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of HIV. “In less than a decade, we’ve proven the skeptics wrong,” says ICAP founder and director Wafaa El-Sadr, MD, MPH, professor of Epidemiology and Medicine and head of the Mailman School’s Global Health Initiative. Even at a small rural clinic—the Andingo Opanga Dispensary, reachable only by a rutted, unpaved road that climbs to an altitude of 9,500 feet, the highest point in Nyanza—patients with HIV demonstrate in just a few words not only the remarkable success of antiretroviral therapy (ART) but also a sophisticated understanding of the disease. In a community meeting held in the shade of a large tree, two women offer testimony to the value of ART. A tall, lean woman in elegant African dress speaks first. She used to be terribly ill, near death. The virus had practically wiped out the critical white blood cells—CD4 cells— that HIV targets. “My CD4 count was 100. Now it’s 410,” she announces to general applause. (The normal range is 500 to 1,500 cells per cubic milliliter of blood.) Antiretroviral drugs have essentially resurrected her. Another woman rises to say that her CD4 count has rebounded from a low of 205. Now she’s doing so well that she can carry out her daily activities—so well, she jokes, that now she can dream of eating things she cannot afford! The small outpost serves ten villages and over a thousand households. More than 300 HIV-positive patients come here for care and treatment, including services to prevent mother-to-child transmission. But until three years ago, such patients had to travel over steep hills to the city of Kisumu, a $20, hour-long ride away, in order to receive treatment and regular monitoring. Few could afford it, and thousands died. “It was essential to bring antiretroviral drugs here,” says Dr. Eliud Mwangi, who heads ICAP’s Nyanza regional office.
“Yes,” he replies. She knows he is HIV-positive, and they are delaying sexual activity. Does his boss know? No, says Robert, “I am afraid he will fire me [if he finds out]. He will think I am weak.” Elizabeth, 23, is a beautiful young woman, with fine braids in a tasseled topknot, and sad eyes. She was diagnosed in 2007, when she was pregnant. When she learned she was infected, “I wanted to die,” she murmurs. She swallowed rat poison. Her parents found her and rushed her to the hospital. They beat her for at-
tempting suicide. She remained ill, and eventually told them the truth about her HIV status. Her father, a driver for an HIV research program, was able to accept her situation. Her son was, unfortunately, born HIV-positive. He takes medication each morning, she says quietly: “He is doing well.” Marianne, at 17, is the youngest in the group, but she lacks a youthful glow. One can tell at a glance that she’s seen many trials in her young life. She was only about 10 when admitted to the hospital very sick and in need of a blood transfusion. Her twin brother
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1 At a tree-side gathering at the remote Andingo Opango Dispensary in Kenya, a woman with HIV tells how antiretroviral drugs saved her life. 2 A modernized clinic awaits patients in Kenya. 3 Keeping small pharmacies in hard-to-reach clinics stocked with essentials is a challenge that ICAP constantly works to address. 4 One way to bring medical supplies into the area: Use a moped.
was also ill and soon died, as did her mother. Her father had already left the family, and she now lives with an aunt. The hardest thing, she says, was losing her mother. Like the others, she finds some strength in the support group, and sees a future for herself. Her dream: to be a lawyer. Richard is 22 and well-educated, having finished a bachelor’s degree in Purchasing at a college in Nairobi. He plans to go on for more education. Aside from his parents, he tells no one of his HIV status. He was just 14 when he became extremely sick, and was
brought to the hospital, a herpes sore near his left eye. He has no idea how he became infected. The shame and isolation he felt in having to leave his boarding school still visibly pain him. The support group, he says, has given him strength and a chance to share his secret: “It used to be only me and all these old people” coming in for regular health checks. What did he get from this group, Hawken asks. “I got that I am never alone.” *All names have been changed.
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