It was another hot sunny day in Mozambique. I passed her on the veranda outside of the clinic as I hurried in to start seeing patients for the day. She had Tendai, her 11-year-old boy, in tow, and her younger child on her lap. I had met them two days ago when she brought Tendai into the clinic because she was worried about his weight loss, lack of energy and nighttime fevers. I had asked her to get Tendai some tests, and it looked like she had returned with the results.
Protocol would usually entail having her check in with the nurse and seeing the family in the consultation room. But when I saw Tendai’s pale, emaciated body and the worried look on her face, I decided to stop what I was doing and take a quick look at the results. She handed me the X-ray and I held it up to the light — so far, so good. “Do you have the other test?” I asked. She dug a piece of paper out of her handbag and I noticed that it was folded and stapled closed, never a good sign. I ripped it open and the results “HIV-Positive” were clearly handwritten on the paper. “We should step inside to chat,” I said.
I sat down with a mom who could just as well have been a mom from Maine. She had lived in the same community her whole life, she worked hard to support her three kids, and she and her husband were barely getting by. When I said the words “HIV,” I turned her life inside out. Not only did Tendai, her oldest boy, have AIDS, but she was surely infected with HIV herself. Her husband probably had it as well, and her two other children had about even odds of having HIV. Every family member with HIV will die without treatment. How do you tell that to a mom who has too many worries already?
Another day at ground zero of the HIV epidemic, already the worst epidemic in the history of mankind. About two-thirds of all the cases of HIV in the world are here in sub-Saharan Africa. I teach in the medical school in Beira, a city of a half-million on the Indian Ocean. Given its status as a port and a transport terminus, Beira has the highest HIV rate in Mozambique. Tendai’s story is not unusual, since 35 percent of all pregnant women here are infected. Without preventive anti-HIV medication at the time of delivery, about 25 percent of their babies will be born with HIV and another 25 percent will get it from breast-feeding.
Beira is a vibrant city, and people here work incredibly hard to feed their families, and many are not able to do much more than that. I live near the hospital and see the funeral parties leave the morgue every day. There are 11 million AIDS orphans in sub-Saharan Africa, many of whom live on the street. I see them near where I live, going through the dumpsters to find scraps of discarded food. But mostly I see and hear the human side of the epidemic when I am at work, administering to patients and teaching medical students.
There are signs here that the huge international effort, led by the U.S., is making a difference. HIV is an incurable illness, but it is controllable through the use of medications that are remarkably well-tolerated, inexpensive and effective for long periods of time. As with all infectious diseases, the virus eventually becomes resistant to first-line medications (especially if the patient is not 100 percent consistent in taking the pills twice every day), and treatment gets more complicated after that.
This is nothing new to me — I saw the same phenomenon of treatment failure when I cared for patients with obesity, diabetes, hypertension and heart disease in Bangor. Those medications are not a piece of cake, either, and, yes, most of those patients will also eventually die of their disease. There is hope that we will eventually have a vaccine for HIV, but I don’t think it likely that we will ever immunize people against obesity, poor diet, physical inactivity or smoking.
I am proud to be an American working in Africa, especially with Barack Obama entering the White House. I am proud to be a Mainer with representatives in Congress who have consistently supported AIDS treatment in Africa. Treatment with medications is the answer for people who are already infected and can help prevent new infections from occurring through sexual transmission and during childbirth and breast-feeding. There is much more we need to do, but we are making a difference and the people of Africa need and deserve our help.
Peter Millard is a family physician in Bangor.