HIV-AIDS Makes the Toughest Job Tougher

Bleeeeep, sounded the buzzer, at a wrong answer to the question posed by the game show host. He turned and quizzed the other team, “What are two ways to help prevent transmission of the HIV virus?” “Condom use during sex and infant formula use as an alternative to breast-feeding by the child of an HIV-infected mother,” came the rapid response from the eventual winning team. “Correct!” shouted the host. Thunderous applause rewarded the victorious contestants, as the host selected students in the audience to ask the next question: “What is the best response to a lover who wants to have sex without using a condom?” Two audience members conferred and announced their response: “No glove, no love.” “Yes!” screamed the host as he danced across the stage tossing free ‘Generations without AIDS’ t-shirts to the audience.

This interaction continued for three hours as finalist teams of teenage boys and then girls, along with their classmates in the audience, competed to give correct responses to HIV/AIDS prevention questions. This was a new spin on College Bowl, adapted to the realities of life and of AIDS in Cote d’Ivoire, a country with the highest HIV prevalence in West Africa where over eleven percent of adults are HIV infected and over 100,000 AIDS orphans now live. The show was videotaped for television and was shown in segments during the year to viewers throughout the country.

I sat in the third row where I attempted to catch and understand the fast flying French words and phrases coming out of the host’s mouth. It was just my first week in a francophone country since my Peace Corps service in Togo in the 80’s. In the intermission between matches, I met a woman, Celestine Navigate, who headed a group of HIV/AIDS prevention non-governmental organizations (NGOs). Her name sounded suspiciously phony, like she was a celestial navigator or angel, which I soon discovered was close to the truth. She explained that she was providing young girls with scholarships to fund their educations and teaching commercial sex workers alternative income-generating skills to get them off the streets. She explained that women’s empowerment was key to reducing the HIV pandemic. I was quite impressed with both the show and with Celestine’s activities.

I was sent to Cote d’Ivoire on a two-month temporary duty for the Centers for Disease Control and Prevention (CDC). While I was assigned various tasks to accomplish, one that I quickly added was to make connections between the Peace Corps community, their activities, and the CDC office in Abidjan to ensure sustainability of activities. It helped that there were already two RPCVs in the CDC office. It was also helpful that I had already met the Peace Corps Director, Marty Mueller, at the NPCA conference in Minnesota a few years ago.

One evening, Marty invited an Abidjan PCV and me to dinner. Since the PCV's job assignment was to coordinate PCVs' HIV/AIDS prevention activities, we had quite a lively discussion. He quizzed me about the most important activities that PCVs should do. I described a variety of activities that would have a major impact on AIDS prevention, such as the provision of safe drinking water and nutritious foods to persons living with HIV/AIDS (PLWHA), and early diagnosis and treatment of opportunistic diseases such as tuberculosis, as well as linking PLWHAs to antiretroviral treatment that is available for a small number of eligible persons. For HIV prevention, I mentioned Celestine's activity of funding scholarships for girls as a great idea. I stressed the need to work with NGOs such as Population Services International to ensure adequate supplies of condoms in all areas and with UNICEF for maternal to child transmission prevention activities.

Our discussion became more heated when I mentioned the need to reduce the stigma associated with HIV and also with homosexuality, almost a taboo subject in many African societies, both among PCVs and villagers. I listed the advantages for gay PCVs to come out to supportive Peace Corps staff and to other PCVs, as healthy for them and as a way to reduce the stigma of homosexuality among PCVs. However, I might not have mentioned the need to reduce the stigma of homosexuality among Ivoirians if I had not just met a group of gay Ivoirian men the previous week at a local restaurant supporting HIV/AIDS prevention efforts. I was well aware that homosexuality exists in Africa, contrary to political assertions, but was also aware of the dangers that a society in deep denial could pose to PCVs talking about its existence. HIV/AIDS already has so much stigma attached to it in Africa that adding one more negative association might be too much. But, I was becoming more convinced each day that HIV/AIDS was having such a large impact on African society, that to deny that risk exists in a supposedly nonexistent subpopulation was even more dangerous. Major tools in fighting bigotry include education and getting to know people who are stigmatized. I explained that this was why I decided to come out as a lesbian to my colleagues at CDC Abidjan, even though it was not on my agenda prior to my arrival.

The following Saturday at a shopping mall restaurant, I met with six PCVs who were organizing an all-volunteer conference on HIV/AIDS. (I didn’t know Africa now had indoor shopping malls!). They told me about their plans for the conference and for providing each PCV with an educational HIV kit that would include written materials on HIV/AIDS prevention as well as condoms and a wooden penis for condom use demonstrations. They said that they contracted with an Ivoirian factory to produce these “grand models.” I had to snicker, knowing that PCVs in Cote d’Ivoire would soon be given a local language name meaning “person with the wooden penis” and would be besieged with this name by crowds of children upon their first arrival to their villages, unbeknownst to the PCVs. Although the group had plans for HIV prevention education activities mostly with school children, they also wanted to hear from me ideas of other types of projects that would be useful. I repeated much of the discussion from my dinner with Marty and the Abidjan PCV who was also part of this group. In addition, I mentioned some successful PCV projects in other countries, such as high school HIV prevention video contests and buyers cooperatives for foods or medications. I told them that I had met Celestine Navigate who had some great ideas-they had already had contact with her, so would follow up with her. We discussed various project ideas and the need for better coordination with NGOs and CDC. I admired their spunk, courage, and motivation.

After my return to the US two days prior to September 11, I have had some time to reflect on this visit and my work in Cote d’Ivoire. While the atrocity of the World Trade Center and Pentagon attacks lingers in the minds of the US public, the horror of the HIV/AIDS pandemic barely registers among the problems in the consciousness of most Americans. We don’t see the countless HIV-infected women disowned by their husbands and families and forced into prostitution or suicide. We can’t imagine the burgeoning multitude of AIDS orphans, who will most likely lose out on education and jobs living with no hope for the future. We can’t conceive of schools empty of schoolteachers or hospitals missing critical healthcare workers because they died of AIDS. We don’t think about the impact of AIDS on food production until we notice the strange lack of nutritious vegetables and fruits in the market, because of deaths in women who are responsible for their production. We fail to think about the impact on security in cities, inevitable when police and military forces succumb to AIDS. We find it hard to believe that factories must hire three times as many workers now to produce as many goods as before, because of the lost productivity of those ill with AIDS and those who die unexpectedly.

The people of Cote d’Ivoire, as in many other African countries, realize their predicament. They are utilizing all available resources to educate school children, through programs such as the Generations without AIDS production. Condom posters and displays are now visible in many public places. Public leaders, such as the president’s wife, act as HIV/AIDS prevention ministers, to promote prevention in public presentations and television shows. Reluctance to talk about sexuality is falling by the wayside. However, the biggest obstacle to success in fighting the pandemic is stigma. We must do what we can to remove the shame and disgrace associated with this medical condition and with those affected by it.

PCVs have joined with the people in their countries of service to come up with innovative and effective ways to battle the pandemic. I encourage all of you to support them in the battle, so we can win the war. Consider funding HIV/AIDS prevention projects through PCVs in your countries of service, either through LGBRPCV or your Friends of group. ©Suzanne Marks.

Suzanne Marks sits on the LGB RPCV steering committee as our Southeast representative. You can reach her at sqm3@cdc.gov.