World AIDS Day Chronologue

12:00 Folding together ribbon and piercing it for the sake of AIDS. Theses upside down gamma signs, as I call them, are indeed aids to remember AIDS. I remembered the times I was in Frist Campus Center, at meetings before World AIDS day and we folded and pinned so many. I only had about thirty or so to do, as I listened to French radio. It was so cool to remember all these friends of mine – so many names that I feel I do not want to omit a single one. So I will omit them all. You are all in my thoughts Student Global AIDS campaign people. Shannon and David and Nick and Joyce and Nam and what was your name again? No not Patty, I remember you clearly, but there were a number of other girls who were there – seated – cutting and folding and pinning and I just helped them. Well I made my thirty ribbons.

8:00 The morning of World AIDS day. I go to the Central Hospital of Windhoek. First I stop by the office of the Ministry of Health, Directorate of Special Programs that is on the same grounds as the hospital. I look for materials, but there are so few – only a few male circumcision and “break the chain” leaflets in languages I do not understand (local ‘venacular languages’). Most of the people have already left to the main World AIDS Day event for our political leadership at the Safari Court. I am not going. I am part of our event – the event by the Namibia HIV clinicians society.

08:10 Ando deprisa y, de repente, me doy cuenta de que me acerco a un médico cubano saliendo de la entrada del hospital, hacia la que me dirijo. Sí, es uno de los médicos con cuya participación cuento esta mañana. “Cuenta con nuestra participación” fue el mensaje que recibí en mi correo electrónico hace una semana, de un médico cubano que trabaja a Windhoek, a lo mejor en este mismo hospital. Pues ¿es él mismo que ahora pasa a mi lado? No sé, pero le digo “buenos días” andando y me devuelve el mismo saludo.

 

Al final no vinieron los cubanos, ninguno de ellos. Seguramente tenían otras cosas que hacer, pacientes de ver. Sin embargo, probablemente alguien de la embajada les prohibió participar en nuestro intercambio y diálogo sobre discriminación y estigma en torno a las personas seropositivas en el ámbito laboral de médicos, enfermeras, farmacéuticos y todos que trabajan dentro de un hospital. Pero solo supongo que les hayan prohibido, porque tengo en cuenta que la embajada controla a sus movimientos. Por el otro lado, es posible que simplemente no les quedaba tiempo para asistir al evento – tenían que cuidar a los pacientes. Y también es posible que se hayan olvidado venir como no se lo había recordado tras recibir su confirmación.  Pero, al salir del evento – cuando todas las enfermeras se pusieron en una cola que llevaba a la mesa con la comida, café y té, les vi a dos médicos (les reconocí por su cara y por el hecho que se vestían como médicos – en blanco) esperando. Quería hablarles en español pero, a los pocos momentos de acercarme a ellos, se fueron a comprar algo de la tienda afuera y no quise perseguirlos. Así no conseguí saber qué pasó con ellos. ¿Por qué no han venido? No sé. Pero, es seguro que para saber el motivo tendré que tener confianza con unos de esos médicos y así me dirían la verdad desde su punto de vista (en vez de la versión ‘oficial’ que es sin duda “disculpe, no pudimos venir porque tuvimos muchos pacientes que nos consultaban…”

08:30 Back to English now. The event oponed with a talk from the president of the Namibia HIV Clinicians society. She gave an overview of HIV in the World and in Namibia, before speaking about stigma and discrimination in the health setting.

I would like to focus here on what struck me. She referred to a figure of 17.8% during her talk about the HIV pandemic in Namibia. Her reference was to point out the amount of HIV positive people out in the whole population, even though she only implied this in her talk. This figure of 17.8% (the result of the 2008 HIV sentinel survey) was given in a context of the history of the pandemic here. She spoke of how in earlier years this figure had been higher and how it had come down. She expressed hope of it coming down further – “we hope it has now decreased to 15%” in reference to the 2010 HIV sentinel results that the Ministry of Health was launching at the event at Safari Court that same morning.

Given that this figure is the HIV prevalence amongst pregnant women that consult state ANC clinics during the times of the survey, what are they ways it can change? It is a proportion of HIV positive women over the total number of women enrolled. So for it decrease, either the total number of HIV negative women enrolled will increase, while keeping the number of HIV positive ones constant, or by decreasing the number of HIV positive women and keeping the number of HIV negative ones constant.

Here I will reflect upon the way either of these processes may occur. Briefly, if new mothers are generally HIV negative, you will see the denominator of that proportion grows, while the numerator stays the same. There we have a situation of fewer new infections, which will reduce this prevalence. But this assumes the number of enrolled women in this survey continues to grow each two years when it is done. Is this true? I would like to look at the sample sizes. Another possibility is that there are fewer HIV positive women. How could this happen? Certainly, in the era of universal antiretroviral therapy, more women are expected to live, so we cannot assume they will just die off. But could HIV positive women just have fewer children than HIV negative women?

The advent of prevention of mother to child transmission means women can have uninfected babies. Nonetheless, HIV positive women are now encouraged to have children. The panelist form the Legal Assistance Centre of Namibia alluded to the contrary as he said the question “Why do you want to have children now that you are HIV positive ?” as an example of discrimination. One of the expert patients on our panel also recounted her experience of giving birth in a state facility a few years ago “When I told the nurse I was in labor, she told me ‘no just wait for me to put on double gloves – you have HIV!’ and I really felt bad.”   Coming full circle, I wonder how stigma and discrimination has affected the decision of HIV positive woman to have a child. What effects does this in turn have on the sample of women who participate in sentinel survey? Is this a random sample or do we tacitly assume it is when calculating the prevalence proportion and corresponding confidence intervals?

Perhaps I will write more on other discussion we had during this even “HIV, AIDS, Stigma and Discrimination in the health profession.” I believe any questions or comments on what I have written so far will inform future recollections and writings.

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About writinghealth

Wannabe Epidemiologist? Wannabe med anthro person? I guess. Christian, scientist (not Christian scientist), i mean like I studied molecular biology and I part of the RC Church. I also completed a Masters of Public Health, at the University of Cape Town, in Epidemiology and Biostatistics.
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