I’ve interviewed HIV-positive people around the developing world. Aspects of the story used to be drearily similar … national health systems ill-equipped to handle patient loads, resistance to tracking contacts to identify those at risk, villages and cities stalked by mass early death.
That’s not the story any more. Many countries in Asia and Africa have mounted strong national campaigns to change behavior, have stressed the importance of adults knowing their HIV status, and have enlisted big voices in the culture to hammer home the threat of an unchecked epidemic.
Recently I was strolling through a neighborhood heavily burdened by HIV and AIDS — one of the most highly infected places in a country that has been trying to stop new infections for decades. There were no gaunt sufferers lining the sidewalks or lying in doorways. There were no lesion-scarred sex workers trying to turn low-cost tricks.
This was Anacostia in Washington, D.C., on a weekday morning — a place of low incomes, high unemployment, and the highest HIV infection rate in the United States. After years of tut-tutting about the battle against AIDS in Asia and sub-Saharan Africa, it’s the developing world that’s now showing the way.
In a coming series of reports called “AIDS: A Turning Point,” the NewsHour in collaboration with GlobalPost will highlight the ways Africa in particular has pushed down the rate of new infections, while the United States has been treading water.
John Donnelly — who’s been covering the spread of HIV and the global struggle to contain it — is by my side as we thread past a church, a barber shop, and a small grocery on a summery spring day. “I would say D.C. is four or five years behind some African countries in their response to AIDS,” he says, “and it wasn’t until some of the veterans from the global AIDS fight came to D.C. to help them, to help figure out how to fight this epidemic, that they really got going.”
Years after national campaigns in the developing world to encourage knowing your HIV status, too many infected people in Anacostia don’t know their own. With the Capitol dome of a rich, globe-straddling power shimmering in the distance, a casual sexual encounter can lead to HIV and a lifetime of treatment at great risk and great expense. Donnelly says as the epidemic shifted away from gay men to heterosexuals the response in places like Washington, D.C., didn’t shift fast enough.
After our conversation about detecting and treating HIV infection in a place like Anacostia is over, Donnelly headed back into downtown. A man who had watched me conduct the interview for the TV cameras called me over. He wanted to know, first, what was the story about? HIV and AIDS. As we talked I noted a casual sexual encounter could be very risky because there are so many infected people who don’t know they are, and take few precautions.
“Well,” the man shot back, “Your friend, that guy, does he have HIV?” I was a little surprised at the question. “I don’t know,” I answered. “I don’t think so.”
“So how you shoot an interview with this guy and you asking his opinion and you don’t even ask him if he got it, too?”
“Well, with what we were talking about, it probably would have meant getting the same exact answers about the disease.”
“Yeah, but he don’t have to say if he got it.”
At that moment, I got it. The man was a little irritated. He watched two outsiders use his street as a set for their conversation on AIDS, then prepare to leave. We had parachuted in just like Western experts, tsk-tsk, and he wanted to know what gave us standing. To talk. To use he and his friend as live props in the background of our shot.
I explained, “We came here because a lot of people in this neighborhood are infected with HIV and don’t know it.”
He immediately shot back, “But you don’t know it either.”
I do, as it happens. I got a test at a Washington, D.C., clinic. It was quick, easy, cheap, and pretty reliable. With better ideas about what works from some of the places where the adult HIV infection rate is high, maybe Anacostia can catch up. Antiretroviral drugs do suppress the level of virus in a body, and make it harder to infect unsuspecting partners. But experts around the world agree we can’t medicate our way out of this disease.
We’ll have more on all this here at the NewsHour’s website, and, of course, on the broadcast. Watch this space … and stay tuned.