HIV Positive and Serving as a Peace Corps Volunteer

-Elizabeth Tunkle, RPCV, Zambia and Lesotho

When you join the Peace Corps, many people ask you why. I never had a very good answer. But the truth is something way down deep inside of me told me that is what I needed to do and I listened. I really had no idea what I was getting into. I thought 2 years would go by in a flash and I would come home better for having gone so far from home and for having done such a noble thing. Two years did not go by in a flash and I came home changed but not how I thought I would.

I started out my service in Zambia and after getting posted to my village, as I was settling in, I met my future boyfriend. When we started dating, I asked him if he had been tested for HIV. He told me yes. He told me his test was negative just 1 year before and he had not had unprotected sex since his last test. We mutually decided it would be safe for us to use birth control and not condoms. We were wrong. Despite the fact that I knew all about HIV prevention I had unprotected sex with him anyway.

A few weeks later, I decided we should get tested. I had a bad feeling. I tried telling myself that it couldn’t be me. I was going to be fine. Too many times in my life I had played with all kinds of fire and survived. Not me. I was too nice and honest and fun and giving and I practiced yoga and meditation. We get bonus points in life for being good, right? No, I guess we don’t. HIV doesn’t just choose mean people or people who tell lies. It turned out it chose me. We found out my boyfriend was positive and that I was also infected. As if that news isn’t devastating enough, the Peace Corps told me I had to go home and that I would not be able to serve as a Peace Corps Volunteer anymore, anywhere. I was too shocked to fully understand what was happening, but I did feel like the Peace Corps was acting contrary to what they teach us. “Fight the virus not people with it.” “Treat people with HIV just like you would treat anyone else.” But yet, here I was going home. I felt like a weed that had been violently ripped out and was being thrown away.

I was shocked and traumatized and had to pack up my things and say goodbye to my life in Zambia. I felt like a failure. I had come to teach prevention and here I was infected. I was asking myself that why question all over again. Why did I come to Zambia, did I come to ruin my life? Who did I think I was coming over to Africa to tell people how to live? I didn’t even know the meaning of my own words.

PC Washington told me that I would be evaluated and then separated. I asked my nurse who worked for PC if it was possible for me to continue to serve and she said no. If I was positive I would have to be separated. However, after I had been home for a month PC changed its mind. Why? My friend was digging around on the Internet and found a story about another volunteer who had been sent home earlier that year because of an HIV infection. He felt like his rights had been violated and had asked the ACLU to help him out. ACLU went to the PC and told them that their policy discriminated against people with HIV and they needed to be more accommodating (see our August 2008 article for information about the Jeremiah Johnson case and changing Peace Corps policy related to PCVs with HIV.) They just told me they were considering clearing me. Everyone seemed to agree that I was physically and mentally well enough to go back.

It was suggested that my asthma was reason enough to keep me from going back to Zambia but I could go to Lesotho if I wanted. I was faced with a big decision. At first, I was not given a choice and now I was. What did I want to do? It seemed like a difficult decision at the time but I think I knew all along that I wanted to finish. That I was not going to let some illness or my shame stop me from returning to do the work I had set out to do. I even had a hint of an idea that I could do it better the second time around. So I said yes!

I was in a plane flying to a new country in Africa. Lesotho was going to be my new home. I arrived and met a whole new group of staff and volunteers. I made the most of my new home and my new family. I started making friends but I kept my status to myself. I felt alienated for having to keep such a heavy secret. I wasn’t sure I wanted to share my status at all. I felt too vulnerable and I wasn’t sure how I would be received. After only 2 months in Lesotho, I went to a volunteer training session. Volunteers were struggling with the emotional toll of living in a country where so many people were infected. We had a session to talk about it. I sat in knowing that no one in the room knew about me. One guy shared, “I found out my counterpart was positive and I am trying to give him support and but it is emotional for me to know.” They were all being so honest and I wanted to run out of the room screaming. After so many people had shared, our director said, “One good thing about all this is that you have each other. We are all in the same boat.” I then did run out of the room screaming. Well, ok, not screaming. I walked actually. But I left the session early and went to the medical office and talked to the only people who did know. “I am not in their boat,” I said. I felt even lonelier and more left out than I had before and I hadn’t thought that was possible.

After I calmed down a bit, I went to see the Country Director. I told him I had been thinking and I wanted to share my status with all of the Peace Corps Volunteers, all 87 of them. We were going to have an All-Volunteer conference in January and I wanted to have a session all to myself to share my story. I knew I couldn’t keep it a secret and this way I could control how the information got to them. I would not be gossip. I would just tell them. So, January of this year (2009) marked my big coming out ceremony. The day of my talk, I was terrified. I knew that I was going to be taking my most personal and private reality and laying it bare for everyone to see. I started my talk with a news article about the ACLU case against the Peace Corps. Then, I told them my story. I told them I knew better than to have sex without a condom. I told them I knew all the things they know that make them feel immune and I still got infected. In the end I asked them to make good use of me. I was the first infected person in service and I wanted to tell people what happened to me so that maybe they could learn from my mistake and not repeat it. That was, after all, why I returned to Africa

They started using me immediately. I went to a Diversity Camp in Butha-Buthe district. 20 something teenagers came together to learn to be more accepting of the differences around them. I was one of the key speakers. I asked them to brainstorm words that came into their mind when they heard “HIV.” “Don’t censor yourselves. Just say what ever comes to mind. Good or bad!” They did. I heard words like prostitute and sex, anger and fear, stigma and blood. We made a long list. And then I told them my story. I told them everything. They were teenagers and statistics said they were all probably having sex already. They really listened. Afterwards, they asked me questions. One woman asked me, “How do you have so much courage to stand up in front of us and tell us these things?” I just looked back at the list we made and said, ”If I feel too afraid to speak about this to all of you then I let this list define me. I refuse to let this illness keep me locked up in my own world of shame. And if by sharing my story with you, maybe one of you rethinks having unprotected sex then I have accomplished something out of this.” For the first time, I felt like I hadn’t become infected for nothing. Maybe this happened to me so that I could share it with people. Maybe it had a purpose in my life.

I did that many more times in my time in Lesotho. I went to 4 Diversity Camps. I spoke at schools and youth centers. I had one audience as big as 140 students. I spoke to peer educators, youth groups, and students. I spoke to primary schools and secondary schools. I even traveled 2 days up into the mountains to speak to a HIV+ support group about a healthy way to deal with hard and dark emotions. People really heard me. I felt connections with the people of Lesotho like I had never felt in Zambia. People came and shared their stories back with me. They asked me questions and invited me to their homes. I felt the force of belonging to a community.

I spent my second year of the Peace Corps speaking my truth over and over again. The fact is none of that would have been possible if it weren’t for the courage of other Volunteers who stood up to the Peace Corps. The Peace Corps did something they had never done before and let me, an HIV+ volunteer serve out my time in Africa. I received more from sharing my story than I could have ever given to the people of Lesotho. I think the Peace Corps is like that. We go to far away lands to give of ourselves, to help, to make something better but it is the people who house us and love us and work beside us that truly give to us. They gave me a sense of purpose. They made me believe that something good could come out of getting a very scary, chronic illness diagnosis. And I believe that it did. I would never had asked to become infected with HIV but without it the community of people living with the virus around the world would be just out of reach and I want to connect. I want to cross over the line that separates and make a connection. So here I find myself. My service is complete. I am back in America. I served my country. I told my story. Somehow I think I answered my “why.” The work I did as a volunteer in Zambia was forever on the outside looking in. Later, infected in Lesotho I felt as though I had stepped through an invisible barrier and was welcomed with open arms.

Elizabeth can be contacted at elizabethtunkle@yahoo.com.

HIV Status and Application to the Peace Corps

-Mike Learned, RPCV Malawi

At annual Pride/Parade celebrations, many Peace Corps regional offices will have information and recruiting staffs present at such events. A question that always comes up on such occasions is “can people who are HIV positive, but otherwise healthy, apply for the Peace Corps?” For the last few years, the answer to this question has been, “yes.” HIV disease is treated as a medical condition. All applicants who are invited to take part in a Peace Corps program are medically evaluated.

Several things have to be determined. Will an applicant’s health allow her or him to serve in a particular Peace Corps assignment without jeopardizing his or her health? Are there medical resources available to support the medical needs of an applicant with a particular medical condition at a particular site, in a particular program, in a particular country? Can the applicant with a medical condition be expected to complete a full tour without undue interruption to his or her program or Peace Corps service?

Peace Corps considers HIV a chronic disease, as it does diabetes, high blood pressure and other medical conditions. Peace Corps does consider applicants with HIV disease, and Peace Corps’ Office of Medical Services advises and has evaluated applicants who are HIV positive.

Our position as an organization is that Peace Corps treat HIV disease in a way similar to other chronic diseases and medical conditions. We understand that most Peace Corps assignments require rigorous good health. Would we recommend that a volunteer with HIV disease be allowed to serve anywhere? I think not. Many of us (young, energetic and healthy) experienced serious health problems during our service in remote and disease-ridden areas. Can you imagine what might have happened with compromised immune systems?

I have chosen not to ask the Office of Medical Services if applicants with HIV disease have served as volunteers. The reason – I don’t think it’s any of our business. If I were an applicant with HIV disease who was accepted, I would not want the Peace Corps or anyone else broadcasting my presence, even if I remained unidentified. On the other hand, if there’s an HIV positive applicant out there who feels he or she has been unfairly evaluated, and she or he wants to pursue that decision as discriminatory, that’s another issue, and we’d like to hear about it.

Mike Learned was a volunteer in Malawi. He can be reached at lgbrpcv-news@lgbrpcv.org.

Peace Corps Service and HIV Disease: Practices, Risks, and Benefits

-Suzanne Marks, RPCV Togo

A question often asked of Peace Corps recruiters by participants at Gay Pride events is: “Can I serve as a volunteer if I am HIV positive?” Peace Corps’ official policy states that the agency does not discriminate on the basis of disability and that it must provide reasonable accommodation for persons with disabilities, in accordance with the Rehabilitation Act of 1973. (Note: The Americans with Disabilities Act of 1990 protects HIV-infected individuals from discrimination by private employers of 15 or more employees, and by state and local governments). However, to date, no HIV-infected applicant has been accepted for Peace Corps service. At a time when protease inhibitors have rendered HIV disease a manageable health condition for many and when persons with HIV disease can provide much needed health education about disease prevention and management to the ever-increasing numbers of HIV-infected in developing countries, the practice of excluding those with HIV disease from Peace Corps service, regardless of policy, is called into question.

To be offered a Peace Corps volunteer position, an interested individual must complete an application form and be medically qualified. While the Peace Corps application does not explicitly request HIV status, it does ask applicants to report their medical history, including infectious diseases. If an applicant responds that s/he has HIV disease, then the health condition of the applicant is assessed. If an HIV-infected person does not voluntarily disclose her/his status, then the required medical exam soon reveals that fact, since Peace Corps policy states that applicants must be HIV tested.

Since 1986, HIV testing has been performed on all applicants prior to service and again at close of service. One reason for this policy is to determine baseline medical status upon entry and post-service medical status to aid in determining valid workers’ compensation claims in the event of disability caused or exacerbated during Peace Corps service. As of 1998, approximately 20 cases of HIV infection have been documented among volunteers since testing began. Another reason for HIV testing is to enable Peace Corps to examine the health status of applicants, so that their medical qualification for posts can be realistically assessed and accommodations made, if needed. The primary motivation underlying the practices of the Office of Medical Services is to protect the health of US citizens serving in the Peace Corps. Medical qualification is based on an applicant’s medical prognosis and on Peace Corps’ ability to meet her/his medical needs, including an assessment of how quickly the volunteer can be provided emergency medical care, if the need arises, and an evaluation of a worst case scenario.

Peace Corps has quite a history of accommodating various disabilities, such as blindness and diabetes. For example, a diabetic volunteer required use of an insulin pump, an uninterrupted supply of insulin, and regular medical monitoring, including lab tests of specimens. When asked whether the cost of accommodating a medical condition figured into the qualification process, the Office of Medical Services stated that the costs of care were not among the determining factors for medical clearance. However, costs might be considered at a higher level in the Peace Corps application process, such as at a policy level. Currently, no policies exist barring expensive medical conditions. But theoretically, an accommodation for a disability may become an undue hardship when it becomes costly, extensive, disruptive, or fundamentally alters the nature or operation of the business. Since the current annual cost of anti-HIV medications is approximately $15,000, and since Peace Corps would be required to pay this cost (excluding the first six months of service, during which the volunteer would bring a supply of medications), resource availability and constraints may become relevant if substantial numbers of HIV-infected individuals applied to the Peace Corps. Costs of accommodating a medical condition are covered either entirely by Peace Corps headquarters, entirely by the post, or are shared by both entities.

Besides medical qualification for service, applicants must be considered “suitable” for their posts. Among considerations of suitability is the acceptability of the medical condition by the culture in which the volunteer would serve. For instance, some cultures do not accept individuals with seizure illnesses such as epilepsy. Given the high prevalence of HIV disease in many developing countries, cultural acceptance of those with HIV is likely to be higher than for persons with diseases that are rare or unusual. However, legal barriers to acceptance of persons with HIV disease exist in countries, like the US, that prohibit entry of HIV-infected individuals.

Peace Corps headquarters weighs the risks and the benefits of each applicant, before deciding to offer a position. Are the skills and abilities that an HIV-positive applicant brings to Peace Corps service worth the risks to that individual’s health? The opinion of a source in the Office of Medical Services is that, currently, the risks are greater than the benefits for most HIV-infected individuals. The high incidence of diarrheal, parasitic, and other infectious diseases among volunteers with functional immune systems suggests that Peace Corps service would be detrimental to the health of HIV-infected individuals. Other organizations and agencies, such as CARE, CDC, USAID, and WHO, are also formulating policies and practices vis-a-vis HIV-infected applicants. Of interest would be the consistency in policies/practices and the actual experiences of HIV-infected employees placed in long-term positions in developing countries. The net risks/benefits depend greatly on the health status of the applicant and on the circumstances of the post. Access to high quality water, food, and needed medications are essential. Also to be considered are prophylactic medications that may lessen an individual’s risk of acquiring diseases. Tuberculosis (TB) is the most common opportunistic infection determining AIDS in the developing world. However, prophylactic medications exist to prevent TB disease. And, if disease develops, TB is as curable in HIV-infected persons as it is in non-infected persons. Peace Corps will help applicants make informed risk/benefit calculations regarding their decisions to continue with the Peace Corps application process. HIV-infected persons who are considering applying for Peace Corps service may contact the Office of Medical Services at 800-424-8580, extension 1500.

The many facets of the decision to send HIV-infected US citizens into developing countries as Peace Corps volunteers highlight the challenges and realities that millions born and living in developing countries face daily in their struggle to survive HIV infection. The developed world has been criticized for their two-tiered approach to preventing and managing HIV disease: with the provision of anti-HIV medications, intensive medical monitoring, and needle exchange in the US and Europe compared with the focus on condom use and partner reduction in Africa, Asia, and Latin America. Since one of Peace Corps’ three goals is to bring the experiences of the developing world back to the US, HIV-infected Peace Corps volunteers can help bridge the gap in the application of AIDS prevention practices and technologies.

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