World AIDS Day 2009

World AIDS Day 2009 – The growing challenge of providing HIV treatment.
Tuesday 1 December 2009 – Freetown , Sierra Leone.
As Jenova and Sentu, two women health workers, took the details of the 190th person willing to have a rapid HIV test, a young street trader arrived at the steps to the veranda with her wares carefully arranged on a large round enamel tray and balanced on her. We were in a suburb known as the Low Cost Housing in the East of Freetown, and were observing the testing of residents and passers-by at the invitation of Ernest Jusu, the leader of the HIV/AIDS team from Kissy United Methodist Church Hospital. The team should have been operating from the local Methodist church but had discovered that its premises were not available, which led to local residents offering their own homes for such purposes. On one side of the narrow, pot-holed and muddy street people were being registered before walking a few steps across the road for testing and counselling.
By the time we reached Low Cost Housing, it was well past lunchtime having spent a long and very humid morning in Victoria Park for the commemoration of World AIDS Day with hundreds of T shirts wearing HIV activists, school children, teachers, police officers, women’s groups and street traders, waving their banners and posters, being led into the park behind a military band. At the opening ceremony, attended by numerous civic and national dignitaries, Dr Brima Kargbo, the Director of the National HIV/AIDS Secretariat had stated that 48,000 people were living with HIV/AIDS in Sierra Leone and that the prevalence rate of 1.5% represented one of the lowest in Sub Saharan Africa. A statistic which should, he said, not be allowed to rise any higher and in time decrease. He also indicated that during the year, the statistics for tested pregnant women had shown that almost 10% were positive which underlined the slogan of the day, “Protect your baby, get tested for HIV!”.
Feeling somewhat hungry, I discovered that the enamel tray of the street trader offered bread buns with a fish ball filling, and onions and chilli if desired. No sooner had she given me the change for two 10p buns, than she was being asked her name and encouraged to take the HIV test. A very softly spoken and diffident Amainda*, gave her full name, followed by her address, age: 22, marital status: married ,occupation: street trader, religion: Muslim and number of children: two. And then with her number on a slip of paper, she crossed the road with carrying her goods, to give a blood sample to the technician who was occupying a cramped space on the veranda of a simple brick-walled home. Built to wall height level by the government in 1979, it had then been and completed by the father of William Saifa, its present owner ,who with his wife,Sally had opened up their home for testing purposes
Inside the house, Ernest explained that the testing was being conducted in confidence, and the possibility of people guessing one another’s status was minimised by the amount of time taken in the post-test counselling. A positive result would be quickly verified, and followed us by another form of testing, and the time given to indicate the two results would be brief and approximate to the time given for a negative result. Ernest called the number of the next client to receive their result and Amainda entered to be told that the two tests had confirmed that she was HIV positive and would she please attend the Kissy hospital the next day or soon thereafter. After a brief pause she had gone as quietly as she had entered.
After completing 213 tests , 15 of them with pregnant women, results showed 3 people had tested positive. We returned Kissy Hospital a few miles away where I raised the question of what the new WHO guidelines would mean for the hospital. There has been universal satisfaction in seeing the annual global rate for new HIV infections decreasing yet again and with it a renewal of commitment to see them fall even faster. However, with only just half of the 20 million people needing Anti Retro Viral medication actually receiving it, the news from the WHO, that commencement of treatment should begin at an earlier stage when the CD4 count is 350 or below, rather than the current practice of 200 or below, has been received by many governments with less enthusiasm. As the number of people continues to rise, starting treatment earlier will only increase the pressure on health budgets with Kenya and South Africa being swift to announce their financial problems.
Ernest explained that Kissy Hospital had pre-empted the WHO recommendation and had been treating people with the higher CD4 count for sometime. Thankfully for Amainda, and perhaps her children and many more women and men in Sierra Leone too, treatment is available at no cost to the individual. Nevertheless I doubt that Amainda would have regarded that as good news on the afternoon of December 1st 2009 but it may well prove significant in what hopefully will be each and every year for many decades to come.
*Not her real name.