A Reflection on World AIDS Day

“I believe that this could very well be looked back on as the sin of our generation…I believe our children and their children, 40 or 50 years from now, are going to ask me, what did you do while 40 million children became orphans in Africa?” –Rich Stearns, World Vision USA President

Before moving to Swaziland, AIDS meant nothing to me.  It was not an issue I cared about…Gay rights, unjust wars, healthcare, global warming….These felt like the issues that my generation would go down in history fighting our parents about.  A disease transmitted primarily through sex half a world away seemed like an issue for someone else’s world- not mine. 

World AIDS Day meant next to nothing to me.  I might have remembered it every two years, depending on whether or not my calendar for that year came with it pre-marked.  It registered somewhere between International Day of the Girl Child (weird holiday name, UN) and Presidents Day in terms of significance to my life.  I have no idea if I ever met an HIV positive person before leaving the States.  Certainly none of my friends or family was openly HIV positive.

At our World AIDS Day booth at the soccer pitch last December, rowdy boys and young men excitedly grabbed condoms and ribbons.  There was lots of laughing and blushes.  During quieter moments, a few asked to be tested.  One boy said his mother told him never to wear a condom.  Horrified, I asked why.  Apparently, he won’t need a condom if he’s only with one person.  Fair enough, but I’m a pragmatist, so please take some condoms. 

Then another man approached.  His cheekbones jutted out, he was too thin for his height- the all too familiar signs of late stage HIV.  He told his story in SiSwati, but I understood enough.  His wife gave birth to seven children, all of whom quickly wasted away and died.  Then in 2004, she also died.  Upon her death, he went and got tested after someone told him about HIV.  He tested positive, and is the sole surviving member of his family.  He thanked us for holding a day of remembrance. 

I don’t know a single person in Swaziland who hasn’t lost a loved one to AIDS.  There are funerals every weekend.  I’m told that in the dark days before ARVs became widely available in the mid-2000s, some funerals were even held on weekdays, which is unthinkable in Swazi culture unless there are too many people to bury.  Most homesteads take in orphans; mine has 2, sometimes 3.  One ponders what psychological effects this abnormal and traumatic situation has on the population since it has perversely become the norm.      

The mind struggles to comprehend the magnitude of such an epidemic.  It is a disease associated with stigmatized populations- homosexuals, prostitutes, and the impoverished. It kills slowly, over years, so that infection spreads so easily and silently that the unknowing carrier can go ten years feeling perfectly healthy.  Even with the miracle of ARVs, a person’s life span is inevitably shortened.  Economic status, genetics, age, HIV subtype, and country of birth also determine how long one will live with the virus.  All individuals with HIV eventually need to take ARVs, but become drug resistant after a period of time, needing to move on to more expensive second and third line ARVS.   All three lines of drugs are currently available in Western Europe and North America.  Third line drugs are still patented and therefore too expensive for any African country to afford for at least another decade.  While activists and governments badger the pharmaceutical industry to provide a generic at reduced cost to Africa, an entire generation of a continent grows up parentless.   

But the picture isn’t all doom and gloom….My friends on ARVs are just as peppy as I am, and they certainly would argue fiercly that they still have long lives ahead of them.  Recent articles I’ve read argue that, for the first time, the World AIDS Conference this past year was one of hope and breakthroughs, not one of despair and hopelessness.  I’m particularly excited about potential breakthroughs in microbiocides.  These are chemicals that can be inserted into the vagina prior to intercourse which may kill off the HIV in sperm.  (thereby giving the woman some agency in situations where she cannot negotiate for condom use). 

 

The tides are turning, and maybe- just maybe- our grandchildren will look upon AIDS as our generation looked upon polio- a horrific disease almost completely eradicated.