Before coming to Kenya, I thought I knew enough about AIDS especially since I had just finished studying for, taking, and passing my recertification examination in internal medicine. I knew about HIV and its effects on the immune system leading to opportunistic infections and cancers. I knew how it is and is not transmitted. I knew how to diagnose and monitor infected patients, and what medications to prescribe and when to prescribe them for prophylaxis against certain diseases. I knew the general principles behind the use of antiretroviral medicines (ARVs). After five months of working at AJAN House and seeing patients at the St Joseph the Worker Dispensary, I now know that I really did not know enough.
Having practiced medicine only in the United States, I did not know the critical role of poverty in the course and treatment of AIDS. In Kenya, I quickly found out that ARVs are beyond the reach of most patients despite the availability of cheaper generic formulations. Even those who have access to free medicines have trouble getting them because they cannot afford the fare to go to the clinic (if there is one nearby) or the fees for the laboratory tests required for monitoring treatment response. Because every single shilling is hard to come by, patients choose to spend their money on basic necessities like food rather than on health-related expenses. Many do not even have the option to choose since they do not have any money to start with.
I had not dealt with AIDS as an epidemic until I came to Africa. Hence, I was not aware of the significant impact the disease has on the family, community and society in general. It is killing a whole generation of young parents, leaving behind ageing grandparents forced to act as parents all over again and a generation of orphans. Children, especially girls, stop going to school to help take care of one or both parents. Many children end up working to supplement the family income that shrinks further as the parents get sicker and cannot work; not a few end up in prostitution. Farms are abandoned because there are not enough able-bodied people to cultivate the land, which leads to increased poverty and a vicious cycle.
I was taught in medical school and during post-graduate training about the risk factors and usual modes of transmission of HIV. Wife inheritance, female circumcision, sex with young virgins as a cure for AIDS – such cultural practices and mistaken beliefs were not mentioned. The same is true of other factors that include political instability and violence. I learned about all these when I came to Kenya.
All my new-found knowledge points to a truth that I did not appreciate before: AIDS is not just a medical problem; it is a complex development and justice issue. Addressing it effectively requires going beyond ARVs and CD4 counts. Employment, income distribution, food availability, education, gender inequality, sexuality, availability and accessibility of health care, peace and order and political stability must be addressed. Given the complexity of the problem, it is imperative that all the different sectors of society and countries of the world come together to control the pandemic. AIDS is a problem that robs those afflicted and affected of their dignity and of their humanity, diminishing ours as well. All of humanity, with God’s grace, is called to solve this problem. And this, perhaps, is the most important lesson of all.
Winston Mina SJ