Eating candy with the wrapper on

Yesterday the project that I am working on in Malawi set aside an entire day for HIV/AIDS with mandatory attendance by all project staff from the cleaner to the Chief of Party. This informational session was supposed to happen months ago, but it kept getting pushed back. Sometimes an outsider is better able to build momentum and just get something done.

Leading up to the day, there was much mumbling in the hallways about whether a full day was needed for this discussion. The hallway talk indicated that everyone knew the basic facts so a reminder was all that was needed. This proved not to be the case and interestingly enough, at the start of the session, we went around the room and several people noted that none of the projects they had worked on before had ever spent a day talking about HIV/AIDS.

The outside consultant who was brought in spent the majority of the day fielding questions from staff from the basic (can you get AIDS from a mosquito or from sharing a meal with someone?[1]) to the more complicated (what does a CD4 count measure[2] or why is the attention for AIDS focused so much more on Africa than on the West?[3]). Questions often revealed viewpoints, which I may disagree with, but which provide a lot of insight. The colleague who asked the question about why the world community is focusing on AIDS in Africa said that people in the West have much more sex than Africans. The instructor asked if he knew how the West had sex (looking for the answer that the West uses more condoms than Africa), but he replied that the west has free and open sex all the time. Definitely a negative influence of US TV and movies and it made me wander how he looks at me.

It became clear as the day went on that everyone in the room had been affected by HIV/AIDS in one way or another. In fact, it is very likely that at least one staff member is already HIV +, given that 1 in 8 Malawians is HIV positive, and that number goes up in Blantyre (where the project is based) to 1 in 4. If that wasn’t serious enough, project staff are at greater risk because almost all staff travel and are given daily allowances when they do so. In other words, they are away from their families with money in their pockets and plenty of women to spent it on (most staff are male).

The strongest point of the training was the person living with HIV AIDS who came to speak to the group. She spoke in Chichewa, so I couldn’t understand most of what she said, but I know she did talk about the common excuse for not using a condom: Who wants to eat candy with the wrapper still on? At the end of the day, people kept saying that they had learned from her that HIV is not a death sentence and that it is possible to live a full life with the virus. The negative view of HIV as an immediate death sentence is one of the main reasons that so few people get tested. I was also able to tell the staff about our company’s HIV/AIDS policy that pays for Antiretroviral Treatment (ART) for staff – hopefully providing them with another incentive to get tested and get tested early.

The highlight of the day for me, was at the end of the day when someone came forward confidentially to ask to access funds for testing. If this is the only outcome from the day (and given the level of attentiveness in the room I am sure it won’t be) it was well worth it. One of the hallway mumblers even said that two days could have been used for this discussion and other staff members have asked that we have a guest speaker every other week to talk about AIDS issues.

[1] No to both questions
[2] CD4 count is the number of CD4 white blood cells per mm2 of blood. This is the particular cell that is targeted by the HIV virus, and so it is used as a measure of the relative strength of the immune system. A health person has a CD4 of between 800-2000. When an HIV + person’s CD4 drops below 200 the individual is put on Antiretroviral Therapy, or AIDS drugs (in the west, the drugs are administered to those with CD4 below 300).
[3] A very good question with many possible explanations from sociocultural issues (e.g. the colonial introduction of moving men to industrial areas without their families), the fact that drugs are readily available in the West, economic issues (women are often forced to resort to transactional sex to feed their families), and sexual habits (condoms are not widely used in Africa, and dry sex – where a drying agent or cloth is used to dry the vagina which increases friction and pleasure for the man, but tearing and vulnerability to HIV for the woman – is widely practiced). There is much contention about all of these issues and this is still a much debated question.