Twifu Praso, Ghana September 12, 2005

Some people, myself included, question our decision to focus narrowly on HIV when Africa is suffering from so many other afflictions. There are several diseases that claim far more African lives than AIDS—diseases that we have a greater ability to treat and contain—and there are issues of social and economic justice that underlay all of the continent's maladies. Sometimes HIV/AIDS seems overemphasized even to the people who devote their lives to working against it. Several people who I respect, who have worked in Africa in the fields of health and education, stress the greater need to focus on Tuberculosis or Malaria—fatal but curable illnesses that claim millions of lives that could otherwise have been protected. Sure, Africans are still dying in large numbers and suffering gruesomely from diseases that we fought hard to evict from the western world. This unfortunate fact seems about as interesting to western audiences as the fact that poor people are provided with miserable education opportunities and little health care. AIDS is more interesting because it is relatively new, reliably fatal, sneaky and willing to kill anybody anywhere. So, what bothers me is the occasional suspicion that I am buying into a sensationalization of the AIDS "pandemic" (the special word coined just for AIDS). My friends and I are aiming to present a particularly balanced and detailed understanding of AIDS in Africa, but our goal establishes a very singular priority and that sometimes feels unwise.

In the work that we have conducted so far there has been nothing that has affected me personally. I haven't tapped the essential dread or tragic sadness that are expected to surround the disease and that is why AIDS has received so little attention in my travel journals to date. Instead, I have dealt with dedicated, professional and informative individuals who have given me valuable insights into the complicated and expensive large scale operations to keep AIDS in check and care for the people who were reached too late. I am grateful to everyone who has shared their experience with our team and I am often impressed by the work that they are doing. Still, though, it often feels as though they might as well be fighting illiteracy or election fraud.

That changed a bit this weekend. On Friday, Sean and I were taken by World Vision to visit what they referred to as "PLs", these were "People Living with Aids". We sped into a small roadside town in the obligatory SUV and piled out with our large driver and two World Vision staffers of the district level—all Ghanaian men in their thirties with better jobs and clothing than anyone else in town. We headed straight for an anonymous compound and waited as a delegate checked on the appropriateness of our sudden unannounced arrival. Not surprisingly, our visit was approved and we were given permission to enter the concrete courtyard around which the compound's various rooms were arranged. The five of us took small wooden chairs and stools while the child population was sent scattering away from our congress. A healthy looking woman in her thirties pulled up the lowest stool and completed our circle, lower, more hunched and more colorfully dressed than the rest of us.

Her husband died of AIDS approximately one year earlier. She contracted the disease from him and spent weeks in the hospital, approaching death. The hospital that first diagnosed her, brought her to the attention of World Vision who sometimes elect to become the comprehensive health care provider of people in her situation. She was fortunate. They decided to care for her and the anti retrovirals that they paid for successfully reversed her trajectory, helping her to regain health, hope and body mass. She spoke with quiet strength. In her opinion, World Vision saved her life. This has prompted her, in spite of anxiety or self-regard, to cooperate with some of their initiatives.

That's the good part. She received counseling, life saving medicine and financial assistance for the schooling and feeding of her half dozen pre-teenage children (who have not been tested for the disease). The bad part is multi-faceted. Firstly, World Vision will withdraw from her district in five years in accordance with their policy of remaining in any given area for just fifteen years—this will mean the sudden end of a massive level of assistance to which she has grown accustomed. Secondly, nobody in her compound or her village knows that she has AIDS. They were all very suspicious when she grew ill after her husband's death and her uncle even removed her belongings from her room in the compound while she was in the hospital. He was preparing for the ostracism that didn't make sense to anyone when she returned in apparent good health. While she speculates that most people in her district have a moderate understanding of what AIDS is, she is keenly aware of how completely her life would change if anyone discovered that she is infected. It is unlikely that her own family would allow her to perform her essential household chores or permit her to eat from their shared dishes; a complete emotional withdrawal would also be likely. Our conversation was literally conducted in whispers.

Impressively, she is not content to live in the comfort of deceptive normalcy. Under the guidance of World Vision, she travels to other towns where she would not be recognized and helps to spread information about the reality of AIDS and its presence in Ghanaian communities. She also works as a "care giver" within her own community. That title designates her role as a counselor and helper to the sick in her village and denotes that she has been trained in such activities by World Vision.

A younger, wide eyed and uncomfortable woman was brought into our circle after we'd finished our discussion with the first. Whereas the first woman had spoken at length and with total confidence about every aspect of her experience, this woman looked a bit cornered, near tears or sudden flight. We asked her one question. World Vision had launched a new program earlier that month that brought together the nine PLs that they support in the district (of 100,000 people) for an informal gathering that enabled them to speak with one another and share experiences. We asked her to tell us about this event. She said that following her diagnosis she lived in miserable, secretive isolation, telling nobody of her condition, waiting to deteriorate. Whenever advertisements about the dangers of AIDS came on the radio or the television, she would break down in tears of self-pity and despair. Since the meeting with other PLs, she has not done this. She said that her interactions were of massive personal importance but they were too recent and too moving for her to discuss. She began to cry and rose to leave the courtyard. The first woman shook her head, saying "she still does not believe in the drugs."

These two women made it acceptable to me that we are focusing on HIV/AIDS. The enormous prejudice and misinformation surrounding AIDS are unparalleled—those who suffer from malaria, TB, leprosy, dysentery or typhoid are pitied and cared for (however inadequately) with relatively little judgment. Ultimately, it is money and medicine that are necessary for the treatment of such diseases. They have not been eradicated from Africa because there is an insufficient willingness to spend time and money on the disgusting illnesses of poverty. In the case of HIV/AIDS there is a massive and growing amount of time and money being deployed; yet the disease is gaining ground and its victims are subjected to all sorts of thoughtless and hurtful treatment. It is uplifting to hear that people and organizations are capable of bringing help and hope to the people touched by this illness and it seems important to share how they do this.
* posted by Nathaniel at 12:15 PM