Misconceptions about antiretroviral drugs hampering the dream for an AIDS-free generation

30 years since the first documented cases of HIV, there are reports of major milestones in the fight against an epidemic that has devastated some parts of the world. UNAids reports that in the last decade the global rate of infections dropped by nearly 25%, while according to the World Health Organization, an estimated 6.6 million people with HIV in developing countries are now on antiretroviral therapy drugs –drugs that keep them from developing Aids and help them live longer.

But as we hail the achievements of the last decade, one very important question begs an urgent answer: “Have we done enough to expect an AIDS-free generation any time soon?” As I’ve recently witnessed, complacency related to antiretroviral drugs may be fast eating into this dream.

EstherWambui/Photos
Participants at Toronto AIDS Walk For Life arrive
at the city's AIDS Memorial

A recent conversation with three young women in Kenya gave me a window into how far we might be from achieving that goal and left me wondering whether time has come to re-examine basic HIV/AIDS education [Esther Wambui/Photos].

I was concluding a visit there after five years of living abroad. And as it is customary I ended up at a hair salon for some braids that would take several hours to do. With so much time to pass, I eventually broached my favourite topic…HIV/AIDS. I instantly noticed something positively different. Unlike five years ago, people are no longer shy to discuss the epidemic. They have seen and heard enough about it already to become part of daily conversation. One of the women was in her mid-30s and she vehemently declared that if some guy thought to “bring” her HIV, she would personally kill him.

The other two women however, were in their early twenties and had a different tone. One said that she did all she could to avoid infection, but that accidents do happen anyway. Then the third woman made a statement that forms the crust of my viewpoint today. Unfazed by all our (ABCD*) talk, she boldly declared that medication for HIV was now available and there was no more need for all the panic. She went on to say that people should be left alone to “enjoy fear-free, guilt-free sex”.

I froze to my bone on hearing this. As a certified basic HIV/AIDS educator, I’m aware that antiretroviral therapy is an important part of the curriculum, with an emphasis on ARVs as one of a number of ways to enhance the life of sufferers. ARVs never have and do not cure AIDS or HIV for that matter.

Thus as we commemorate three decades of HIV, we need to remember the under-thirty generation, for whom the epidemic has always been a way of both vocabulary and life; a generation that didn’t have to deal with the shock-value of the emergence of an incurable disease. For them, HIV/AIDS is one of the many other chronic diseases.

EstherWambui/Photos
Two TCE [South Africa] Field Officers give an HIV/AIDS
awareness lesson to a teenage girl

Is it time to revisit the focus of ARVs education or do we need to implement an altogether new program?

While we must continue giving hope to those already infected, we need to make sure that the uninfected know all there is to know about these drugs. Let’s have an ARV-only program. A program that tells the young that yes ARVs are there. Yes, they are available although to a relatively small and select number in poor countries. And yes, they do improve the quality of life for the infected. Likewise, I believe time has come to revisit the education of earlier years. Be forthright, open, frank, and remind people that these drugs are not a cure.

Let emphasis be placed on the ills of long-term use of these drug: The numerous side effects that range from relatively mild ones, to very serious ones that in themselves impact quality of life. Add that to treatment failure, drug toxicity and in some cases, resistance to these drugs. This in itself should disturb the unfazed, the fact that once you’re on ARVs you’re always on ARVs. That you never stop taking them, a concoction of pills for the remainder of your life!

In the fight against HIV, we always hope that everyone gets the message. But as is the way of life, some people might or probably will always fall through the cracks. I’m okay with that as long as they fall knowing that crack is a life-altering one to fall into - one that you eventually pay for with your life.

With an estimated 33.3 million people currently living with the virus, the only thing I can hope for is that the young woman is by all means an exception, not an indicator of her generation’s mindset.

*Abstain, Be Faithful, Condomize, or Do-it-Yourself.

Been away

It's been many months since I last wrote a word in here. A lot has been going on that kept me away. The good thing is, in about two months I'll be back. After taking the first part of 2011 to travel across Kenya and now heading to Ecuador, look out for more stories; focusing on my greater passions of Travel, HIV/AIDS and Development. Watch this space!

“Yes” or “No”, decision time for Kenya

One of the best advices anyone ever gave me was that it was likely that in immigrating I’d lose my sense of “belonging”. He said that while in my new country, I’d long for the country of my birth and vice versa. This is why after some struggle I have quit trying to either be fully Kenyan or wholly Canadian; recognizing it will never happen. For the rest of my life, I unashamedly expect to be satisfied with the hybrid third personality, sometimes 50:50 and other times 70:30, the ratio often depending on the day and the news headlines.

I can therefore confess that in recent days and up until Wednesday this week, I have been and expect to be more Kenyan than Canadian. Instead of joining in the jingle “to bring back the long-form census”, I have turned to constantly scouring news channels regarding the proposed Kenyan constitution which will be subjected to a referendum on August 4, 2010.

You cannot blame Kenyans in the diaspora for selfishly wanting this draft constitution to pass. The main reason is that one of the clauses guarantees that Kenyan citizens who acquire foreign citizenship will not lose their Kenyan citizenship. Considering that most of our families remain in Kenya and that Kenyans abroad contribute significantly to nation-building through direct financial remittances, a dual citizenship seems like a fair deal.

But looking at the bigger picture, we out here support by all means a constitution that will help Kenya improve its poor democracy as well as avoid a repeat of the 2007-08 violence which rocked the country following disputed national elections. With only two years till the next polls, Kenyans cannot afford any more senseless politicking.

It appears though that majority of Kenyans are in support of the new constitution.

Although campaigns for both the “Yes” and “No” camps have been intense, Kenyan groups and political leaders have been keen to avoid violence. But, there have been a few glitches. For instance; at a rally against the constitution in downtown Nairobi in June, grenade attacks killed six people, while a number of politicians have been charged with hate speech for inciting crowds. There have also been reports of distributed leaflets threatening violence.

Another reason the draft constitution seems to garner wide support among Kenyans is that it cuts down the president's enormous powers by setting up a presidential system with checks and balances. This is important because, 47 years after independence, one of the country’s main sources of tension remains the unequal distribution of resources; with consequent presidents being accused of favouring their tribesmen.

There is of course some opposition to the new constitution, particularly from church groups who fear it opens up the issue of abortion. They argue the abortion clause — which says abortion is not permitted unless the life or health of the mother is in danger according to the opinion of a trained health professional — could be interpreted broadly. [This is despite the proposed constitution not changing the current legality of abortion only for maternal health]. Another clause considered contentious is the inclusion of Kadhis Courts - publicly funded family courts for Muslims.

In 2005, Kenya held a referendum on a draft constitution, but it was shot down. This time around, rewriting the constitution was part of the peace deal signed in February 2008 between President Mwai Kibaki and PM Raila Odinga, who are both in support of this proposed constitution.

The way I see it albeit from outside, a yes vote will push Kenya into the future, where the country can finally embark into other issues of nation-building. Since we seem unable to correct the past, let us at least pursue a better future for all Kenyans.

Thus on this day, with only a virtual vote, I back the “Yes” campaign.