Conversations in Transit
September 25, 2009
I am based in Gaborone, Botswana. Even though Gaborone is the capital city, it feels like a town in this country of only 1.7 million people. Speeding along its busy roads, I see herds of goats waiting to cross at traffic signals and cows grazing on sparse patches of grass.
I am in a combi, a van that carries people through town, much like a public bus, only smaller. I am seated in the second row, squeezed between an older woman and a businessman. My knees are pressed through a ripped section of the gray vinyl seat in front of me, resting against the scratchy cold metal of a rusted pole, which provides welcome relief in the midday heat.
I start a conversation with Rebecca, the passenger on my right. She tells me, “HIV, it’s a problem here. It doesn’t mind age; it will select anyone, a child, someone as old as me, a baby. The hospitals aren’t open all the time to get the medicine.”
She speaks candidly, as many people do here. About 33 percent of the people of Botswana live with the HIV virus. Antiretroviral (ARV) treatment allows people with the virus to live longer, fuller lives. Even though ARVs are now available in this part of the world, not everyone is getting them, and not everyone is using them properly.
I arrived in Botswana five months ago to work for a friend on the Botswana Project. I have been interested in working in resource-poor settings for some years now. I jumped at the opportunity to come to southern Africa, a hot spot in the HIV/AIDS pandemic.
The Botswana Project proposes a solution to the issue of treatment adherence for people taking ARVs. We are providing a service that sends text messages to cell phones as reminders for people to take medicines, go to clinic appointments, and refill prescriptions. The service is free for all patients and doctors involved. The cell phone market in Africa has grown tremendously in recent years, and many people in Botswana own a phone–or even two. As I waited for the pilot project to start, my understanding of HIV on the ground in Botswana was being shaped mostly by conversations during transit.
I had just arrived from the States to South Africa and boarded a bus from Johannesburg to Gaborone. Before the bus took off, a woman stepped on board and began a speech to ask for donations for the HIV/AIDS orphanage where she worked. She told us she was HIV-positive, which moved me; she was the first person I had ever met whom I knew to be HIV-positive. She told us she wasn’t trying to make her problem our problem, but she would be grateful for any contribution we could give.
At that moment, I felt a surge of emotion and purpose, realizing I had come to a place in need of a lot of help. I also noticed the groans and passive looks directed her way as she passed by rows of seats. The stigma attached to those with HIV/AIDS was evident through the passengers’ reactions to this woman. From this brief encounter, I began to understand how stigma manifests itself and that it is a real challenge to confront while doing this type of work.
On a later trip from Johannesburg to Gaborone, I met a Zimbabwean woman named Tami. As we started chatting, our conversation became free and easy. Tami said she was 43, “an old person.” As she said this, she laughed and I nudged her plushy body and laughed with her, telling her she was still young. She asked where I was from and what I was doing here. When I explained my work, she told me she was HIV-positive. She was open about it, shaking her head saying, “That’s me, I have it, but I don’t take the medicine because my CD4 levels are still high.” CD4 levels are a measurement of a person’s immunity, and the ARV treatment is useful only after a person’s natural defense is low enough.
“But what to do?” she asked. “Can’t just lie down and die, have to keep going, keep living.” A shudder ran along my spine. I felt for her and also admired her strength. “Our husbands, we think they are faithful, but they are not.” Of course there are many circumstances that lead to transmission of the disease, but husbands cheating on their wives is a familiar one.
I sat with her words for a minute, feeling the weight of her situation. Her age of 43 seemed much older to me now. With the virus, she won’t live to be what I think of as an old woman. We moved along in conversation–I told her about the school garden I am planning, and she showed me pictures of her family on her cell phone, which she keeps tucked in her bosom. During the six-hour bus ride I came to understand that Tami is a woman who has had multiple strokes of bad luck. However, she has a willingness to carry on and to remain upbeat, focusing on the life she has instead of what she lacks or her inevitable early demise. The memory of her inspiring disposition stays with me.
Through these simple interactions and conversations, I have begun to develop a real-life picture of HIV/AIDS in southern Africa–filled with color and shades of lightness and darkness. This is an important dimension of the work I am doing here–seeing the faces of people with the virus, hearing their stories, and weighing the opinions of everyone, infected or not. It is the human side of my work, and these are experiences I could have only by living in Africa.
Prentiss Darden B.A. ‘08, who majored in international affairs, is a member of the Core Project Team for the Botswana Project (www.thebotswanaproject.com).