TASO & AIDS: Week of March 12-18

one of the beautiful little girls who is HIV positive

My favorite quote of the week: “Laundry is not one of my greater talents, but I do love ironing.” – Brian, 24-year-old employee at CURE. (I told you they like to iron!)

Monday, March 12 – Tuesday, March 13

We began our first full week at TASO (http://www.tasouganda.org/; my site is www.tasouganda.org/mbl.php). I was surprised to learn that many TASO employees are HIV+ themselves and even more surprised to realize that people with AIDS have a lot of hope for the future. Living positively with AIDS is one of their goals.

They start the patients off with septrin, a drug that basically wards off sickness since their bodies’ immune systems are weakened by the HIV virus. HIV attacks the body’s CD4s, which are part of the immune system (they call them “little soldiers” when talking to the children). When the person’s CD4s go below 200, they are put on ARVs (antiretroviral drugs) that cause the HIV virus to become dormant, allowing the body’s CD4s to rise again. Otherwise, the person would get sicker as opportunistic diseases continue to manifest themselves in the body.

Here’s Wickipedia’s explanation: “CD4 is also a primary receptor used by HIV-1 to gain entry into host T cells. The HIV-1 virus attaches to CD4 with a particular protein in its viral envelope known as gp120. The binding to CD4 creates a shift in the conformation of the viral gp120 protein allowing HIV-1 to bind to two other cell surface receptors on the host cell (the chemokine receptors CCR5 and CXCR4). Following another change in shape of a different viral protein (gp41), HIV inserts a fusion peptide into the host T cell that allows the outer membrane of the virus to fuse with the T-cell membrane. HIV infection leads to a progressive reduction in the number of T cells possessing CD4 receptors and, therefore, the CD4 count is used as an indicator to help physicians decide when to begin treatment in HIV-infected patients.” (http://en.wikipedia.org/wiki/CD4)

TASO works with clients to counsel them throughout the entire process, from pre-testing to death. They provide clients with food, ARVs, septrin, support, and income-generating projects. They work to sensitize the communities, dispelling myths about the disease.
On Tuesday, they held a general health clinic, so Aubrey and I took down the information of about 150 patients. Some of the names of their hometowns are crazy: Budaka, Namakwekwe, Bukedea, Sironko … you get the idea. Now try only hearing the names and figuring out how to spell it!

Wednesday, March 14

We played with the kids in the Children’s Play Center today. Most of these kids are aged 3-12, and most of them look fairly healthy. Trained counselors work with them, going through their ARV regimen and making sure they are taken care of. They read a comic book of sorts to the children that explains HIV, CD4s, and ARVs. It breaks my heart to see these happy children, knowing they are HIV positive through no fault of their own.

The first client we saw was a thirteen-year-old girl who attends boarding school in town and travels to TASO alone. She’s been on ARVs for about four years and has consistently attended TASO workshops and counseling by herself. I don’t understand.

these boys were goofballs. they don't look like they're HIV+, do they?

The funny thing is, I thought at first I would be uncomfortable working with so many people who have a fatal and somewhat contagious disease. But knowing that I can’t get it easily (you can only contract it through sex, sharing infected needles, receiving an infected blood transfusion, etc.) means that I don’t mind being around them at all. In fact, I feel very lucky to see their struggles and victories with this disease. It’s very encouraging in light of the disheartening situation.

Sarah, age 12, wrote this poem.

AIDS! AIDS!

Who created you?
You are finishing us all
You kill the young and the old
You are finishing our lives
What is your mission?
You are a threat to the population
Why do you rob a man of his good life?
Last week you killed our father
The other month you killed our mother
Now you are killing our brother
Leaving us orphans
We wish we knew where you live.
Where are you, AIDS?
The old and the young have died
The poor and the rich have vanished
The handsome, the beautiful, the ugly have disappeared
Because of AIDS, the killer.

Thursday, March 15

We did intake again today with a TASO employee and client named Doka. He’s 47 and was diagnosed with HIV a few years ago. At that point, he had two wives (remember, polygamy is not a big deal here), and one was HIV+, the other HIV-. The uninfected one left him. He went from 77 kilograms (170 pounds) down to 49 (108 pounds), and his CD4 count dwindled to 43 (a healthy person has about 800-900 per cubic milliliter of blood, I think). However, he began taking ARVs, and his CD4 count went back up. I honestly had no idea he even had HIV; he looks very healthy and happy. Again, it was so encouraging to see that life does not have to stop when someone is diagnosed with HIV.

We traveled to Mbale Progressive School (a secondary school) for a school outreach in which we showed two videos to a group of about 300 in a small room. They didn’t seem to pay attention very much. I guess it was a typical high school crowd, but it was frustrating.
I did see an ostrich across the street in someone’s yard, though! I’m going to go visit it before I leave.

Friday, March 16

These goats and the cage were given to clients to generate income

Friday we went into the field for follow-up again. We drove out of Mbale into the villages to check on a few income-generating projects involving goats, chickens, and cages for them. Driving through miles of lush green rice fields to reach the towns was amazing. I love driving through Uganda. I never get bored.

a home visit with the group. Seated L-R is Dennis from Malawi, Prisca from Zambia, a TASO employee, a member of the client family, and Aubrey. Dennis and Prisca are part of our TEACH group.

We also went to another outreach in another school, though this one was intended for the entire community. A singing and drama group from TASO presented songs and skits to explain AIDS, and several HIV-positive clients shared their stories.

Barbara, our supervisor at TASO, relayed two stories of confusion about transmission of HIV. One drug user was using needles without fear, and when asked why he wasn’t scared of contracting HIV, he replied, “Oh, I’m safe! I have on three condoms!”

Up north in Karamoja, there is a group called the Karamojong. I haven’t visited them, but they seem quite interesting. They hardly wear anything except for their AK-47s, and they believe that all the cows in the world belong to them (don’t ask me why). So they often raid villages and take their cows.

Anyway, apparently the Karamojong were given condoms as well so they could practice safer sex. So what did they do? They put on the condoms and wore them all day, took them off to pee, and then put them back on. They would take them off to have sex, and then put them back on (remember that these guys are in the nude most of the time anyway). Oh my.

Saturday, March 17

A friend here at the hospital visited today (Brian, the one who gave me that wonderful quote about ironing). He believes that there is not one person in Ugandan unaffected by AIDS in one way or another. “I personally have lost count,” he said. He has lost two brothers and a sister to AIDS as well as countless aunts, uncles, and cousins. This is a man from a well-educated, seemingly well-off family, and they are still suffering from this disease. I didn’t realize how much it has affected this country.