July 27, 2007

Correspondent’s Diary: Kanyama

(Note: as some have pleaded, whenever I write my weekly JHR correspondence I’m not allowed to post it here - just link to it. Instead I’m to attempt a story-behind-the-story narrative that will poorly mimic the excellent feature on The Economist’s website)

Despite its location deep in south-central Africa, Lusaka has very Western feel about it. Tinted-window SUVs roar down multi-lane roads, winding their way around shopping plazas, landscaped roundabouts and austere international hotels. Land Rovers painted UN-white haul families to the local burger joint for combo meals before they amble to Blockbuster to rent the latest Hollywood film.

But from my suburbian enclave it doesn’t take long to see Zambians “living in their true nature,” as a colleague described it to me.

Going downtown, the façade of development holds up well as you cross Cairo and Cha Cha Cha roads, where retro-chic Independence-era buildings and soaring palms charm with a fashionable amount of tropical dilapidation. You pass over a single set of railway tracks to see a different sort of freight train: a teeming horde trudging along the narrow gauge in the typical African fashion. Babies dangle from their mothers' backs, tethered with a brilliant fabric that matches the one cushioning the woman's head from her precarious load.

Paved roads become badly potholed and eventually degenerate into ragged dirt pathways as our bus plods ever westward, parting a river of harried pedestrians. They pass so close to my window I can smell them. It's not the North American 'I'm sweating out my high-cholesterol diet' body odour, but something earthy, not necessarily foul. It's only as we pass the acrid dried fish stands that I wince. The brightly-painted shops of the city have given way to the dizzying spectrum of a sprawling open-air market. Heaping baskets of dried beans and nshima (the local cornmeal-like staple) contrast with a rainbow of fruits and vegetables displayed under gnarled wooden shelters. Large women stare out from behind them with snow-white eyes.

As we approach Kanyama Clinic, there's litter everywhere and animals running loose in the streets and sewage canals.
Kids run alongside the bus in grubby flip-flops while adults look idly by, aloof to the passage of journalists through a thousand untold stories.

At our destination we finally pile out of the bus, into the courtyard of the biggest anti-retroviral treatment (ART) centre in the country. We're there as part of PANOS-sponsored journalism workshop to improve reporting on HIV and AIDS. The apparent problem as we're led into the bowels of the clinic is that it didn't look like there was all that much to report on. Certainly not the abbatoir of human misery I was expecting.

The previous day I'd given a presentation on the 'human rights dimensions' of the pandemic, the real reasons why HIV has spread so rapidly here. Gender inequality, lack of access to prevention/treatment and stigma surrounding positive status were my main points. Despite the obvious majority of ARV patients being young women, these stories were conspicuously absent in Kanyama: the wards were empty, the store rooms were overflowing with free drugs and we were treated to a stigma-fighting theatrical performace and song.

As I wrote, the real human rights story is no longer access to treatment, but rather its more elusive cousin, adherence. Thanks to president Bush's PEPFAR plan and Billanthropic (Clinton and Gates) initiatives, the clinics are overflowing with free, generically produced ARVs. That's obviously a step in the right direction, but it fails to address why, in Lusaka, over three years of free access has failed to make anything but a cosmetic change in the AIDS death rate. Patients may not be showing up to clinics in wheelbarrows anymore, but they're still dying at the same depressingly high rate.

The point that PEPFAR and Project (RED) miss is that HIV/AIDS is a social, not medical problem. The plea for more pills = less death might sell a boatload of t-shirts and get you on the cover of Vanity Fair, but access alone is no magic bullet.


Anonymous said...

Hi Brandon,
I've been enjoying your blog and I particularly liked your "Life after HIV, sometimes" report. You did a great job of showing how complicated the situation is with HIV/AIDS and ART. I agree that "More pills = less death" is way off the mark.

One thing caught my attention, though:
"transactional sex". Where did this term come from? Did someone tell you to use it? Is this just a PC way of saying prostitution or does it mean something else as well? I have mixed feelings about using a term that seems sanitized for an act that I consider dehumanizing. On the other hand, calling sex workers "prostitutes" etc. feels like being needlessly cruel to the victim.

I would love to hear your opinion on this, and I look forward to reading whatever you write next.

Stay safe
Best wishes
Good luck,


B. Scott Currie said...

Hey Jess,

Good to hear from you. Thanks for reading!

In HIV/AIDS parlance 'transactional sex' is used to describe a number of different scenarios, prostitution being just one of them. It also refers to young girls (and sometimes, boys) who are lured into sexual relations with adults offering cell phones, cars, even food and candy. These are usually people in positions of dominance and trust (uncles, friends of parents) who exploit girls' economic insecurity and lack of education. It's the same prospect of destitution that prevents women from disclosing their HIV status to their husbands, who'll likely abandon them for being 'promiscuous.' So yeah, like so many other social issues, investing in female education/empowerment is key to any lasting solution, though that sort of thing doesn't lend itself to catchy slogans and impulse activism.

Mike said...

This is really informational, which is great, but allow me to be a nerd and just say that your imagery is blowing my mind. Keep it up, B-Rock.