status. The positives do not associate with the negatives, sort of like a class struggle found in most areas. Once a colleague, friend, or neighbor finds out that Suzy has HIV, they inform Suzy's employer. If Suzy has children, teachers are told. The children are removed from school until parents can prove that they are not positive as well. Employers (illegally) fire affected individuals.

It's easy to realize that this wreaks psychological havoc on people's lives, and creates a void that counseling can help occupy. The children I encountered were particularly emotionally bruised. It was important to convince them to still go to school and stay with their education.

Many individuals, once they are tested positive for HIV, do not ever come back to the clinic. They think that no one will look at them, and consider themselves banished form society. Antiretrovirals (ARVs) do not help if they are sitting unused on the shelf, and I realized it is important to follow-up with patients who had not come back since their diagnosis and make them cognizant of the resources that are available. This proved to be difficult work. We had only the name and last known address, so much detective work had to be done. After asking around and finding the patient, it was even more difficult to convince them to seek help.

As people found out that someone from the US was visiting, they flocked to where I was trying to find the AWOL Ushirika patient. This is when I learned that even though ARVs were given to those who needed the medication, food was out of stock. MSF Belgium provides much of the food to this area, but it is often stolen by corrupt managers and sold in black markets. The amount of corruption continues to astound me--I saw a truck marked "donations from the british people" unload a stack of books at a drop-off point. A day later, these books were on sale by a street vendor. Few things infuriate me more than stealing from the sick and hungry, and I was disappointed to have seen this side of Kibera.

Without food, the ARVs do more harm than good and actually shorten one's lifespan compared to if one had not been taking any medication. People stop taking the medication because they do not have food, and you can assume the downward spiral in health this ultimately creates. Instead of donating food, I hope a wealthy individual can purchase large amounts of land outside of the city limits, employ the people of Kibera to tend to it, and use the food to feed people taking ARVs. Many ideas have been tried to remedy the situation, but corruption ultimately outdoes people's goodwill. Seeing people laden with disease unable to take medication because they're also starving has a profound impact on my overall mentality.