One thing leads to another

Question: How do you set up systems to care for this disease: HIV/AIDS in a community with so many risk factors?


When the risk factors are so plentiful: poverty, lack of education, inadequate access and knowledge regarding health care, cultural/traditional beliefs & barriers. I have learned from this experience many things, one being that you cannot talk about health and prevention of HIV/AIDS without discussing these matters.

Last week we drove to one of the farthest village areas of the community known as Msinga Top. The drive is at least an hour up a mountain. Most people who live there do not have cars. We knew we reached our destination when we arrived at a tree surrounded by at least 20 women sitting beneath it, awaiting our arrival. There were about 5-7 men scattered close enough to listen to the conversation that ensued. We visited Msinga Top with Mary, the home-based caregiver leader. She frequently goes on home visits herself to visit patients out in the community & tirelessly visits communities to speak to members to educate them on their health & safety.


On this day we were visiting to give a talk on prevention of HIV/AIDS. Susan was speaking & Mary translated her words into Zulu. The discussion went well- it was spectacular to witness community education on a mountaintop, under a tree, & out in the winter sun. The women of the community listened carefully but did not ask any questions. The men however spoke up with many thoughts, concerns & jokes. It was eyeopening to watch the conversation move from HIV prevention & testing to the pressing issues of poverty, unemployment, & lack of resources & transportation. One man asked how he could make money from the crops growing in the nearby community field. Another man asked what he was to do for money, with no job, in order to pay for transportation to the clinic or hospital. "How do I even afford to go the clinic to have a test." Another man questioned how he was to stop having sex with women other than his wife. This was a significant concern for the men. They expressed that the prevention tactic of remaining faithful to their partners was unrealistic. "Are we to get rid of our concubines?" An older man asked, seemingly a little angry. He actually stomped away a little later. One man mentioned how it is hard with his wife because she is always so tired when she comes back from gathering water & firewood. He said that because she is tired she ends up yelling at him. Susan asked if perhaps he could help his wife with her work so she would be less tired. All the men laughed, as well as the women. What a peek we had into the men's perspectives, at least, on this area of their lives. The answers are not easy. At the end of the discussion the men strolled away casually & the, until then silent women, thanked us warmly. There is much to think about here, everyday. The problems before us in the community are many & complex. There are people dying from AIDS everyday here in Tugela Ferry. Nearly everyone is affected in some way by the disease.