Wednesday, March 11, 2009

Stigmatizing Stigma (and also Nginemidlwane!)

So the other day I was sitting in the Deputy Head Teacher’s office (he was gone) busy doing nothing when two Form 4 (Grade 11) boys walked in to ask me questions about sex and HIV and other things they can’t talk to their normal teachers about. They asked me about ARVs and how do ARVs work? (There are reverse transcriptase and protease inhibitors.) Do they cure HIV? (No, they just slow the progression of the virus.) Can you still spread HIV if you’re taking ARVs? (Even with treatment, it is still possible to spread HIV to others.) Why do people wait to start taking ARVs? (You don’t start taking ARVs in Swaziland until your CD4 count is 200 or lower, which can be up to 10 years after infection.) How long can you live once you start taking ARVs? (Ten years is pretty standard, but it depends on a lot of other factors.

At this point, they did some math. If you are infected for 10 years before you have to take ARVs, and if you can live on ARVs for about 10 years, a person who is infected with HIV when they’re 20 can live to be 40 years old. Or, the way they put it, “If I don’t get infected until I’m 20, I’ll live just as long as I would even if I never got HIV.” At this point I was horrified for 2 reasons: (1) Something has gone terribly wrong in this country that a 17-year-old boy doesn’t plan on living past 40 (the life expectancy is 31), and (2) Maybe eliminating stigma is a bad thing…

Okay, I do still have a heart…but I also have a brain. Stigma causes all sorts of bad things—people refuse to test for fear that they’ll be positive and others will shun them, women are afraid to disclose their status to their husbands for fear they’ll be blamed, people on ARVs don’t take them when they have company or when they’re traveling for fear of being found out, people who choose to be openly positive are alienated by those who are not openly positive, etc.—but I honestly think that a certain level of stigma is required to make people afraid of getting HIV in the first place. Why waste your time and money with condoms when the worst thing that could happen is that you’d get a disease that everyone else has and that won’t do anything worse than inconvenience you twice a day when you have to take pills? How do I teach my students that they should treat people with HIV just like they treat anyone else, but that they should try their best to never become one of those people because it’s bad to be like them? That’s a dilemma…

Can you imagine if we, as a society, completely destigmatized teenage pregnancy? What if every health teacher and guidance counselor told high school students that getting pregnant when you’re 15 is no big deal, that you can live a completely normal life, that 1 in 4 people in the country have kids before they’re 18 and it’s not the end of the world for them? What if parents sat their kids down and told them that they would be okay with it if they had a kid before they graduated high school? What incentive would high school students have NOT to have sex, or what incentive would they have to use contraception? Honestly, that’s kind of what it’s like in Swaziland. And kids have lots of sex. And lots of 17-year-olds have kids. Because there’s nothing bad that happens to you if you do (and, in fact, it proves your fertility so it’s a good thing for marriage prospects).

I don’t know that I’m going to change what I’m teaching, but I am having something of a personal crisis about whether my anti-stigma lessons are doing more harm than good. Maybe I’ll just try to emphasize the “visualizing your future” lesson where students think about how different their lives would be with and without HIV. But maybe in rural Swaziland—where nobody has jobs, nobody gets educated, nobody lives to meet their grandchildren except those born to their 17-year-old daughters—getting HIV doesn’t really make your life any worse than it would have been otherwise. Why bother trying not to get it?

Wow, that’s depressing.

In other news, life is going well. This week I’m teaching the “ABCDEFG Model” of prevention (Abstain, Be faithful, Condomise, Delay sexual debut, Educate yourself, Fight stigma, Get tested) and I’m taking entries for the HIV prevention art competition that PEPFAR is paying for. I’m also working in my own garden and that of the NCP (the place where they feed orphans) so that me and the orphans in my community can eat more than just carbs. The small business thing at Hluti Central HS has been put on hold for a week for some sort of track meet that justifies canceling school all week (after last week school was cancelled for a teacher strike). Also, after MUCH waiting, I SHOULD have the list of kids who need sponsorship after one final meeting today…hopefully. I saw the list on Monday so I know it exists, but apparently it has to be finalized in a meeting with the chief today (Wednesday), so hopefully this weekend I’ll be able to post more information.

Also, NGINEMIDLWANE (ngee-nay-mee-dluh-WAA-nay). I have puppies! My mother/grandmother warned me that Bokhi would look kind of confused or have glazed-over eyes before she went into labor, and on Tuesday afternoon when I came home from the school she was acting kind of weird. (I couldn’t tell about the cloudy eyes thing because she only has one eye and it’s pretty cloudy all the time because she’s 9 years old.) It was a week early, but she had the puppies in the afternoon and I know at least 2 of them survived. She has them hidden away in a stack of thatch that my family intends to use on the kitchen roof so I haven’t been able to steal them and put them in my house yet, but this morning I got a good look at two tiny little white fuzzy heads so I know there are at least 2 of them. And I know who the baby daddy is (he’s the more attractive of the boys I saw her having relations with)…I’ll post pictures whenever I get a good look at them. And, most importantly, Bokhi is doing well. I was worried since it’s about like a 65-year-old woman having babies, but she’s happy and busy being a good mom (this is litter number 8 so she’s had lots of practice).

That’s all for today. Happy Belated Daylight Savings Time, even though we don’t have that here. Instead we have no concept of time whatsoever.

Love from the Swaz!

Mukelo, Kwanele and Xolile with the newest addition to the homestead, who I've named "Baby Goat." Original, I know. They think it's hilarious to sneak the goat into my house through my burglar bars when I'm busy doing work at my table so that I don't notice him unti he starts crying. I'm sure there's something unsanitary about that, but I enjoy the company.

Hlengiwe and the "Alphabet Tree" my parents sent. They love it! And it's really funny when they get to "Z" because they call it "zed" and they get into an argument with it, saying "no, zed!"

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