What You Pretend You Don’t Know Won’t Hurt You!?

Today I met an 11 year old boy who is HIV+. He was born positive, had no say in the matter and now lives his life knowing that one day his cd4 count will drop and he will either have to start taking Anti Retro Viral drugs (ARVs) or fall prey to opportunistic infections that will lead to his death. It is possible to reduce the chances of transmission of HIV from mother to child if it is known that the expectant mother is positive. However, convincing mothers to get tested and start the necessary medication if they turn out to be positive is a hard task because most women remain stubbornly in denial about the possibility that they could have contracted this virus. Denial is an act that has great destructive strength and is not confined to mothers in Zambia but exists in all sections of society all over the world.

While I have seen many in denial, I could not say to you that people in Zambia lack awareness about HIV/AIDS. I have found that the lay person’s knowledge about the disease, its transmission, methods of prevention and even treatment is far greater than that of people in the UK or India (having lived in both countries I speak of just these 2, though I am sure one could list many more). In fact, the level of ignorance and denial about HIV and other sexually transmitted diseases in the UK and India is frighteningly high. The consequences of this can be significant in both countries though the potential impact might be greater in India as AIDS is silently and surely creeping up on India’s youth.

With the decline of traditional values in Indian cities, young men and women have become increasingly promiscuous. I make no moral judgment on the issue but merely wish to point out the different implications that promiscuity has in the west and in India. While it is quite standard, across the globe, that young adults exercise their freedom to have premarital sex, many sexual partners (consecutively or at the same time) unprotected sex with multiple partners (again, this could be consecutively or at the same time), the difference that I have noticed between the youth in the west and that in India is this – empowerment! It is quite normal for youth in the west to be open about their sexual activity. This gives the advantage of being able to openly seek medical help and keep track of their sexual health. The situation is just not the same in India. The average sexually active Indian youth has never been tested for HIV or sexually transmitted infections. Even though they are aware of the possibility of having contracted something they will be hesitant to seek medical attention. This is a result of stigma or perceived stigma against sexual activity/promiscuity. Though it is still not OK for the Indian youth to engage in sexual intercourse outside of wedlock, it happens, and stigma persists. The issue that arises out of this partial rejection and partial preservation of traditional values is that the Indian youth remain in denial about their sexual health which should be a cause of great concern.

It will take ages for attitudes to change. I cannot even say with a great deal of confidence what these attitudes should be. Working so closely with people living with and affected by HIV/AIDS I feel there is strong case to be made for abstinence. But I do not think it very realistic to hope that young people will stay away from sex. Hoping that this will be the case and in fact assuming that it is might be the easy Indian way but it is extremely dangerous. The repercussions of such an attitude in the age of HIV can and possibly will be disastrous. We live in the 21^st century, everything we hear about it is not ‘out there’ but ‘right here’! So while we wait for things to change, my message is really quite simple – be strong, shake yourself out of denial, get tested and use a condom.

Hakuna Matata

“It’s a problem free philosophy”

- A warthog named Pumba

I recently had the loveliest holiday on Lake Malawi. Snorkeling, boating, hiking and eating lots of seafood, it really doesn’t get much better than that. Malawi is a beautiful country and the lake just has the most diverse array of fish species I have ever seen. Apart from the exotic and colourful fish that one sees when snorkeling in the lovely rock pools, there is a variety of fish available for eating, the most delicious of which is the ‘Chombe’.

The lake is central to the lives of those Malawians that are lucky enough to live around it. It supports the local fisherman (though due to over-fishing this is becoming more and more unsustainable), it attracts tourists and therefore benefits the local tour guides, boatmen, artisans and lodge owners (though the latter lot is mainly white, not local). The lake also provides a steady water supply to the surrounding villages. As you walk along the lake shore in the morning, you can see people bathing (the soap, shampoo, loofah type of bathing), washing their dishes, washing their clothes and/or generally having a swim in the lake. So when we decided to have a New Year’s Eve barbeque and were looking for a spot to gut and scale the Chombe we had just bought from a local fisherman, well, no problem, we were just directed to the lake. Post feast dishwashing was also done in the lake, using the gritty sand in lieu of dishwashing liquid and scrubber. Hakuna matata!

The only issue with all this usage of Lake Malawi (or Lake Nyasa which is why Malawi under the British was known as Nyasaland) is that this fresh water lake in southern Africa is perhaps the worlds most Bilharzia ridden spot. Bilharzia or Schistosomiasis is found in fresh water lakes where a certain type of snail is present. The larvae of the schistosome penetrate the skin and travel to the blood vessels in the urinary bladder and intestine where they reproduce. However, there is no need to worry about deadly diseases contracted by swimming in lakes, for, hakuna matata, you’ve got praziquantel! Just pop a few pills and you’ll probably be fine.

So after lots of swimming, eating, drinking and being merry despite snail infested lakes our sojourn at Cape Maclear came to an end. On the first day of 2009, at 5.30am, my fellow travelers and I set off for Lilongwe (the capital city of Malawi) for one night en route to Zambia. There are two options for traveling between Cape Maclear and Lilongwe. One is short and sweet, the other, well, you’ll soon know more about that. On our way out, we decided to take a bus from Lilongwe to Salima and then a short (45minute) speed boat ride to Cape Maclear. This was just lovely. However, at the end of our holiday when the time came to return, we were too broke to pay for the speed boat so decided to hit the road! Now the route was as follows – jump onto back of pickup truck that takes you out of Cape Maclear to main road, jump onto the back of another pick up truck after that that takes you to the nearest bus station, then take mini bus from this bus station to Salima, on reaching Salima jump onto yet another minibus going to Lilongwe. Sounds slightly annoying yet fairly easy? It wasn’t!

It would be all the more dramatic for me to be able to tell you the time frame for all this but to be completely honest I have no recollection of how many hours we must have spent on this journey. Time was no longer a concept that mattered. In fact, it was the last thing on our or anyone else’s mind. The only thing that mattered was survival between point A and B. Managing to stay on the truck, not getting flung off, squashed, trampled or suffocated, gathering enough strength to bear the icy rain and wind, hoping that when the tyre went *BANG* and the truck began swerving that we would be able to avoid the tree, the ditch and the oncoming traffic. These things became much more relevant than time.

Needless to say, it was a journey from hell. The strangest way I have ever begun a new year. But that’s not why I decided to write about it. Not because of what it meant to me, and how it affected me, but because this is how it is in Africa. The Malawian people deal with this on a daily basis. There is no reliable, timely, safe public transport system. There is not enough money for people to have their own cars. What you have to do to get from one place to the next, be it from the lake to the market where you can sell your fish, or from your home to your school, or from the nearest shop to your home, you get there on the back of a run down pick up truck, driven by a drunken stranger, packed in the back like sardines (and yes, along with sardines). The resilience that these people have built to the stresses of their everyday existence is just tremendous. I have the greatest respect for people who can face such circumstance with a sense of humour. For I never could. So while I sat there fretting and fuming, all my fellow sardines could say to me was Hakuna Matata!