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.

___

* 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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Experiences, Learning

The Age of Sustainable Development: What gets measured, gets managed

This is a series from our writers Holly Narey and Michelle Gonzalez Amador who are taking Jeffrey Sachs’ online course The Age of Sustainable Development. They will be sending out an update on the course every week. Click here for more on all our writers. Check this tag to see all posts on this topic.

Have you heard the phrase ‘what gets measured, gets managed’? Jeffrey Sachs has, apparently, and he is a big fan.

When talking about development projects in a wider context, it is hard to get a clear picture. Part of the reason of this is because most projects have such a small impact in the overall development framework. It is easy to have a pessimistic view when we remember the statistic which introduced us to this course: there are one billion people living in extreme poverty.

This one statistic, however, does not show the progress over time. In the 1980’s, for example, the World Bank calculated that a little more than half of the people n the developing world lived in extreme poverty. By 1990, it had gone down to 45%, and by 2010, around 20%.

Setting goals

Lesson 5 of the series focused on the importance of setting goals for development, using the Millennium Development Goals as an example.

Economic progress, Sachs echoed from Keynesian ideas, is not the permanent problem of the human race – given no important wars and no significant population increase, that is. The real problem lies in concentrating efforts for a particular goal. That is true achievement of the MDGs: an ambitious project to fight extreme poverty. They are clear goals for people to understand, to promote, and to use to urge governments to take serious action that could end extreme poverty. They may be ambitious, and to a certain point, onerous, but they serve the purpose of setting the ideal to help mobilize efforts that would otherwise be disperse. Beneath those eight, broad and ambitious goals, there are twenty one specific and quantified targets and sixty detailed indicators that have better allowed us to measure the progress made.

The story so far

Because of the unenforceable nature of the MDGs, efforts may be uneven or prioritized differently from country to country. For example, China’s remarkable economic growth is a big part of the success of reduction of poverty (MDG 1). However, more globalized achievements have been found in the steady decline of malaria and other tropical diseases.

The establishment of the MDGs has both propelled the scaling up of development projects, and also permitted us to identify the remaining challenges. These include:

  • Agriculture in Africa. The source of food supply for the continent faces many obstacles. Namely the low yield and the lack of funding to invest in better management for irrigation, good seeds variety, etc.
  • The lack of government investment in infrastructure. A particular issue in certain parts of the developing world, this leaves regions isolated, hindering trade and its spillovers.
  • High fertility rates. Not only does this pose a problem for urban-planners but also, in terms of food and other production, directly influencing the environment.
  • Food security. As broad as this is it continues to be one of the biggest challenges if poverty eradication wishes to be environmentally sustainable.

How to tackle poverty

Sachs makes an interesting three-pronged proposal to tackle poverty:

  1. Investing in GMOs. Sachs used the case of India’s green revolution in the 60’s to back this point up. Certainly a controversial topic, as GMO production is, to my knowledge, monopolized by MONSANTO. Sachs himself did not say it, but perhaps it is important to note that, for such an action to work, certain prerequisites need to be met, particularly concentrating research in solving specific agricultural challenges in poor regions, as opposed to general increase in food production.
  2. Official Development Assistance. Otherwise said, a temporary injection of funds for targeted investments so that a poor place can jump-start a process of sustainable growth. Highly contested by other experts, such as Easterly or Moyo, who’ve used Sach’s own love for hard data against himself by exposing the side-effects of Aid money in African countries, it is probably the most complex solution, for it involves political will and efficient management from the part of the receiver-country. Sachs argues that because of the inherent risks of borrowing money, such as debt-crisis, a financial grant could provide the initial investment a country needs to leave the poverty-trap. Sadly, it has been shown that certain countries have become dependent on AID money, in detriment of initiatives to mobilize their own resources.
  3. Practical interventions: specifically, the Millennium Villages. Implementation has always been a big issue for development practitioners. By designing such a project and applying the MDGs as a guiding principle, Sachs wished to understand through empirical evidence which where the hardest steps of implementation. In its eighth year, the extremely controversial Millennium Villages project has, Sachs argues, shown that it is possible to help mobilize a community. ‘By harnessing the energies of communities, with a little bit of help, best practices, etc. tremendous things can be achieved’ concluded Sachs. Probably the solution that concentrated more on explaining the project than on explaining the findings, it still gave a spot-on argument. Realizing the potential of social capital in each community can lead to high-impact beneficial changes in a development framework.

Lesson 5 has been the most controversial lesson thus far, exposing the personally biased ideas of the professor. Whatever the faults of Sachs and despite his many detractors, he has clearly held onto his vision of ending poverty sometime soon.

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Experiences

Getting Lost At The EU-Africa Summit

It is easy to forget that Brussels is the second most powerful city in the world. The smell of frites fill the air, policemen stroll down the streets puffing on cigarettes and tourists huddle around a statue of a tiny, peeing boy. It is an unkempt, slightly disorganised town, not quite the capital city home to the European Union, NATO and, of course, the Belgian government. Then Obama arrived, closely followed by Chinese Premier Xi Jingpao. A week later around sixty Heads of State from both Europe and Africa follow suit.

Within a matter of days, Brussels exploded into a flurry of policemen and barricades. No longer could you park, unticketed, five meters from the Commission building. Snipers lined the buildings outside of the Council and helicopters patrolled the skies day and night.

It was for the Fourth EU-Africa Summit that I had managed to slip out of Oxfam for a couple of days under the guise of a journalist working for the Europhilic online paper CaféBabel to cover this event. My first summit as an amateur journalist would be one which would bring together a bizarre mix democrats, kings, polygamists and bureaucrats in the name of “People, Prosperity and Peace”. This was an opportunity for the populists to say something outlandish, for the political nobodies to huddle with the elites and, at the end, extol a new era as “a partnership of equals”.

History has entwined the two continents, but despite Europe being by far the largest donor of foreign aid, the Summit arrived at a time of tension. Migration and failed trade talks represent two of the key disputes, as well as the older issue of human rights emerging with new crackdowns on LGBT communities. The EU refused to invite a representative from neither Western Sahara nor Omar al-Bashir of Sudan, contributing to Robert Mugabe’s boycotting of the event.

In the jungle of photographers at the VIP entrance, the president of Niger briefly stopped for the camera’s to say “Europe doesn’t care about Africa”.

Expecting further anti-colonial sentiments and heated table-thumping I  headed for the press zone where hundreds of journalists from the global media frantically typed on their computers and consumed copious amounts of coffee. I felt entirely lost, out of my depth. It quickly became apparent to me that, unless you are from high-brow media, you were doomed to watch from the sidelines. Despite frantic requests for interviews with anyone from the King of Swaziland to the President of Latvia, CaféBabel held no swing with their press officers.

My image of stumbling across a story quickly disappeared; this was a job for the BBC or AFP, not a blog with a readership entirely disinterested by African development. Instead, I saw this as an opportunity to learn a little bit more about a continent I know little more about than a few well-constructed Oxfam sound bites.

With this is mind, I wondered across a press briefing from Madagascar. Now this is a country I know nothing about. As I waited for the conference to start, I looked up a few things. Madagascar: unstable political structure, President who resembles Kim Jong-Un, national language French. The last point was disconcerting for me, but I stayed put. In came the President to a room of around seven journalists, surrounded by a few officers, and delivered his speech in a language I could not speak. He looked happy, so I smiled at him, but the other journalists – primarily from African press – were frowning, scribbling frantically on their pads. It later transpired that he was desperately trying to convince us that “rule of law” was being restored in his country.

Outside of the sporadic press conferences, the leaders spent most of their time huddled round conference tables reading statements on issues as broad as trade deals to gay rights, climate change to migration. Naturally my press credentials didn’t allow me access to this room, so like most of the journalists we sat in the press briefing room watching it on a big screen (without translation and streamed online). I think in my mind I imagined walking shoulder-to-shoulder with the leaders, watching their discussions live; not on a TV next to a passed-out cameraman.

Disheartened, I went to a jargon-filled briefing on Europe’s imminent intervention in the Central African Republic; interesting, but uninspiring. I had no story, just a few quotes already broadcast and published online. With little to write about, I headed for the exit. But chance was on my side again as I stumbled in on another press conference; this time with Hollande and Merkel. It was genuinely exciting and the atmosphere was buzzing. It might be true that, for a first time journalist, a summit might not give much room for original thought, but as the two prominent heads of states entered the room, I realised that it didn’t matter. I was sitting in a room with some of media’s biggest European correspondents, watching the President of France and the Chancellor of Merkel deliver their vision on Africa’s future; it might not excite everyone, but it fascinated me.

 

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Learning

Top Five Posts Of The Year

In a time honoured blogging-in-December tradition, here is the run down of our five most popular posts this year in order of hits.

  1. We Need To Do Something About Television – a post on a shocking Italian reality TV show filmed in a refugee camp. Yes, seriously. [Written by Rowan Emslie]
  2. Working For The Poverty Barons – a look inside the oft-misunderstood world of development consultancies. [Written by Julia Lipowiecka]
  3. Networking: A guide for interns – a somewhat snarky take on the difficulties of networking for bottom rungers. [Written by Iris Leikanger]
  4. Optimism In Africa – an examination of polling and the importance of governance in measurements of optimism. [Written by John Favini]
  5. Before The Internship: What I’m expecting – useful for prospective interns and employers alike, some nice insight into what expectations first-time interns have before entering an NGO. [Written by Ben Butcher]

We’re delighted to announce that we hit our first 10,000 hits late last month. For those of you who were interested in this whydev.org published article by me about how useful Reddit is for development organisations/blogs/websites, more than 40% of those 10,000 hits were generated through the so-called ‘frontpage of the internet’. Ignore it at your peril, particularly as it seems that Facebook has begun its inevitable decline.

We’re excited to develop this site as we continue to work out exactly where we fit in the wide world of the development blogosphere. We’d like to thank our good friends at whydev.org and Aidsource for support and feedback in the last few months.

Finally, we’re always looking to publish new writers (our No 2 most popular post was written by a guest writer) as well as invite people to join our core team of talents.

Go ahead and take a look at the Submissions page – we’re excited to hear from you.

Here’s to more posts, hits and voices in 2013.

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