Ethiopia part 3: Life, marriage, death hang in HIV test results

Strings mean some clinics don’t qualify for U.S. aid

Rekha Basu's Ethiopia Journey

By REKHA BASU
REGISTER COLUMNIST
Dessie, Ethiopia — The man and woman were ushered into a private office in a tidy white concrete structure with metal gratings on the windows.Behind the desk, wearing a white coat, sat Waizer Belay, an efficient, energetic nurse now confronting a difficult task. She had to tell the two, who were planning to marry, that their AIDS tests had come in, and the outcome did not bode well for a marriage.The multi-service Family Guidance Association clinic sits on a bustling stretch of this Ethiopian highland town. Posters on clinic walls tout the benefits of family planning and warn of the dangers of back-alley abortions and ignorance about AIDS.
The meeting took place in a ground-floor office down a hall from the reception area, where the benches were filled with male and female clients of all ages. Belay spoke matter of factly, while in the corner, an interpreter translated for me in whispers. I had been told only seconds before what was to take place.
“We have the results of the HIV tests you took,” the nurse said, then reminded the two of an agreement they had made that whatever the results, they would deal with them appropriately. “You are thinking about marriage. If the results show you are different, then we have to remember [the agreement].”
The man and woman nodded. He was 30, she 18, both divorced. She was wearing a green skirt over pants and a head scarf, and was draped in a bright orange shawl. She was smiling, leaning toward him, her elbow resting on the back of his chair.
The man had closely cropped hair. He wore a brown suit under his shawl.
”She is negative, and you are positive,” Belay said. The man’s face clouded. He said nothing. Neither did the woman. Her smile seemed frozen. Belay asked the man what he was thinking.
”Well, I suppose I can’t marry her,” he said quietly.
The nurse then pressed him on what he understood about living with HIV.
”That person has to be careful throughout his life to not transmit the virus,” replied the man.
The nurse turned to the woman. “And you?” she asked.
”I have to keep myself away from activities that may result in my getting it,” she replied, as if reciting from a manual.
Belay pressed her, suggesting she didn’t think the woman had absorbed the information. “You need to talk freely,” she said. “What did I say to you about your result?”
The woman kept silent.
”Do you think you can marry?” the nurse asked.
”Yes,” she replied, then asked, “What did we say earlier?” It wasn’t registering.
”This is a big issue,” the nurse chided. “You can’t forget this.”
”No, we can’t marry,” the woman said, then adding, “I have to desist from any unprotected sex until marriage.”
The nurse was firm now. “You can’t marry, that is the bottom line,” she said. “If you can’t resist sex actively, use condoms, but abstention is another option.”
The couple left the room, and I asked Belay about their stoic reactions. She explained that it was common in their Muslim culture not to show public emotion.
I pressed: Their marriage plans had just been dashed.
The nurse explained that the couple didn’t actually know each other. The match was arranged by their families.
It was just the luck of the draw that her family picked a man with the AIDS virus. But it’s not uncommon, either. Nineteen percent of the 1,920 people who came in for HIV tests in the past six months were positive.
If the couple hadn’t gotten tested and counseled, the woman’s wedding could also have been her death sentence.An estimated 4.4 percent of Ethiopia’s adult population has the AIDS virus. That translates to 1.5 million or more people — about half the population of Iowa. About that many children have lost at least one parent to AIDS.
It’s becoming more common to see such “discordant couples,” where one is positive and the other negative, Belay said.
It’s a tough sell convincing men to use condoms. And in that region, it’s not uncommon for women to be passed around for sex to their husbands’ brothers.
The two now returned from the waiting room with their brothers.
The nurse asked the men what they had been told. “He told me he has a problem with his blood,” said the man’s brother.
She asked the woman’s brother what the couple had said they were planning to do.
”They told me they haven’t yet decided.”
”Do you know why they came here?” asked the nurse.
”For marriage,” said one brother.
”No, for an HIV test. But until they are willing, I cannot tell you [about it].”
She urged the woman to speak up, and was met again by silence. So the man spoke. “She is free. I have a problem,” he said. “The HIV virus.”
The brothers said little. The nurse confirmed the results and told the relatives this had to be kept secret, and that the marriage could not take place.
They left in apparent agreement.
And that was that.
The good news, if you had to find some in this, is that people are getting tested and counseled appropriately, and it’s making a dent in AIDS transmission. Ethiopia’s government, which in the past denied there was an AIDS problem, is stepping up its AIDS-fighting efforts, aimed at integrating prevention and treatment with reproductive health care so people going in for AIDS aren’t stigmatized. “We shouldn’t force people to reveal themselves,” declares Ethiopia’s health minister, Dr. Tewodros Adhanom.
”We are the source of stigma, the health system itself, in the way that we are approaching HIV,” Adhanom said. “Why do we treat them specially? They are sick, like any other sick person.”
Unfortunately, our own government will not support that approach. The U.S. Agency for International Development won’t give any AIDS money to the Dessie clinic because we require AIDS money to be spent separately from family-planning funds and because of the global gag rule. Under the gag rule, no U.S. government money can go to an organization that also gets money from a source that provides or supports abortion. Abortion is illegal in Ethiopia under most circumstances, but the Family Guidance Association is still ineligible for U.S. aid because it gets money from the International Planned Parenthood Federation, which supports abortion services.
I’m not sure how this makes sense, either to the goal of fighting AIDS or to the goal of promoting family planning. I can’t see it making sense to people like these clients.
They’re having a hard enough time making sense of a fatal diagnosis and a foiled future together.

REKHA BASU can be reached at rbasu@dmreg.com or (515) 284-8584.

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