More Suprises: Teachers, Epidemics and a Celebrity Visitor

Something that I learned early on in studying HIV/AIDS is that the epidemic is vastly different in every setting. This lesson is reiterated weekly as I discuss the client population at the Durham SHAC HIV testing site with my co-coordinators who work at the Carrboro SHAC HIV testing site. With such different populations and two different epidemiological pictures of HIV/AIDS in towns as close as Carrboro and Durham, it seems ludicrous that HIV/AIDS in Africa is so often spoken of as one single epidemic.

So often in both popular media and academic discourse we hear of the HIV/AIDS epidemic of Sub-Saharan Africa. How imprecise! It seems that such a concept must have extremely limited utility, if any at all, considering the wide variety of cultures, economic structures, and public health infrastructure the term Sub Saharan Africa encompasses. (In fact, I  think the Western World spends far too much time lumping African or Sub-Saharan African countries together as if they are all the same)

Returning to the idea of the diverse picture of HIV/AIDS, one critical aspect of epidemiology is high risk groups. These groups vary greatly with the setting, though surely there are some common high risk groups sex workers, and men who have sex with men, for example. Today I was suprised to learn that in Malawi the number three high risk group (behind sex workers and police men) is teachers!

The salary and societal position of teachers in Malawi affords them power, which some use for transactional sex. Apparently, teacher/student sexual relations are not uncommon in Malawi. Moreover, teachers are often posted in remote areas where they are isolated from other similarly educated people which leads to promiscuity and transactional sex. This causes problems not only for the spreading of HIV, but also because teachers are supposed to be teaching their students about the virus and how to protect themselves. Yet according to the physician I was speaking with this morning, teachers have many misconceptions about HIV/AIDS and by-and-large are not equipped to provide accurate information.

In response to this problem, teachers are being targeted by non-profit risk-reduction agencies. In educating teachers these organizations are thus able to prevent the spread of HIV through a high-risk population and discount misconceptions and myths so that Malawian teachers are better able to inform their students about HIV/AIDS.

This lesson has reinforced to me the danger of making assumptions about populations or individuals and their risk level. It also makes me think that in facing this epidemic collective honesty and compassion are essential to making any headway against the disease. Shame so often keeps people from disclosing their status, or even from asking questions to obtain an understanding of HIV/AIDS- an understanding that could be critical to avoid becoming infected. Yet changing the societal structures that allow the powerful to manipulate others for sex, that put children at risk and that disenfranchise women is equally important. Whether in Durham or Lilongwe HIV/AIDS thrives on inequality and we cannot eradicate one without minimizing the other.

Postscript:
Leaving the clinic today I got a call that Bill Clinton was coming to the hospital! The Clinton Foundation donated a new maternity wing so he was coming for a tour. I got to meet him and had a group photo op. Pictures of weeks 1-3 to be posted this weekend!