Rough Moments = Personal Growth

If you had to tell someone that from this moment on, their life will be, now and forever, changed and it will affect not only their health, but potentially the health of their sexual partners and children, their ability to work and provide for their family, and then to top it off, their closest friends and neighbors may begin to look at and treat them differently, how would you do it? Do you apologize first? Or does that make it seem like you are apologizing to yourself for getting into a situation like this? Or do you act like it doesn’t mean anything to you to deliver life changing news? Would that make you appear callous and uncaring?

In reality, it isn’t about you. Does the manner in which the message is delivered make any difference to the receiver? Or do they only hear “your HIV test came back positive” and the rest just becomes background noise?

During training, 8 months ago, my language group took a “field trip” to the hospital to experience what happens before, during, and after an HIV test. I remember asking a lot of questions about the tests used and why you should get tested every three months, but I never thought that my curiosity in the nitpicky details of the process would be so incredibly useful. Little did I know, I would be the person explaining to another the process of taking an HIV test. First, pre-test counseling and then, the inevitable question: do you feel prepared for whatever the outcome of the test? (I am not even sure that is a realistic question. Can you ever be fully prepared for something like HIV?) Next, the finger prick and finally, the results of the test appear. One line: negative. Two lines: positive. If the test only has one line, the person is told to make sure they always use a condom, try to limit the number of partners they have, and to get tested again in three months. If there are two lines, however, the person is told the test came back indeterminate and a second, more accurate test is performed. Once again, one line means HIV negative and two lines indicate a positive test result. If two lines appear, then the counselor must tell the person in a sensitive, yet indisputable manner, that they are HIV positive.

Most of the time, this is just a process I observe, but when I was the only person who spoke English, I found myself looking for answers to all of those questions I addressed earlier. I wish I could say I thought only about the people to whom I was delivering this life changing information, but part of me kept thinking about how unprepared I felt. I kept thinking that I should have been taught how to say this the right way. How should I feel about the situation? How do I feel?

But, again, it isn’t about me. It is about the people who have an enormous decision to make. Do they keep living their lives as they did before they were tested? Or do they make the necessary changes and live a longer, healthier life with a few small sacrifices along the way?

ATSC

It has been awhile since I have talked about what exactly I do every week day 8am – 5pm, but recently, I can finally say that I LOVE my job! I know that love (especially in capital letters) is a strong word, but what I am doing right now not only keeps me from being absolutely and totally bored, but makes me feel like I have the opportunity to make a difference in peoples’ lives. To be honest, my job description is still not perfect or complete by any means, but every month I am given more and more responsibilities and my boss seems to really value my opinion and gives me positive feedback.

Over the past few months, I have been responsible for contacting the lodges/resorts/hotels in the area to ask them to ask their employees if they would be interested in voluntary HIV counseling and testing. If the employees respond positively (they all have so far) then one or two of the ATS-C counselors (Aconselhamento, Testagem, e Saúde – Comunitário) aka Community Counseling and Testing counselors and I go to the lodges and give an HIV/health session (around 30 minutes) and then test people. My role in all of this is to contact the lodges and speak to the managers who pretty much all happen to be South African or Zimbabwean and therefore, all speak English. I also organize all of the ATS-C activities and make sure we don’t forget to bring condoms to hand out after the tests and basically supervise the team. The pre-session counseling is usually given in the local language which means that I just sit there and nod my head while the counselors do their thing. Occasionally the pre and post-test counseling are given in Portuguese, but the counselors are trained to give it in the local language since only a small portion of the population speaks Portuguese.

Community Counseling and Testing is, at the present, only facilitating activities in the Vilankulo District, but eventually, ATS-C will spread to Inhassoro, Mabote, and Govuro (there are four districts in the northern part of the Inhambane Province where CARE works). CARE works through the hospital which means that the counselors were hired by the hospital and trained according to Ministry of Health (MOH) guidelines. If a person tests positive for HIV, they will be given a referral form to take to the hospital to have a CD4 count test taken. A CD4 count test determines if the person needs to start taking anti-retrovirals (ARVs) immediately or if their immune system is strong enough to delay treatment. One of my personal goals with this project is to determine if the people who test positive are actually making it to the hospital and if they are not, what are the barriers and how can we help them overcome them. Ideally, information that CARE collects will be given to the MOH and used in the 2009 HIV/AIDS report in Mozambique. In 2008, the prevalence rate of HIV in the Inhambane Province was reported to be 12%. Unfortunately, the data we have collected so far indicates that the HIV prevalence is higher than expected.

A random guy who wanted to be in the picture, one of the ATSC counselors, and me