Believing AIDS is Real
August 24, 2004
-Timothy Mah, RPCV, The Gambia, 2001-03
The Peace Corps experience is filled with hurdles and obstacles, which if overcome, can turn into very positive defining moments. As a recent college graduate, I looked upon my Peace Corps service as an opportunity to find that specific path that I knew awaited me somewhere – possibly in one of those Peace Corps moments that I had previously heard about.
I applied to the Peace Corps with the notion that I wanted to do HIV/AIDS work – whatever that meant in the context of my assigned country and community. I had some previous experience as a pediatric AIDS researcher during college and as an intern at an AIDS service organization, but I was unsure what those experiences would mean to me as a community health educator in Africa. At some point during the application process, I was asked why I wanted to work in the HIV/AIDS field. At the time, I didn’t have a very clear answer. But I think I can answer that now.
AIDS is an intriguing epidemic that has affected communities in countless ways – some foreseeable, others with surprise. AIDS is unique in its ability to transcend its label as solely a health problem; it has social and cultural, religious, political, and economic components, all of which have had a role in defining the epidemic. For many years, HIV was seen as a gay disease. Some purported it be punishment for homosexual deviance, and some people continue to believe this. It was at another time a Haitian disease, brought to the US by unwanted immigrants. Some have theorized that it was engineered as a social and scientific tool to dissuade overly sexual and promiscuous people from their immoral behaviors. It has been and still is used as a political vehicle – linking funding for prevention efforts with primarily one form of prevention, abstinence, rather than a more effective and comprehensive approach. From an economic perspective, an entire generation of working age men and women in parts of southern Africa has nearly been wiped out.
It is different from any other disease that has so affected people. Unlike many of the common ailments found in developing countries, HIV doesn’t necessarily show outward symptoms all the time. While sicknesses such as malaria, tuberculosis, or a host of stomach ailments can be easily seen and understood, HIV is invisible and more often than not, not understood. HIV also strikes through a basic yet taboo subject – sex, which is rarely if ever breached in many communities. All of these factors make this epidemic multi-faceted and utterly dynamic – changing with time and place.
I spent much of my Peace Corps service organizing HIV/AIDS education programs and events for youths throughout The Gambia, a small country in West Africa. These programs provided the youths with basic information about HIV/AIDS – prevention strategies and modes of transmission, as well as more general “life skills,” such as relationship, decision-making, thinking, and negotiating skills. Some of the boys were trained to be peer health advocates in their schools and communities, while others were trained simply to help prevent themselves and their friends from becoming infected and to dispel the rumors and misinformation that floated around the villages.
During many of my workshops on HIV/AIDS with Gambian youths, the questions would inevitably come up: “Where is AIDS from? How was it found?” How could such simple questions be so difficult to answer? I could easily have said, “AIDS was discovered in America and France in 1981, by doctors who noticed an unusual number of gay men were becoming sick with strange and rare sicknesses.” Finished. Next topic. That answer however was not as simple as it sounds and introduced myriad cultural, political, and colonialist issues into the discussion: If it was discovered in America, why do people say it started in Africa? If it started among gay men, how did it get to Africa, since there are no gay people here? If it was discovered in America, why are there so many more people in Africa who have it now?
At first, the answers to these questions just seemed secondary. Shouldn’t these boys ultimately be concerned with whether or not they have the information and ability to prevent themselves and their friends from getting HIV? To the participants however, the answers they knew to these questions were the basis for their denial of the existence of HIV. The answers fed into the numerous conspiracy theories that surround the AIDS epidemic in The Gambia. I soon learned that it didn’t matter if the boys knew everything about prevention or the modes of transmission. It mattered that they first believe that HIV was real and could have an impact on their health and well being. It therefore often became my role to persuade the youths that HIV was indeed real and that it could affect anyone in their community, from their friends and siblings to their parents and the village leaders. Whenever possible, I would include HIV positive individuals in the workshops. 99% of the youths I worked with had never known, heard of, seen, or interacted with a Gambian living with the virus. My hope was that seeing truly would mean believing.
So many of the simple scientific aspects of the AIDS epidemic are completely intertwined with seemingly distant political and cultural issues. From questions about the discovery of the disease to prevention (aren’t condoms just a western way of keeping Africa’s population in check?) and treatment issues (why are there drug treatments widely available in the US, but not in The Gambia?), there are no simple answers. But these are the challenges that make the AIDS epidemic unique, interesting and frustrating.
In addition to those motives for being interested in working in the HIV/AIDS field, there were the more personal reasons. There was the issue of being gay. Did I subconsciously feel that I needed to give back in some way to the gay community, which has been so grossly affected by AIDS? Would I be able to do that by going to The Gambia? Would my efforts in The Gambia even have an impact on the gay community in the US?
In a general sense, no, my efforts in The Gambia didn’t have an effect on the gay community in the US. However, despite the obvious differences, the epidemics in the US and throughout Africa are inextricably linked. Progress on one front means progress on another. My work in The Gambia gave me the opportunity to see the epidemic from a different perspective. It put me in a place where the reality of the epidemic was still not understood. I was lucky to have the foresight when I worked in the Gambian villages that if people weren’t educated early on about the dangers and consequences of this disease, then communities there and around the world would continue to be unnecessarily hurt.
In the past two decades, there has been much progress in the fight against AIDS. While the epidemic has hopefully peaked in many communities, there are countless others in every corner of the world where it is just beginning. There is still so much work left to be done.
Tim Mah has spent the last 7 months working in the Public Policy Department of the San Francisco AIDS Foundation. He starts graduate work at the Harvard School of Public Health in September. He can be contacted email@example.com.