The Inevitable

Last week, while Ricardo and I were on safari in Botswana, Zeca passed away. He was 26 years old. Zeca had been sick with visible symptoms for at least a year, but only received his HIV+ diagnosis last month when urged by our friend B. to go to the clinic for a free blood test. Our friends back in Chimoio pooled money to pay for Zeca's funeral, and are trying to establish a bank account where Zeca's widow can withdraw about $50 each month to support herself and their children.

I am deeply saddened by the loss of the local person in Chimoio with whom I felt the greatest connection, but more than anything Zeca's death makes me feel angry. How is it possible that billions and billions of dollars are pledged anually to fight HIV/AIDS in Africa and yet a person like Zeca can go up to 1 month of his death without getting an HIV test??? Every time Zeca would get sick we'd pay for him to have a consultations with western practitioners either at the local public hospital or at the Clínica Fátima, supposedly the best private clinic in Chimoio. Zeca would also meet with traditional healers, and I find it OUTRAGEOUS that between both western and traditional doctors NOBODY recommended that Zeca have an HIV test. I also feel a fair amount of guilt that I never did more to help, given my background in HIV prevention. I simply assumed that Zeca already knew his status and, out of a desire not to offend him, never probed any deeper into the matter until it was already way too late.

I understand that there are overwhelming cultural barriers to be overcome when dealing with HIV/AIDS in Africa, and in just about any community for that matter. But what makes me want to pull my hair out is that so much of the money that is donated for HIV/AIDS prevention - especially from the US - is full of conditions as to how it must be used that end up rendering the programs inefficient and ineffective. Instead of focusing on strategies that combine traditional beliefs with the best in modern medicine, prevention initiatives are filtered through the values and priorities of the western world.

Mozambique and Angola are just 2 of the many countries in Africa that, since they receive funding from the US to fight HIV/AIDS, must push the "A-B-C's of Prevention" as follows: 'A' is for Abstinence and that is the best and most recommended strategy to avoid HIV/AIDS. 'B' is for Be Faithful, what you should be to your partner if you fail the whole abstinence part. 'C' is for Condoms, third in priority and what you should do if you have (gasp!) more than one sexual partner. Thanks to a certain president's agenda of morals and family values, an HIV/AIDS program in Africa is not eligible for federal dollars unless it pushes the A-B-C's as the primary strategy for prevention.

The fight against HIV/AIDS is an industry, just like the fight against poverty or malnutrition or infant mortality. Many people are getting rich from the perpetuity of these problems, from the bureaucrats in Washington or Brussels making funding decisions and taking their respective administrative overheads (sometimes up to 34% of the program's budget), to in-country NGO directors with $10,000-a-month salaries and brand new Land Cruisers, to the local government officials lining their pockets under the table. There is not enough accountability, and the most perverse part is that once the problems at hand are tackled, there will be no need for all these government programs and NGO workers and local staff with stable jobs and good pay.

Certainly there are some people and organizations fighting the good fight, but the more time I spend here in Mozambique the more cynical I become about the whole situation. Until enough people call a spade a spade and admit that our current models for combating HIV/AIDS, malaria, food shortages, etc. are pitifully ineffective, the situation will continue to worsen and there will only be more stories like Zeca's to tell.

(I have an image to go along with this post but Blogger won't let me upload the photo. Will try again later.)