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International AIDS Conference and Getting tested for HIV/AIDS: Should I do it?

CHAI Saisi and Florence Wyson 2Next week, the International AIDS Conference (AIDS 2012) will be held in Washington DC.  This is a huge meeting with more than 20,000 participants and it’s the first time in 25 years that it will be held in the U.S.  P&G will participate in three different events at the AIDS 2012 meeting including co-leading a panel on water, sanitation, and hygiene (WASH) for people living with HIV/AIDS.  I’m thrilled to have the honor to introduce Debra Messing at the panel.  Debra recently traveled as a PSI ambassador to Zambia where she did a demonstration of the P&G water purification packets for people living with HIV/AIDS. 

Debra Messing 2To celebrate the AIDS 2012 meeting, I’m posting this blog from my most recent trip to Africa.  It summarizes an emotional day for me and I hope it makes my readers think about the importance of testing for the HIV virus.

HIV/AIDS remains a leading killer of adults in Africa.  But, great progress has been made through the development of antiretroviral drugs.  Because of these life-saving drugs, having HIV/AIDS is no longer a death sentence and people can live positively with the virus.  One of the most important ways to attack this pandemic is for people to be tested and then to take antiretroviral drugs if they have the virus.  Recent research by the UNC Medical School has shown that that treatment with antiretroviral drugs can reduce transmission of the virus by more than 90% among couples where one person had the virus and the other did not. 
And, the pandemic is not only in Africa.  For example, the CDC estimates that 1.2 million people in the U.S. are living with HIV infection.  New infections continue at far too high of a level, with approximately 50,000 Americans becoming infected with HIV each year.  And, the CDC estimates that 20% of people are infected and not aware of their status.

Today, I’m in Malawi visiting the newest collaboration between P&G, the Clinton Health Access Initiative (CHAI), the Malawian Ministry of Health, and PSI.  The goal of this collaboration is to use the P&G water purification packets as an incentive to get couples to go to the clinic to be tested for HIV/AIDS and then to encourage them to deliver in a health facility.  This is critical because Malawi has one of the highest death rates in the world during childbirth for both the mother and child.  Almost half of Malawi women (46%) do not deliver in a health facility - that’s about a quarter of a million births outside the clinic every year and tens of thousands of deaths during childbirth. 

Unfortunately, phone and email service has been down for the last four days.  I’ve made plans to meet the CHAI staff but not agreed the time of the meeting or asked for the location because I was planning to confirm a couple of days prior to our meeting.  That was a bad idea.  I only know the name of the city, Liwonde.  Luckily, it’s not a big city and I know that CHAI works within the existing health care facilities.  So, after about 7 tries, we find someone that directs us to the local hospital.  And, after a few misses, a nurse takes us to the CHAI office. CHAI keeps a very low profile with no sign so I feel lucky to have found them in less than an hour of hunting. 

Yuwen, pronounced “UN”, Chipatala of CHAI is as happy to see me as I am to see him.  We’re only a bit late so we quickly head to the clinic after asking permission from the District Health Officer.

We’re spending the day at Ntaja Health Center in Machenga District.  Our research partners, primarily the CDC and UNC, have measured in several programs that the P&G packets can act as a powerful incentive to get women to the clinic. This CHAI program is another variation on that same overall approach.  Pregnant women are given a hygiene kit containing a month of P&G packets to treat their drinking water but only if they come to the clinic with their partner and agree to be tested for HIV/AIDS and syphilis.  They’re also given additional packets at delivery to encourage them to return to the clinic to have their baby.

CHAI buckets 2Nurse Hazel has worked at Ntaja Health Center for 23 years.  She’s seen a lot in her time and is very positive about the impact of our program.  Hazel tells me that the clinic is providing a huge number of P&G packets and buckets for preparing the treated water.  I see a room stacked full of buckets and cartons of packets and I’m told that will only last a few months before PSI provides more.  In total, the program will provide packets for 10,000 pregnant women and provide 11 million liters of clean drinking water.

CHAI water collecting 2This area is perfect for this effort because of the contaminated water sources and resulting high rates of diarrheal illness.  To see this first-hand, we make a quick stop to meet Chibalo and Mage Muhosha in Masambuka Village.  Mage tells us she collects her drinking water from a well and when we visit the “well” we see that it’s a hand dug shallow hole in the furrow of their field.  It’s not a surprise when she tells us that her family used to have a lot of sickness from diarrheal disease. 

CHAI water carrying 2After using the P&G packets, they’re not suffering from waterborne disease.  She also tells us that receiving clean drinking water from the clinic was an incentive to have her daughter, Samitau, at the Ntaja Health Center.  It’s clear from our visit with Mage that the packets can provide motivation to attend and deliver in the clinic. 

CHAI family 2Back at the Health Center, Nurse Hazel suggests that to really understand their work, I should go through the entire process with one couple.  I think this is a great idea but only if the couple fully agrees.  I’m introduced to Florence and Saisi Wyson and they agree that I can accompany them and that its fine for me to write about what happens today.

As I listen to Nurse Hazel explain the procedure, I wonder if I should also get tested for HIV.  At least once, I was exposed to blood from an infected person.  I helped carry a woman who was hemorrhaging from an ambulance into a clinic. I didn’t have any cuts and don’t think I actually came into contact with her blood, but it’s enough to raise some doubt.  So, I’m emotionally invested in learning about the process of being tested.

The testing for HIV/AIDS and syphilis is done confidentially one couple at a time, but in this case with the addition of me.  We go into a very small room about the size of a closet.  First, Florence and Saisi are shown the test kits and learn that if one line appears then the results are negative for the infection.  If two lines appear then the results are positive for the infection and obviously bad news.  The clinician first pricks Saisi’s finger and with a small glass tube collects and places a drop of blood onto the AIDS strip and then a drop of blood on the syphilis strip.  Next, the procedure is repeated with Florence.  
CHAI waiting 2It would be nice if the results are instantaneous, but there’s a 15 minute waiting period.  We go into the waiting area and try to sit and wait.  Saisi is nervous, as am I, and he does what I’d like to do and that’s take a walk.  It’s during this agonizing 15 minutes that I begin to have thoughts about whether I really want to be tested myself.  On one hand, I tell myself that the chances are so slim that I’m infected that it’s not really worth the time and expense as well as the inevitable torture of waiting for the result.  On the other hand, I know that anything is possible and with antiretroviral drugs, having HIV/AIDS is not a death sentence like in the past.  While I’m sweating bullets, Saisi evidently realizes that Florence also needs some emotional support so quickly rejoins her. 

CHAI HIV test 2Saisi, Florence, and I are invited back into the closet to be shown their results.  There’s only one line on the test strips for each of them for both syphilis and HIV/AIDS.  They are not infected!  Saisi’s face reveals his joy when he is shown the test results and his words match his face when he tells me, “I’m overwhelmed with joy”.  Florence is less animated but her words are clear when she says “I am so happy for me and my baby”.  Importantly, the clinician immediately tells the couple that they both need to stay in a faithful relationship or the result may be different next time. 

CHAI results 2It’s hard to explain the raw emotions that are generated by the testing.  We’re asked to leave the closet of a counseling room and then have a chance to collect ourselves.  And, I say “we” because it was an emotional experience for me as well as Saisi and Florence.

CHAI getting P&G 2


And now I fully understand what happens next.  In behavior change communication, we call this a “teachable” moment.  Saisi and Florence are ready to hear and are much more likely to retain and act on credible health advice at this moment.  Nurse Hazel explains the importance of clean drinking water and how to use the P&G packets.  They’re given the packets and told that they can have more if Florence delivers her baby in the clinic.

CHAI Saisa and Flo with P&G 2Before Saisi and Florence make their 3 hour bicycle journey home, we ask them a few more questions.  They have family and friends who have HIV/AIDS so they knew there was some chance they could have been positive.  And, they know they could get antiretroviral drugs from the clinic if the result would have been unfavorable. Florence tells us that she’s very happy to receive the P&G packets because her two small children have frequently been ill from diarrheal disease.  Her biggest hope now is that she will deliver a healthy baby.  She and Saisi enthusiastically agree that they plan to have their baby in the clinic.  They know they’ll be treated well and will be glad to receive more P&G packets. 

Now, I need to make my own decision about being tested….

Post-script:  Upon my arrival back into the US, I went to my family doctor and was tested for HIV.  It’s a simple test and while I didn’t have the results in 15 minutes, I knew within 24 hours.  Like Saisi, I was glad to hear that I don’t have the virus.  If there’s any chance that you’ve been exposed, then I urge you to be tested.  There are great treatment options so that people who are positive can live positively.  If people agree to be tested and, if they’re positive take antiretroviral therapy and other precautions to prevent transmission, then this deadly epidemic can finally be conquered.


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