In Zambia - 28 stories and the AIDS pandemic

We just arrived in Southern Africa to spend three months visiting friends learning a bit about the local realities for some of the people in Kitwe, in the Copperbelt region of Zambia. My wife has visited here twice before and will be doing some research for her masters while we are here. I have been involved in international development from Canada for about five years, primarily through Engineers Without Borders Canada. Many friends and family have taken time to visit and work internationally in different parts of the development industry.

It is not easy to write about poverty and development because there are so many things about it that are confusing, complex, emotional, injust and sometimes just plain wrong. I believe that attitudes and assumptions matter so I will try to clarify and justify many of my word choices and assumptions as I write. The first of these challenging words and perspectives is calling development an industry. On the surface it is pretty inspirational and beautiful that a so many people have devoted their lives and careers to making the world better that we can call development an industry. When I pause for a second longer though it makes me a little sick that there is a sustainable industry built around poverty and instability – it wreaks of a new type of colonialism, of conflicts of interest, of bureaucracy where the price of the flaws of the industry and the fact that it has sustained itself for a so long is quite often paid in human lives. But another layer deeper and I think of some of the individuals I have met that work in development- people with incredible integrity, perseverance, intelligence, creativity, and the ability and desire to critically engage with the complexities of development and find appropriate ways for themselves and their organizations and peers to support the people they work for, the poor and marginalized.

As I prepared to come to Zambia I knew that one of the critical development related challenges facing this region that I knew little about was disease and access to health services – especially as it relates to HIV/AIDS. There are many statistics that indicate the severity of the HIV/AIDS crisis and the impact it continues to have on this region, but statistics don’t tell the story. This is an human issue that affects people at the most personal level and each personal crisis ripples out through society affecting every layer. In order to try to understand a little more of the issues around HIV/AIDS and prepare myself to learn more in person I read “28 stories of AIDS in Africa” by Stephanie Nolan. I finished it on the plane ride here. I will encourage you and every other person I interact with to read this book until, hopefully some day soon, it no longer reflects the reality of the issue, and then I will still encourage every person to read it as a way of understanding how low we sunk.

This book attempts to tell the stories of 28 different individuals in different parts of Africa and the nature of HIV/AIDS as it affects them. As you glimpse into the lives and struggles of truck drivers, soldiers, health practitioners and researchers, priests, sex workers, and activists you see different sides of the issue all at a very personal level. To tell the stories of AIDS is to tell stories of pain and injustice that are not enjoyable to think about, but when the stories of the individual people they are also stories of inspiration and the beauty and strength of humanity that often shines through in our darkest struggles. The book is incredibly readable and informative, and respectful to the subjects. The message that I came away with is:
AIDS is complex and it reaches into every aspect of society – and it is a major contributor to the poverty and injustices affecting so many people in the world
AIDS matters to every aspect of development and is humanity’s most urgent challenge
No single factor, person or group of people are to blame but every single person has a role and responsibility in overcoming this challenge – and some of us are not living up to this responsibility

AIDS can be beat, and we have to act now decisively and continuously until no more children, mothers, brothers, teachers, doctors – no more people are lost to this disease
The questions I keep turning over and over in my mind as I think about this issue are how does it relate to me, and what is my role? I feel indignant, and culpable, angry and guilty as I think about it. I am part of the systems contributing to the injustices and I am a glaring example of the injustices.
I am from Canada, a place blessed with good health care and the prosperity and priorities to support it. Yes our health care system is far from perfect, but it is also far better than what the majority of the world has access to – and I have access to it because I did well in the lottery of nationality. Today I will take a prescription to fight the inflammation in my colon caused by ulcerative colitis, one to thin the bile flowing through my liver to reduce the damage to my liver and the risk of cancer associated with PSC, one to slightly slow down my immune system which is overactive for some reason and the cause of both of these diseases, I will also take a multivitamin to make sure my damaged colon is getting me the nutrients I need and to top it off I am taking an antimalarial to hopefully make sure I don’t get malaria. The total value of these drugs would be around $35. Because I have decent health coverage I won’t pay all of this cost. A person with HIV or AIDS in Canada would also have a cocktail of drugs to take each day that would turn this potentially fatal disease into a chronic illness. Its not fun to be on this much prescription and it would be nice to not need it, but we are incredibly blessed to have the health care system to diagnose our illnesses, prescribe things that fight the symptoms and causes and research the solutions. The amount of money that goes into my health care today could probably keep alive a couple dozen people that will die today because they don’t have access to much more basic health needs – and the injustice of this is very heavy on my mind and on my heart.

My attempt at a better world is not to stop taking my drugs and using my health care services and try to give the money to these dozen people. The issue is more complex and much bigger than this and I am unwilling- for many different reasons, rationalizations, especially fears- to take an action like this. Some people have taken this type of action, like Zackie a south African AIDS activist who refused to take antiretrovirals that would help his body fight AIDS until his government would acknowledge the gravity of the AIDS crisis and provide them to everyone who was dying for lack of these drugs in their country. My attempts are less extreme and less direct. I attempt to bring about a better world for people and societies affected by AIDS by:
· Donating to the Stephen Lewis Foundation and MSF (Doctors Without Borders), two great organizations doing AIDS related work (and peer pressuring Heather to Bungee jump for the Stephen Lewis foundation "dare to care" initiative),
· Advocating for changes to Canada’s laws that would enable the manufacture and distribution of cheaper generic drugs to countries that can not afford to provide them to their populations who are in dire need, and
· Learning, and raising awareness of the issues associated with the AIDS pandemic and fighting our misconceptions that allow us to remain apathetic in the face of a disease that has killed more people than all the wars in history and has eliminated a significant portion of the people needed to bring about a better world for all

Finally, I have to write about sex. Our discomfort with topics related to sex and sexuality are at the root of a bunch of the injustices perpetuating the AIDS pandemic around the world. People everywhere have sex, for all kinds of reasons and in all kinds of circumstances that I don’t necessarily understand or agree with. Encouraging healthy sexual behaviour is a valuable activity that parents, teachers, doctors, sexual partners and friends all have a role in. Abstinence is the only guaranteed way to prevent transmission of sexually transmitted infections (STIs). But abstinence will not eliminate STIs. We have been hard wired to have sex and even firm believers of abstinence will have moments of weakness or desire. In those cases condoms can and should be used unless you are trying to conceive. This does not always happen either unfortunately. Sex is hopefully an act of trust and love – and one person wanting to use a condom when the other doesn’t can seem like mistrust or fear. Especially in relationships of unequal respect or power even the fear of implying mistrust or fear or discomfort with any conversation related to sex can lead to a condom not being used, especially if the woman is on birth control. We need to change this. Sex can not be a taboo topic. All sexual relationships need to be safe enough that the conversations can be had, and each individual must be in control of their sexuality. This is a goal worth working toward at an individual and societal level, but people should not die in the interim. AIDS can not be taboo either and it can not be a death sentence. We need to build health care systems everywhere that can meet the needs of their populations – people need to have access to doctors, prescriptions, and societal support to fight diseases, especially AIDS – and we need to work hard to find cures. This should all be prioritized based on the impact of the health issues on humanity, not based on the money to be made by the doctors or drug companies or the wealth of the patients.