Tuesday, May 1, 2007

Frightened for Fifteen Minutes

My counselor’s name is Mercy. She is in her early twenties and pretty with intensely sad brown eyes. She speaks so quietly I have to lean forward to hear her. I have the strangest flashback, I am eleven years old again and about to be examined for nits by the school nurse. I am suddenly and irrationally anxious. The morning sun is beating on the tin roof; I can feel the radiated heat and begin to sweat. She is cool and dignified in her clinical coat. In matter-of fact tones she explains the intimate biology of HIV/AIDS pausing now and then to ask me, “Do you have a question?” Each time I answer, a little too firmly, “No.”

We are sitting facing each other; she looks into my face and tells me this is a voluntary test and asks me if I wish to carry on. She follows this by asking me if I am prepared for the result to be positive and what I intend to do. I reply with an overly firm “Yes” and “ I will tell my sexual partner(s). ” She has one more question. Do I understand there is a “window period” between infection and antibodies being produced and if I have had “risky sex” within the last six weeks or so I could test negative but still be at risk? I assure her I am not at risk but have another bout of white-coat hypertension.

Mercy explains the procedure we are about to embark upon. She unwraps the RapidTest. It is a small flat white plastic strip with a long “V” running its length. The test takes ten minutes. She will place one drop of my blood at the cleft. It will disperse and move down the “V”. After about two minutes it will leave a fine red line about three quarters up. This is the control line. If within the next eight to nine minutes a second line appears between the cleft and the control line it will indicate that I am almost certainly HIV Positive (but another test will be made to be certain) if no line appears I am negative.

She produces one of those awful little stabbing instruments; I suppress a shiver and offer the middle finger of my right hand. She cleans it with a soapy disinfectant and squeezes the last knuckle until the pulp is dark red. She picks up the “stabber”…my cell phone rings! I frantically search for the phone to switch it off but she insists I answer it. It’s the garage, my car is finished its service. Sotto voce I answer, “Can I call you back, I am in the middle of…something.” I wonder what his reaction would be if I had said “ an HIV test.”

I apologize. She stabs; I wince and watch the drop of blood ooze to the surface, she deftly places it the cleft of the “V”. We both stare at the plastic strip in silence. I search for something to say. I ask how long she has worked as a counselor, she tells me three years. She is a volunteer counselor, which means she gets paid a stipend whilst she trains and looks for paid work. All the time, I have one eye on the test strip. A line appears three quarters along! Mercy whispers it’s the control line. Inanely I answer “Oh good!” We carry on with the small talk. I ask her if later I can interview her and the other staff for an article I want to write on VCT. I don’t hear the answer; my eyes are glued on the strip. I was last tested in 1997 and although a lot of water has gone under my personal bridge since then I am neither promiscuous nor stupid. But I live in East Africa where hundreds of people die of HIV/AIDS every day; it’s easy to be irrational even if you are sure you are not at risk.

Mercy looks at her watch. Ten minutes are up, no second line. I am negative. I cannot suppress a grin of relief. I thank her (a little too profusely?) and tell her I will be back in a short while to do the interview. Outside, the day looks even more beautiful as I join the throng from our office We have come for a group VCT, an idea dreamed up to promote a national VCT and “know-your-status” campaign. The argument being we cannot exhort people to do it unless we do it too. We all admit to being anxious waiting for the second line. They clamber into vehicles chattering happily and roar off in a cloud of dust. I cannot help thinking how lucky we are; relatively well off, educated and having the support of our friends. What must it be like to come to this place poor, alone and worried?

I return to the small, neat blue-painted building. It is one of a number dotted around the periphery of a huge slum at the edge of the city. The staff is made up of one paid and three volunteer counsellors.
Between them they counsel about 15 clients a day. Few are local, they prefer not to be recognized going into the centre. The majority too (about two-thirds) are women. Most seek help because they are worried or unwell or both. Mainly they come alone but married Muslims almost always together. The test costs the equivalent of $0.50. The key is continuity of caring. Whether the result is positive or negative, clients are encouraged to join the “Post Test Club” which meets frequently in the largest of the center’s rooms. The aim is promote self-help and for the negative to mix with and care for the positive. They also take part in ‘Income Generating Activities’. The NGO that runs the VCT will bank whatever money they can muster until they reach the equivalent of $8.00 which qualifies for a loan to begin a small business such as selling charcoal, or cooked maize snacks. In the face of abject poverty and huge levels of disease in the slum, it may all seem too little too late. But my time in Africa has taught me that only community solutions work and that small is best.

I am buoyed by the moment and the sheer dedication of the staff. Then I witness the classic VCT client case; a metaphor for HIV/AIDS in SSA. She is 32 years of age, a single mother of one small daughter. Her only living relative is a brother who does not want to know her. She is a ‘commercial sex worker’. She uses Depo-Provera as contraception and tries to insist that her clients use condoms but they most times simply refuse and find another sex worker. She needs the money so she takes the risk. She has come to us because she is worried. Her test is negative. She is more determined than ever to give up sex work but desperately needs money to feed herself and her child. She agrees to join the ‘Post Test Club’ and to start saving what little she can of her earnings, to make the key $8.00, so she can get a loan; she thinks she can make a living selling children’s clothes. I look at her face, full of desperate hope, know that the only way she will save that money is from continuing to sell her body, and pray she stays negative for another three months.

My interview finished I head for a cold beer. I think about Mercy taking a two-hour ride to her brothers and sisters totally dependent on her and the mother whose only hope is to get out of commercial sex work. I think back to this morning and my own experience with VCT. I remember the feeling of being ‘frightened for fifteen minutes’. And I feel a fraud.

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