According to the World Health Organization (WHO), 19.6 million people are living with human immunodeficiency virus (HIV) in eastern and southern Africa as of 2017. As part of McGill’s Africa Field Study Semester (AFSS), students had the opportunity to interact with local individuals and public health practitioners that deal with HIV prevention and treatment on a daily basis. Through their visits to healthcare facilities, they learned about the ongoing HIV struggle in East Africa.
HIV is a virus that impairs the immune system, leading to immunodeficiency, or the inability to form a normal immune response to common infections. Transmitted through fluids such as breast milk, semen, and blood, the virus is often spread from mother to child, through sexual intercourse, and through sharing infected needles. People with HIV are also more susceptible to acquiring illnesses such as tuberculosis, meningitis, bacterial infections, and lymphomas. These illnesses can become even more severe if HIV advances into acquired immunodeficiency syndrome (AIDS).
While developed countries have made major advances in terms of access to HIV treatment and the stigma associated with HIV, many developing countries, such as those in East Africa, continue to struggle with the devastating virus. AFSS students visited Jinja, a Ugandan fishing community on the shores of Lake Victoria whose high rates of HIV are largely due to low levels of education, economic hardship, and a migratory lifestyle. The fishermen live day to day with the little money they earn, and their lifestyle revolves around “the four w’s”: Waragi (alcohol), water, wealth, and women. After a long fishing trip, they often spend their earnings on waragi and have sex with different women. This high level of prostitution coupled with low condom usage increases HIV transmission. Additionally, due to the fishermen’s migratory lifestyle, access to HIV treatment poses a problem. For example, if fishermen obtain drugs at a clinic to treat HIV or prevent infection following exposure to the virus, they often do not follow up with their treatment because they have moved to another community.
AFSS students also visited a Maasai community in Maji Moto, Kenya, another HIV-prone community. The prevalence of HIV in Maji Moto is due largely to the people’s polygamist lifestyle: On average, men in this Maasai community have three wives. If a Maasai man is infected with HIV, he will likely infect all his wives. Women, who can transmit HIV to their child during pregnancy, birth, or breastfeeding, are at a greater risk of acquiring HIV from heterosexual sex compared to men, since the layer of mucus surrounding the cervix is not thick enough to act as an effective barrier against the virus. Due to the Maasai polygamist lifestyle and the different ways in which women can transmit HIV to their children, people in Maasai communities are at a higher risk of getting infected with HIV. In addition, the Maasai community’s traditional way of life and bias against Western medicine impedes access to treatment. Many Maasai elders in Maji Moto believe that various plants and roots in the Kenyan bush can cure HIV, and, often, the Maasai people would prefer to visit the traditional medicine man rather than use Western treatments.
Finally, students visited Kakamega, a city near the border of Kenya and Uganda that serves as home base for a transient truck driver community. Hosting one of the first HIV clinics in East Africa, many HIV-positive patients settled in the Kakamega area after the clinic was opened. Consequently, the Kenyan town became home to one of the highest rates of HIV in the country. When AFSS students spoke to the public health workers in this facility, they explained that truck drivers have sex with prostitutes, increasing HIV transmission on the Kenyan–Ugandan border. Similar to the fishermen, truck drivers move from place to place and often do not follow up with their HIV treatment.
According to Avert, an international HIV and AIDS charity, overcoming the HIV epidemic in East Africa requires long-term commitment of the international community and national governments, as well as the involvement of civil society to address gender inequality, barriers to treatment, and the differing needs of each community. In trying to reach global HIV targets, Kenya and Uganda have made significant improvements, but the virus remains a major concern. Preventing infection and promoting routine treatments are of vital importance, and they will likely involve locally-driven educational initiatives to empower men and women and facilitate access to medical services.
McGill’s AFSS introduces students to the wildlife, history, and culture of East Africa. During the winter semester, students conduct research and take courses in Kenya, Uganda, and Tanzania.