There’s Hope in Them Buckets

On my solo tour of sub-Saharan Africa in 2001, I heard one message over and over again from the locals and expats I met in each country I passed through—an entire generation was about to be wiped out by AIDS. Many country’s leaders openly questioned whether HIV was real, the only medical education campaigns I saw were focused on an abstinence-only solution (that would have been hilarious in its incompetence and lack of understanding about local culture if the consequences hadn’t been so damn sad), and it was considered hopelessly naïve to think that the antiretrovirals that were quickly gaining momentum in America would ever be inexpensive enough to be dispensed in Africa.

Well, while a glance at Meg’s last post will show you that there are no shortages of problems in the local healthcare systems, and my four days in one corner of Kenya doesn’t qualify me to be an expert on the African AIDS problem, I’m here to tell you, in a town a couple hours away from our President's father’s birthplace, where people all around you claim that Obama is their cousin, uncle, or even “niece”, there is a little bit of hope here.

I spent Tuesday at a rural clinic with Meg, checking in on patients from the local villages. One man with six kids and two wives eagerly nodded YES! when Meg asked if he’d like to be prescribed more condoms along with his medications. Another woman who had walked three hours to get to the clinic beamed when Meg explained to her that her T-cell count had increased significantly due to the antiretrovirals she had started taking a few months earlier. When we walked home yesterday, we passed a police station where a police car with a huge megaphone attached to the roof began to roll by us and the six cops inside grinned at me, shouted through the megaphone “Hey John, how are you, are you feeling fine?” and then started singing together at ear-shattering volume at the top of their lungs to encourage the entire town to come to a free HIV education and training session.

Meg and her many UCSF and FACES colleagues are far better qualified to discuss why things may be starting to change here—activist pressure to allow generic medications to bring the price of ARVs down, financial and logistical support from governments and foundations, increased vigilance from local people as they watch the people they love die. And, god knows, there’s a lot left to be done. Mothers with HIV still often don’t bring their children in to be tested, afraid of knowing the results. Husband don't tell their wives that they're positive. Plenty of people tell doctors like Meg that they’ll use condoms but don’t. There still isn’t nearly enough funding or doctors or education or drugs to reach the people here that need them. 22 million people in sub-Saharan Africa have HIV (2/3 of the world’s total cases), and while in many countries that number is starting to stabilize, one look at San Francisco will tell you that as ARVs start to save more lives, people will often start to become complacent about transmission, and rates will increase again.

But amidst the tragic stories, you’ve gotta find those signs of change when you can. A couple days ago, Meg and I were sitting in the back of a truck coming back from one of the clinics out by Lake Victoria. In Kenya, there’s been a major adult male circumcision campaign, in direct opposition to the growing anti-circumcision movement in America, due to studies that have shown that HIV transmission rates are lower among circumcised males. We stopped at another clinic, and some men got in carrying two large purple buckets. They were clearly being careful to put the lids on tight and keep the buckets on a flat surface. So, we asked them, “Jambo, what’s in the buckets?” They smiled, paused for a second and said, “foreskins”. We couldn’t tell for sure if they were joking, but for the next two hours, on the bumpy ride home, as the truck careened over rocks and tilted at a forty-five degree angle on the shoulder of the dirt road, I have to admit, I liked thinking “Here I am, 8 years after my journey alone through an AIDS-raved Africa, sitting in the back of a truck in Kenya, with my passionate save-the-world doctor wife who works at a local HIV clinic on one side, and two buckets of foreskins on the other.” Can we win the battle against AIDS? Yes we can.

--rahul