World AIDS Day 2007

December 1st marks the annual World AIDS Day, and the residents of Nakuru honored the occasion with a large gathering in the downtown Nyayo Gardens. There were a multitude of large tents set up, representing organizations such as Family Health International, the Catholic Diocese of Nakuru, and the Nakuru Police Department. Each had its own unique activities, ranging from the sales of arts and crafts made by various support groups to the distribution of free health information, condoms, and nutritional supplements. The main tent was home to a host of local health, youth, and political leaders, along with the winners of the Miss Red Ribbon Pageant and other prominent HIV + individuals. This tent opened out onto a central stage area, in which arts and youth organizations alternated performances with poetry readings and ensemble dance pieces by local school children. The rest of the clearing was occupied by hundreds of seated school children ringed by invited guests, concerned residents, and curious onlookers. The flowering trees and other foliage towering overhead gave the whole place a serene natural feel.

Behind the main tent the volunteers from the Red Cross and Nuru Ya Jamii had established two Voluntary Counseling and Testing tents, outside of which dozens of people had lined up to receive information and learn their HIV status. Partially at the urging of my host mother Jane and partially to satisfy my own curiosity about the process, I eventually found my own way into this same line. I was surprised to learn that a few of the members of REPACTED did not actually know their own statuses, and I was able to convince them that if I was going to be tested, they should be too. So it came to be that three of us spent well over an hour waiting in the line (or the jumble, if you will, as there were often contentions and near-fights over the true sequence of the “line,” especially as the clock marched on towards closing time.)

I began to grow unexpectedly apprehensive as our time to be tested grew neigh, as did most of the group around me. Because of my personal circumstances, decisions, and environment, I knew that the odds of my being HIV+ were tremendously small. But as I grew ever closer to actually determining my status for sure, a few small doubts began to creep into my mind. What if I was one of those miracle cases where infection stems from the slightest encounter with an infected medical instrument or a handshake where both people unknowingly had broken skin? What if there were no discernable explanation at all, but I was somehow infected nonetheless? I had been in close proximity to many affected individuals in the past few months, perhaps some mistake had accidentally been made. I wondered if I could possible have the strength to face a positive result, or if I would be took weak to live up to the very same advice I had been distributing for two months. I found myself sympathizing with the host of anxious individuals around me, many of whom had surely been in far more compromising situations than myself.

Fortunately, this anxious waiting period also turned out to be a fabulous teaching and learning experience. Many of the people in line, assuming that I was present as some sort of AIDS expert or foreign medical official, began to ask me questions. “Can white people get AIDS?” was one of the most common. “Is this a problem for the whole world, or just Africa?” “Is it true that AIDS was made by the Americans to kill black people?” I was amazed that such basic questions still persist, despite the mass-education programs that have been taking place. Many other questions of more detailed natures also came up, and the REPACTED members (names omitted to protect the innocent) and I took turns providing the best information we could. This job was soon made easier by the arrival of one of the VCT counselors, who began to prepare us all for our test with a brief conversation about the means of transmission of HIV, and what knowing our statuses would mean for us in the future. Most of the information was a repeat of things I have already learned, but I was still pleased to see that everyone who gets tested also gets this sort of lesson. I was also impressed with the confidence of many of the patients who asked rather difficult questions in front of their peers. Perhaps the knowledge that we were all feeling the same vulnerability emboldened them. Regardless of the cause, the last few minutes before I entered the tent were occupied with a tremendous exchange of information.

The two other group members and I agreed to be tested as a group, and to share our statuses from the moment we heard them. This meant entering the tent together, and it proved to be a great idea, as my apprehension was growing by the minute as I waited for our turn to come. Finally the counselor came to get us (all VCT “doctors” have been thoroughly trained in the requisite sanitation, medical, and counseling skills, but few are actually medical experts beyond the issues of HIV.) Once inside, we examined the literature and equipment arranged before us like an exhibit in an HIV museum. As the councilor prepared his equipment, the three of us took turns saying encouraging things and holding hands.

The test itself was a relatively simple process. The counselor used a fresh and sterilized disposable “sharp” to prick the end of a finger, and then drew enough blood to fill a small dropper, probably about 5ml. He then opened a disposable test strip (something rather akin to pool chlorine-level test strips), and placed a few drops of blood on one end. He then disposed of the sharp and dropper in a biohazard box and placed a few drops of a test solution on the strip. He then hid the strip from view while we waited for it to develop, and moved on to the next patient. The whole process for all three of us took no more than ten minutes. While we waited, he filled out some demographic information that we provided in individual interview sessions. This was rather straightforward, although looking over his shoulder I did notice that he made a handful of assumptions about me and the other members of the group. Between the spaces for “age” and “marital status” there was a space for “sexual orientation.” For all three of us he assumed heterosexual without even asking the question. We were all also automatically recorded as Christians.
After a brief waiting period, we were instructed how to interpret our test results. You have to read your own results in order to help you feel like you "own them" and to help you accept the truth, one way or the other. For me, it also served to further intensify the situation. With one final reminder - "one stripe, negative; two stripes, positive" - and one last set of reassurances, he handed us our tests. First there were sighs of relief. Then a moment of tension again as we realized our friends might not have been so fortunate. Then a burst of laughter as we realized we were all okay. The moment that followed was as momentus for its joy as the one before had been for fear. We were all okay. But this sensation also passed as we realized that many of the people who had passed through this tent before us had not been so lucky, and that millions more awaited that same fate.

Later in the day I accompanied REPACTED and a host of Red Cross volunteers to a local slum area where we brought a VCT tent and loads of information to hand out. For me and the others with whom I had been tested, encouraging people to learn their status took on a new meaning. Having been through that experience ourselves (and in my case, with much less to fear than many others), I could appreciate the horror that many felt at the suggestion. But I also recognized in a new light the importance of knowing your status, both to help you protect yourself and to protect those you love. In the end, I probably shouldn't have let the day be so much about myself. But in so, I certainly gained a new appreciation for what it means to be HIV-, and for the challenges facing the campaign to raise awareness and defeat stigma and fear. Certainly a World AIDS Day that I won't be able to forget.