The Common Good Forum, February 2, 2011
Confronting AIDS in Africa
by Mary K. Grabowski, doctoral candidate at John Hopkins University School of Public Health
In August of 2009, I returned to the United States after a little over two years of living and working in Kigali, Rwanda. Moving back home was not easy. Rwanda is a small country, approximately the size of Maryland, in central Africa. It is a beautiful country with a landscape defined by verdant rolling hills and tropical fruits and flowers. To me it is paradise, an escape from the modernity and materialism that consumes American life. Beneath its enchanting exterior, Rwanda has a troubled modern history that includes one of the worst genocides ever recorded. Nearly seventeen years after the now infamous 1994 Rwandan genocide, where almost over one million Rwandan citizens were brutally murdered or injured, the country has experienced what many describe as a rebirth. A now stable government, thriving tourism and coffee industries, and peaceful countrysides have all made Rwanda a light within a continent too often overshadowed by abject poverty and widespread corruption. Yet despite these strides, Rwanda still bears great burdens of mass deprivation and disease like its other African neighbors. The human immunodeficiency virus (HIV) has had particularly devastating consequences here, overburdening health care systems and disrupting families among other tragedies.
In Kigali, I worked as a research coordinator for HIV prevention studies, trying to understand how we could prevent transmission of the virus as opposed to how we could treat a person once they were already infected. Within Africa, Rwanda has relatively low levels of HIV infection, but the problem persists and has left many infected and on treatment or waiting to be treated, and thousands of parentless children, crowding already overcrowded orphanages. My research specifically focused on HIV transmission within couples, most of them married. Unlike other parts of the world, the epidemic here is predominately heterosexual, with drug use having little if any role in transmission dynamics. Most infections, contrary to popular opinion, are also transmitted within these stable partnerships. It is unclear why the African epidemic is the world's worst, although it is likely a complex interplay between viral and host genetics, human behaviors, and environment.
Recent scientific advances in prevention products, including HIV vaccines and microbicides (anti-viral gels applied directly to the vagina), are promising, however any widespread dissemination of these products for public use in the near future doesn't seem likely. There have been other successes in HIV prevention, not limited to but including circumcision, couples voluntary testing and counseling programs, and condoms. Condom use is especially effective for HIV prevention. Public health advocates, bearing witness to the carnage and havoc that HIV has caused, view them, very literally, as life savers.
The African people have handled the HIV epidemic with grace. I am amazed by their abilities to press on in the face of such great adversity. When things are bad here they often get worse, but when given an HIV positive test result in Africa, it does not mean give up. When one million of your fellow countrymen and women are murdered in war, it does not mean move away. In moments when I would have imagined an American falling to his knees, the African stands. No wallowing. No crying. The people here press forward, and they do it together. It is this spirit, this fortitude, which I miss most in the wake of my return to the United States.
People often tell me how selfless I was to go to Rwanda and fight the good fight, whatever that is. If I am honest, I tell them the experience was egocentric. I took more from Africa than I am sure I gave. I returned with a new sense of self and a set of values centered on family, friends, and community. I am sure most people who go here, even if just for a short trip, will tell you the same. I am now doctoral student at Johns Hopkins University, where I continue to research novel methods for HIV prevention. I am sorry to say that there is no vaccine or cure, yet. Despite these disappointments and setbacks, I am not giving up. There's work to be done and progress to be made, not matter what challenges come our way.
