Causes, Experiences

HIV: A heavyweight in my suitcase

I have been travelling to different countries for a long time. I was born in one country and raised in another. My parents are not only from different countries, they are from different continents.

Canada, USA, inter-railing in Europe, a university internship in overseas, four years abroad for my first job, volunteering in different African countries and tourism around the world. So far, I have visited 26 countries in total.

I can not imagine no longer travelling and exploring other places of the world. Travelling from one place to another is what has made me the person I am today.

But now things won’t be as easy as saving money and booking holidays.

Since I found out I was HIV positive my life has been passing in slow motion. Each day I am more conscience about how much my life has changed. It won’t be as simple as taking some pills each day for the rest of my life. Now I need to check laws. Am I allowed to enter this country? For how long? Work permit? Resident permit? Will I be able to continue my career in international development?

There are 24 countries where I could get deported if they found out I am HIV positive.

From now on I am categorized as PLHIV (people living with HIV) and I will face discrimination in my international movements.

For example, long stays for study or work require permits that could include an HIV test. I am not against HIV testing if it is done with the intention of stopping people from remaining infected without knowing it. But when tests are used simply to deny visas, I cannot support them.

The Global Database on HIV related travel restrictions gives different categories:

  • Countries without restrictions.
  • Countries with entry bar.
  • Countries with short term restrictions.
  • Countries with long term restrictions.
  • Countries with unclear laws/practices; more information needed.
  • Countries without information.
  • Countries deporting people with HIV.

I encourage you to check about your own country legislations.

doi:10.3402/gha.v6i0.20472

Fig. 1. Status of HIV-related restrictions on entry, stay, and residence in 193 member states of the World Health Organization in June 2011.

We are in 2015, and just 5 years ago, the USA removed its “travel ban” for PLHIV to enter, stay or reside – the ban that meant there could not be international HIV/AIDS conferences in USA. This ban was place from 1987, the year I was born.

Some bans are supposedly based on economic concerns: how much does HIV cost the national health system?

If the reasons are economic why not extend the travel ban to people with other diseases/disabilities or family history of diabetes, cancer, heart disease, alzheimers, alcoholism, mental disorders or obesity? Those cost a lot of money too.

In real life, nobody is free of getting sick at some time or another.

Other justifications are based on the perceived danger to public health or public safety. As somebody with HIV, I have developed a high awareness of my situation and I and other HIV positive people engage in different levels of activism to reduce new infections. This does not mean that all people with HIV are “good citizens”, but this goes beyond moral or judicial judgement, also applied to non-positive citizens.

To be forced to declare your positive status, if you will face discrimination to obtain a visa, only dissuades people from getting tested.

HIV ban restrictions don’t stop the spread. People need to get tested to prevent new infections, but this won’t be universalized until HIV positive people stop suffering from stigma and discrimination.

I have already travelled abroad since discovering my HIV status. I took a note from my doctor in case I faced some problems carrying my medicine. My next step will be to move back to my host country in Africa, where I will sign my contract, my boss will pay all the legal requirements for a non-citizen and I will start paying taxes.

My diagnosis doesn’t mean I can’t or won’t contribute.

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Commentary, Experiences, Learning, Platform

The Danger Of Playing Doctors

Back in March 2014 I caught malaria.

My host organization took me to a clinic for a test but it was closed so we went straight to the pharmacy and bought malaria treatment. From my previous 9 months experience in Africa I had found that most people self-diagnose malaria. I allowed myself to be self-diagnosed too.

I thought, “Well they certainly know more about malaria than me”.

The symptoms were pretty much like a flu, feeling unwell, vomiting, diarrhoea, but nothing too extreme. It lasted a week.

But now I know it wasn’t malaria. It was the acute infection, seroconversion or primary HIV infection phase which usually appears between the 2nd-4th weeks after the person has been infected with HIV.

One of the MDGs is about combating HIV/AIDS, malaria and other diseases. Some of the WHO recommended strategies for this MDG include diagnostics and treatment with quality-assured antimalarial medicines, tracking every malaria case in a surveillance system.

If people can get malaria treatment in the pharmacy without a test that confirms you actually have malaria, some real cases of malaria aren’t being reported properly. Treatment efficacy can also be reduced as a result of drug resistance.

After my experience of an erroneous malaria self-diagnosis finding out that I could get malaria treatment from the pharmacy just by saying, ‘hey, I am not feeling well, they think I have malaria,’ a few question comes to my mind:

  • Why did I follow self-diagnosis and self-treatment in Africa knowing the high prevalence of these diseases if I would never do it even with just the flu back home?
  • Is self-treating with anti-malarials as prevalent as taking, for example, an ibuprofen for a headache?
  • What are the regulations to sell medicines without medical prescription in Africa?
  • Are the drugs sold without prescription actually quality drugs?
  • Do they sell malaria medicine so easily because people can’t afford the cost of transport to a health facility or the tests once they’re there?*
  • Do they practice free malaria tests?
  • Are there any program focused in training pharmacist to advise about the importance of testing?

Until I was diagnosed with HIV I didn’t know about the acute infection. I think it should be an important concept when giving information about HIV as people in general could realize two things:

  1. Feeling unwell doesn’t always mean you have malaria.
  2. Infections have phases and symptoms, and so has HIV/AIDS. From a prevention phase with sexual education, used of condoms and pre-exposure prophylaxis (PrEP), to the different stages of the HIV infection.

Stages of HIV infection

stages-of-hiv-1LINKS: Post Exposure ProphylaxisAcute infection

stages-of-hiv-2

LINKS: Window periodELISAWestern Blot

stages-of-hiv-3LINKS: CD4Viral loadOpportunistic infections

After my time in Africa, and not because I thought I had contracted any disease, just as I always do after long periods abroad, I went for a general check-up.

Although I was feeling great and active, It didn’t surprise me to find that I had a deficiency in iron and vitamin B12, but then my doctor called me in to hear the other result:

“You have tested positive for HIV”

I still remember the scary feeling when I understood the meaning of my 274 CD4. Without specific antiretroviral treatment, people will progress from HIV to AIDS in a span of 8-12 years, but mine in 6 months were almost as little as 200.

18 days after I was diagnosed HIV positive, with CD4 of 274 and a viral load of 94.200 copies, I started my antiretroviral treatment. I take 3 tablets each morning at the same time (Prestiza Norvir, Kivexa). After 2 months under treatment my CD4 were 542 and my viral load 516 copies. In the doctor appointment after 4 months under treatment, my CD4 continued to increase, to 581, and I have undetectable levels of virus (<20 copies). My HIV specialist is aware of my plans to continue my aid career and has given me advice and recommendations and has approved for me to move back to Africa.

In 2015 HIV is a chronic disease for all who can access care and treatment. Going back to Africa will open a window to all of us interested in the real similarities and differences between being HIV positive in a developed country and in a developing one.

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* I went to the doctor/hospital on another occasion and whilst I mentioned that I had had unprotected sex, HIV was never mentioned nor a test recommended by the doctor. The costs of consultation, blood tests, surgery, anaesthesia, etc… would not have been affordable with my local salary. Luckily, medical travel insurance took care of it.
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Advice, Experiences, Platform, Support

My Positive Mistake

Written by Sigo Still*

Is sex a taboo in the world of international development?

Do you think sex is a taboo when it comes together with an STD? Have you always, 100% of the time, used condoms? Do you speak about all this with your sexual partners?

Does anyone think that it can happen to them? Well, it happened to me.

Yes, I had unprotected sex, and yes, I am talking about HIV, a virus which doesn’t care about gender, age, sexual orientation, education level, religion, good or bad people, national borders or anything else.

Here is my story:

After my Master in International Development, I went to an African country* as a volunteer to gain experience at the beginning of a career in aid. It was not my first time on the continent, I had been before: volunteering during a summer, tourism and on a university grant. After my 9 months volunteering abroad, I came back home and I went to the doctor for a general check up. The news was devastating. During my time as a volunteer, working, meeting amazing people, learning from a different culture, eating the food, dancing to the music, wearing the clothes, travelling around, I also had unprotected sex and the test came positive for HIV.

I have learnt that some mistakes are forever. I can not change my HIV positive status, it will be with me the rest of my life. Apart from the tears, nights without sleeping, doctor appointments and psychological therapy, I have used the situation to learn a lot about HIV/AIDS: treatment, visa regulations, prevention campaigns, organizations and other people stories. For me, getting to know the story of other aid workers in the same situation as me gave me hope and courage to continue.

Sex is part of our private lives and HIV is also part of mine, but I couldn’t think for a second not to tell my previous sexual partners. These were difficult phonecalls to make. and I was afraid of two things:

  1.  Losing my privacy because they can choose to tell others about it.
  2. It is going to continue to affect other people, as they don’t want to get tested.

Religion is a big part of their lives and they want to believe that they are alright. But the real reasons that make it very scary to know that maybe you can test positive is all the social stigma as well as the lack of information about access to treatment.

Why would you want to know if you think that other people will treat you bad or that you can not get treatment because you think you won’t be able to afford to pay for it?

Believe me, sometimes I have wished that I didn’t know. But I could become very sick, die or even transmitted to someone else (my future babies?).

In my story I didn’t use condom, but the only true prevention is for people to know their status. If you use condom you can still get infected – it can break, for example. I know what I am going to say is difficult to understand or believe, but it can be safe to practice sex with a HIV positive person under treatment, as the virus load get to undetectable levels in which case you don’t transmit it even without using condom. But condoms should be used – also to prevent many other STD, especially for the HIV positive person, as they are more exposed to new infections and it can lead to difficult to treatment combinations.

The risk is not in the number of sexual partners, the risk is in the lack of protection and unknown personal status. It can only take one time in your entire life without a condom (or with a broken one) to get infected.

Before I knew my status, I had an offer for my first real job in my aid career. A local NGO in Africa wanted me to be part of their team. Initially I decided to hide the truth from my future boss and I refused to take the job, as I couldn’t get answers from the embassies about work and resident permits for a HIV positive person and, more importantly, whether or not I would be able to follow my treatment there.

After the initial shock, I felt braver and I told my boss the truth. I sent him all my research with information of access to treatment and visas regulations. He has been very professional and has given me the time I needed to get myself together and deal with the situation. In few weeks I will start working with them. I am going back to work, live, and get HIV care/treatment in Africa.

I hope that to share my knowledge and experiences with HIV in Africa can, little by little, fight to reduce the stigma around this disease. People must not be afraid to know their status and to deal with it, or there will never stop being new infections add to the HIV/AIDS pandemic.

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*The name of both the author and the relevant country has been left out to preserve anonymity.

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