Global HIV/AIDS timeline

The Kaiser Family Foundation has put together an interactive timeline that provides information on key HIV/AIDS-related events since 1981. Also, if you look just below the timeline, there is an estimate of the number of people living with HIV/AIDS for each year. If you're interested, visit http://www.kff.org/hivaids/timeline/hivtimeline.cfm.

Sunday brunch

My favorite new thing in Rwanda is Sunday brunch with my expat coworkers. Today we met at eleven for a brunch of pancakes, eggs, bacon, fruit, juice and coffee on the patio of one of the houses. It was another beautiful day and the perfect to spend a few relaxing hours together between Sunday morning mass and an afternoon in the office.

Thieves and police

Yesterday became quite eventful as I had my first (and hopefully only) encounter with the Rwandan police. The entire experience was bizarre and shocking.

Around three o’clock, one of my friends and coworkers came to my house and told me that her cell phone had been stolen by a man who came to her house and pretended to be enrolled in a study at PSF. We decided to call the phone to see if anyone would answer, and, amazing, a man answered and demanded that my coworker pay him Rwf40,000 (US$80) for the phone. She, of course, refused, and we called the police. The police showed up at my house about an hour later and, after hearing my coworker’s story, assured us that they would have the phone back by Monday afternoon. I was certain we’d never see them, or the phone, again.

No more than two hours later, the police returned to my house, literally dragging the three men involved in the theft – the man who stole the phone, the man who bought the phone from him on the street and the commissioner of the deal – to my front porch. Everyone sat down at the table and an absurd conversation of English, French and Kinyarwanda ensued. In the end, my coworker identified the thief, he confessed and the phone was returned, but the man who bought the phone from the thief threw a fit because he had lost Rwf25,000 (US$50) in the deal. I might have felt sorry for him, were it not well known that phones purchased on the street in Kigali are stolen goods and had he not been the man with whom we spoke on the phone, who was demanding an even higher price from my coworker for her own stolen phone. Adding to that, we later found out that this man makes his living by buying and reselling stolen goods. I had no sympathy for him; but the police seemed on his side. It seems they promised him that he would be repaid if he provided information about the thief to them.

So now that my coworker’s phone was returned, the main issue was repaying Rwf25,000 to the man who bought the phone. The commissioner claimed to have received no money in the transaction, and the thief only had Rwf6,500 remaining from the deal. The policemen wanted everyone involved in the sale of the phone to come to the police station to give statements, but the man who bought the phone refused (probably knowing that he had no legitimate claim and, really, could be arrested himself), so everyone left, supposedly to resolve things “outside of the police station.”

This morning, my coworker called one of the policemen to find out about the resolution of the situation. The man calmly explained that the thief had given his Rwf6,500 to the man who bought the phone, as well as Rwf18,500 of heroin that he had in a matchbox in his pocket. And just like that, the commotion was over.

But I can’t decide what part of this story is the most absurd. Is it the fact that the police could actually track a stolen phone and return it? Or that they showed up at my house with the three guilty men in tow and we all sat on the front porch to discuss the incident? Or that the situation with the man who bought the phone was resolved by a thief handing over a matchbox of heroin to another criminal in a police station? It certainly leaves me with a mixed opinions of the justice system.

Umuganda

Today, like the last Saturday of every month, is umuganda, a mandatory day of community work. From six in the morning until noon, businesses close and public transportation stops, and everyone in Kigali is expected to work in and clean their neighborhoods. Supposedly, refusal to participate in umuganda is punishable by arrest and even government officials (including President Kagame) participate in the day’s events. It's no wonder, then, that Kigali is so surprisingly clean!

I have to confess, though, I've spent the morning sitting on my front porch, drinking coffee and reading, but I'm curious to see if the road is any cleaner when I open our front gate.

Floods in the west

The western provinces of Rwanda have been some of the hardest-hit areas during recent flooding throughout East Africa. Homes, crops and herds have been destroyed by floods and landslides, many people have been killed and thousands have become refugees within their own country. Unfortunately, the rainy season has only just begun. The following article comes from the Rwandan newspaper, New Times.

Rwanda: Fears for Epidemics High as Rains Continue to Batter West
by: Martin Tindiwensi and George Barya Rubavu

The continued influx of people who have fled their homes due to floods in parts of Western Province has increased fears for possible outbreak of epidemic diseases.

By yesterday, flood levels were still rising as more rains continued to hit the districts of Rubavu and Nyabihu. More people evacuated on Monday in Kazenze Sector, Nyabihu District as their houses go submerged by the floods. According to Kanzenze Sector Coordinator Felicien Kanzendebe, the situation is well beyond the capacity of both the affected districts.

He said that 2,734 people had been evacuated to Nkamira camp in Rubavu District. The camp also has 1596 Congolese refugees.

"With the current outbreak of Ebola in the neighboring (DR) Congo from where people have been coming until recently, there are serious health concerns," he said.

He added that despite the fact that the displaced flood victims live in separate camps with the Congolese refugees, their children share the same playground.

Red Cross which is hitherto the only humanitarian organisation assisting the affected people is concerned with provision of basic supplies whereas the district authorities are devising means of resettling those displaced and providing them with food.

Among the main problems is that of school children who are likely to miss classes for the rest of the term. "We have not done anything yet to get children back to school because there are still more pressing problems to attend to. We have to first move those displaced to temporary camps in Nkamira, Bigogwe where we are currently installing tents," said John Bosco Musana, the coordinator of Red Cross in the province.

On food shortage, Musana said that a recent meeting with World Food Programme had recognized the need for humanitarian food supplies, but that no promise had been made.

"We had a meeting with World Food Programme officials; they took statistics of the displaced people but up to now they have not promised anything," he said.

When contacted, Nyabihu district mayor Charles Ngirabatware admitted the needs were beyond his district capacity but said that he was working closely with the provincial governor Penelope Kantarama and mayors of non-affected districts to come up with both financial and food assistance.

"I think other districts' assistance will be of great importance in meeting most of the needs," he said.

However, Ngirabatware, whose district was most hit by the torrential rains that started last week said that central government officials who are also trying to help in various ways. The district lost 15 people on September 12 due to floods.

"We have received officials from the Ministry of Health trying to provide medical support to the victims and we are working on resettling them in Bigogwe Sector where we procured land from SOPYIRWA (a pyrethrum processing industry). Soon the situation will be back to normal," Ngirabatware said.

He said they are still searching for more people who could have been buried under the collapsed structures.

"This district is known to be very fertile and therefore many people come here to work on plantations some of whose identities are not known," he said. The central government promised to provide iron sheets to the displaced persons.

At least 1,000 houses are reported to have been destroyed following the heavy rains in the two districts. Experts have warned that the East African region could face torrential rains in the coming months.

Great news

A couple days ago, I posted an article about a vaccine trial by Merck that was canceled because the potential vaccine failed to prevent HIV infection in study participants. The news was particularly disappointing because many vaccines that are far along in development use a concept similar to that of the Merck vaccine. In light of the failed trial, there were rumors that scientists would reevaluate other vaccines, to make sure that each one is different enough from the Merck vaccine to have a chance of success. Thankfully, we've received the green light to go ahead with our vaccine trial at PSF. We'll be able to continue as scheduled, which means we should be start within a couple weeks. Even after Friday's disappointment, there's still hope that our vaccine will be effective.

Walking home

Walking home after work may be my favorite part of the day. Not because it means that I’m finished with work until the next morning or that it’s time for dinner or anything like that, but because of the walk itself.

I leave the office each afternoon and walk up the dirt road toward the paved one. On my way, I greet and am greeted by nurses, counselors, general workers and other project staff who, by this point, have started to recognize me. (I don’t exactly blend in in a crowd here!) Just before I get to the main road, I pass a bench where the three or four security guards sit, listening to an ancient, static-y, portable radio. Watching them sit on this bench always amazes me – the bench is made of two two-by-two’s sticking out of the ground with a worn board about the size of a one-by-six laid across the top. In the middle, a plastic chair (with legs removed, of course) is screwed into the bench to create a nicer place to sit.

As I turn left onto the paved road, it’s a beautiful sight. I am walking west and have an incredible view of the sunset over the hills of Kigali. After taking in the sunset, I usually watch the soccer game on the opposite side of the road. Ten to thirty children play soccer on a small grass bank every single afternoon. It’s an intense game, but I still manage to steal at least some of their attention. Most days, three or four point at me and talk amongst themselves about the muzungu across the street, but one day my presence brought the entire game to a halt as everyone stopped to point and yell “Muzungu!” I just smiled and waved back at them. As I continue walking, I pass children, old women, mothers with babies strapped to their backs, men selling shoes/fruit/purses/phonecards/pants and everyone else. People here are friendly, so many of them speak to me or I to them. Usually the conversations are short – “Bonjour.” “Comment ça va?” “Ça va bien.” or “Maramutze.” “Amakoro?” “Nimeza.” – not so much because I don’t want to talk or am in a hurry, but because my French and Kinyarwanda are so limited. Thankfully very little conversation is expected when you pass someone on the street! I love passing the children as I walk. The older ones always want to speak, and the brave ones will dare to shake my hand. The tiny ones seem so intrigued by me. Most of them just stare, but one day a tiny little boy walked up to me and stuck both arms high in the air, like a child who wants to be picked up or hugged. I knelt down and played and spoke for a couple minutes while his mother encouraged and smiled. As I walked away, she convinced him to say "bye bye."

As I approach the main road, I pass an open sewer, the one unpleasant aspect of my walk. I always try to cross the road as quickly as possible to escape the stink, but sometimes it is difficult since the road is a main one and therefore full of cars, taxis, minibuses and motos.

Soon after crossing the road though, I turn down a “short cut” to my house, which is little more than a path for water to run off the street. Walking down this little alley, I pass several buildings surrounded by a “fence” of some spiny, green plant on my left and a house enclosed by a bamboo fence on my right. There are several chickens in the yard on the right, and I think this might be the home of the rooster that wakes me every morning. I always wonder if I could trade them another chicken for their rooster to gain a couple extra hours of sleep each morning. I doubt it.

At the end of the short cut, I turn onto my dirt road and greet the men on the corner selling sunglasses and vegetables. The road is rough and bumpy and I’m always amazed when I see a car driving up or down it. There are always many more people than cars, so I join them, trying not to trip over rocks and corncobs in the road. Even though it is only a few yards from the corner to my house, there are always many more people to greet, especially young teenagers who want to practice their English or French. I’m sure I disappoint them with the latter.

Soon I see the gray and yellow gate on the left, and I know I’m home.

Disappointing news

There was some disappointing news this past Friday in the world of HIV/AIDS vaccine research. I thought I should share this article from TIME with ya'll. Hopefully these results won't affect our upcoming vaccine trial at PSF.

Experimental AIDS Vaccine Fails
By: Linda A. Johnson

In a disappointing setback, a promising experimental AIDS vaccine failed to work in a large international test, leading the developer to halt the study.

Merck & Co. said Friday that it is ending enrollment and vaccination of volunteers in the study, which was partly funded by the National Institutes of Health.

It was a high-profile failure in the daunting quest to develop a vaccine to prevent AIDS. Merck's vaccine was the farthest along, considered the most promising and was closely watched by experts in the field.

Officials at the company, based in Whitehouse Station, N.J., said 24 of 741 volunteers who got the vaccine in one segment of the experiment later became infected with HIV, the virus that causes AIDS. In a comparison group of volunteers who got dummy shots, 21 of 762 participants also became infected.

"It's very disappointing news," said Keith Gottesdiener, head of Merck's clinical infectious disease and vaccine research group. "A major effort to develop a vaccine for HIV really did not deliver on the promise."

Michael Zwick, an HIV researcher at Scripps Research Institute, said it's too soon to know if other vaccines using the same strategy would also fail.

"It's par for the course in the HIV field," he said of the Merck result.

The volunteers in the experiment were all free of HIV at the start. But they were at high risk for getting the virus: Most were homosexual men or female sex workers. They were all repeatedly counseled about how to reduce their risk of HIV infections, including use of condoms, according to Merck.

In a statement, the NIH said a data safety monitoring board, reviewing interim results, found the vaccine did not prevent HIV infection. Nor did it limit severity of the disease "in those who become infected with HIV as a result of their own behaviors that exposed them to the virus" — another goal of the study.

Merck's was the first major test of a new strategy to prevent HIV infection. The first wave of attempts to develop a vaccine tried to stimulate antibodies against the virus, but that hasn't worked so far.

The new effort - an approach that Gottesdiener said is being tried in most other current research - is aimed at making the body produce more of a crucial immune cell called killer T cells. The goal is to simultaneously "train" those cells, like an army, to quickly recognize and destroy the AIDS virus when it enters cells in the bloodstream.

Dr. Anthony Fauci, head of NIH's National Institute of Allergy and Infectious Diseases, said other vaccines are in line for testing that use a similar strategy but with important differences. One developed by the NIH — containing the same three genes as the Merck vaccine, plus 3 versions of another gene — is set in January to enter the same large, "proof of concept" testing stage as the Merck vaccine, Fauci said.

Zwick said some researchers still are working on vaccines to neutralize the AIDS virus. He thinks ultimately what's needed is one that combines that approach with a way to stimulate and train killer T cells.

Merck and the HIV Vaccine Trials Network, an international collaboration of researchers and institutions funded by the NIH, co-sponsored the study. The experiment, called STEP, began in December 2004 and had enrolled 3,000 volunteers in Australia, Brazil, Canada, the Dominican Republic, Haiti, Jamaica, Peru, Puerto Rico and the United States.

The results announced Friday involved volunteers who researchers thought would benefit most because they had never been exposed to the particular cold virus used in the vaccine.

Wall Street, on a generally upbeat day, showed little reaction to the news, with Merck shares rising 44 cents to $51.82.

Analyst Steve Brozak of WBB Securities said the failure won't hurt Merck's bottom line in the short term. But he said a vaccine is the only financially feasible way to fight the AIDS epidemic in poor countries and that the company that comes up with the first successful shot would have "a license to print money."

"You're talking about a Carl Sagan kind of number — billions and billions" of dollars, he said.

The Merck vaccine, known only as V520, also was being tested in a similar study in South Africa and in two smaller studies, which also were halted.

Mark Feinberg, head of medical affairs in Merck's vaccine division, said it has no other candidates in development. The company still must do a detailed review of the data but he said he thinks this approach is dead.

Other scientists disagreed.

"You can't say that the whole field of T cell vaccines has been dealt a death blow" by the Merck results, Fauci said. But if further examination of the Merck data and research on similar vaccines show that's the case, he said, "then we're in some serious trouble because the candidates representing different vaccine concepts are years away from development."

Dr. Wayne Koff, head research and development at the International AIDS Vaccine Initiative, said the results give important data on what is not going to work and researchers will build on that as other potential vaccines are tested. He said roughly 30 are in the pipeline.

The nonprofit AIDS Vaccine Advocacy Coalition said in a statement that "while this is a disappointment, it is in no way the end of the search for an AIDS vaccine."

Lake Muhazi

We spent the day at Lake Muhazi, about and hour and a half east of Kigali. We went to a place called Jambo Beach on the eastern shore of the lake. When we pulled up to the gate, it was actually closed, and there was a sign posted by the government about the closure. But there were several cars parked outside the gate, and a couple people showed us the milk crates that had been stacked to ease the climb over the wall. So after making sure that the seal on the government's letter didn't say "Ministry of Health", we climbed the wall with everyone else, and, surprisingly, from the other side of the wall, you would have never known the place was closed. It was such a beautiful day, perfect for being at the lake. The restaurant was open, so we ordered lunch - fresh fish from the lake, fries and bananas - and then spent the afternoon by the water (not in the water, for fear of schistosomiasis).
On the way home from the lake, I decided (1) to play with my camera a little bit, and (2) to try to give ya'll a glimpse into what Rwanda looks like outside Kigali. It's not the most exciting video, but it does paint a pretty good picture of life here.

Thought for the day

Last night I finished reading "Untapped: The Scramble for Africa's Oil", and the final sentence of the epilogue has really stood out in my mind. According to John Ghazvinian, author of the book, it is an African proverb, but, whatever its origins, I think it's very thought-provoking and pretty hard to refute:

"If today we become soldiers and fight, it is so tomorrow our children will have the peace of mind to become doctors and engineers and politicians, so that their children, in turn, will have the luxury to become writers and dancers and architects."

Life is good

My first two days at work were busy, so it’s been nice to have a weekend so quickly to relax and finish settling in. On Friday night I went to dinner with three of my expat coworkers and a couple of their friends. We had a delicious Indian dinner and then stopped by a bar near our houses for a beer. Both the restaurant and bar were full of expats, but it was nice to get out. (Note: expat = expatriate = foreign, but in-country long term)

Yesterday, I slept late to get rid of the last of my jet lag and woke up to a beautiful day. I spent most of it sitting on my front porch - reading, doing some work, listening to the children sing and play nearby and just enjoying the beautiful day. It was so nice! Then, in the afternoon, I wandered down to town and visited the grocery store. There are about four different groceries within walking distance, but I just checked out the one closest to my house. It wasn't bad - it had all the basics, plus "fresh" bread and a decent meat selection. It had everything that I needed since I was just shopping for breakfasts and snacks; if I needed to do any more shopping, though, it might be a little more difficult. Still, I love where I'm living; it's such a convenient location to be so close to the city centre.

Today was great too. I met Taylor, one of my coworkers, at the CVCT site at Gatsata this morning, and we went hiking for most of the day. We wandered up and down several of the nearby hills (everything here is a hill) with no particular destination or plan. We passed through fields and villages and markets and rural areas. Sometimes we’d be walking on a dirt road that was wide enough for vehicles; sometimes we were on paths barely wide enough for a single person; and sometimes we were making our own path through irrigation fields. It was really, really nice. And everyone wanted to speak to us as we walked. People would come running out of their houses shouting "mzungu!", which is what the Rwandans call white people. Children would follow us and walk with us too, so excited to practice their English (which usually consisted of "Hello", "How are you?" and "I am fine") or their French (which was about as extensive as their English - but I was thankful for that because my French is just as limited). I saw a lot more of Kigali, and the views from the tops of the hills were nice enough that I was even able to start getting my bearings on where everything is in the city. (see pictures below!) I can’t wait to get out and see not only more of the city, but more of the whole country. Too bad I have to go to work tomorrow!

But life is good. I think I’m really going to enjoy being here.

My house

I live with two other girls (both of whom are my coworkers) in a great house in an area of Kigali called Gitega. The house is only a few minutes away from both work and the city centre.
The backyard has a fantastic view of Kigali and some beautiful plants.
We're painting and moving furniture inside the house right now, so I don't want to post any pictures from inside, but here's the layout. I'll take some pictures as soon as we finish painting and arranging things.

CVCT

Before I begin my own work at Projet San Francisco (PSF), I will complete rotations through each of the departments and aspects of the project. I began today with the Couples’ Voluntary Counseling and Testing (CVCT) centers.

PSF operates three CVCT centers that are spread throughout Kigali. When couples arrive at one of the three PSF sites in town for CVCT, they first go through verification to ensure that they are truly a cohabiting couple (a later requirement for participation in our studies). They then participate in a group session, which I observed at Gitega (the CVCT site located at our main site), where ten couples were present for testing. The group first participates in an information session that covers topics including background information on PSF, the differences between HIV and AIDS, possible test results (both partners positive, both negative, one positive and one negative), how to prevent transmission (including how to use a condom), and various other topics such as prevention of mother to child transmission (PMTCT) and sexually transmitted infections. After each topic is presented in a video, a senior nurse counselor highlights important points and answers any questions. The group then watches a video about informed consent. Since we are a research institution, all couples must sign a document that states their consent to participate before they are even counseled.

After the group sessions, each couple is seen separately for pre-test counseling. For this session, I went to the PSF site at Gatsata, which is about a 15 minute drive away. I sat in on two pre-test counseling sessions, during which a nurse counselor makes sure the couple understands testing and is prepared for whatever results they may receive. Although these sessions (like all others) are conducted in Kinyarwanda (the local language here), I could tell that the nurse counselor is very thorough and very sensitive to the couples. After pre-test counseling, the couples are sent to the lab, where blood is drawn for testing. They then return to the group room, where they receive lunch while waiting for their results. I joined the lab technicians to centrifuge samples and run rapid tests for HIV and syphilis. We then prepared the results for each couple, sealing each person’s results in a separate envelope. After lunch, the couples return to nurse counselors for post-test counseling and to receive their results. Before giving results to the couple, the nurse counselor was careful to make sure that couples again understood and were prepared for the results they were about to receive. Then each individual was handed his or her envelope, which he/she opened for his/her results. Both couples I joined for CVCT were concordant negative, meaning both partners received negative results from their HIV tests. And both were so thankful – one couple even jumped to their feet and hugged the nurse counselor and I after reading their results. I was thankful too; it’s going to be really difficult to be in the room with a couple when at least one partner is positive. The nurse counselor again made sure the couple understood the results after reading them and, for the two discordant negative couples, discussed the importance of fidelity in order to maintain their negative status.

After all the couples were counseled and dismissed, I joined the nurse counselors and lab technicians for lunch. We had a truly hearty lunch of rice, beans, meat (I couldn’t tell you what kind, but it was good), and cassava. I don’t know if I can eat that large and hearty of a meal every day, but it was a good introduction to Rwandan cuisine.

At the end of the day, I left the site and stopped by the third PSF site at Kicukiro to check on the day’s results there.

It was a good first day, but very busy and very full. There's a lot of work to be done.

About RZHRG and PSF

(Note: This post is copied from the RZHRG website with only a few updates and a little editing from me. If you still have questions about RZHRG or PSF after reading this, let me know, and I'll be happy to answer them!)

About RZHRG

The principal research objectives of RZHRG are to uncover factors relating to HIV risk and transmission, to gain a better understanding of how to prevent the spread of HIV and to improve the quality of life among HIV infected African adults. To achieve these goals, the project sites in Kigali, Rwanda, and Lusaka, Ndola, and Kitwe, Zambia, operate couples’ voluntary counseling and testing (CVCT) centers where couples receive education about HIV/AIDS, pre- and post-test counseling and free testing for HIV. Couples eligible for ongoing studies are invited to participate in follow-up research and provided with free outpatient reproductive and general health care.

Until an effective HIV vaccine is found, prevention of new infections in African adults must rely on behavioral interventions. RZHRG and its many collaborators first published the beneficial impact of CVCT on risk reduction in African couples in 1991 but widespread implementation of VCT was delayed 10 years by a variety of controversies. There is now consensus that VCT is an effective prevention strategy, and that the impact of this strategy is greatest in the world’s largest risk group: African cohabiting couples.

The RZHRG same-day couples’ VCT programs were intended to be a screening tool to identify HIV discordant heterosexual couples (one partner HIV positive and the other HIV negative) for prevention, pathogenesis and vaccine evaluation research. In the process, RZHRG’s research sites in Rwanda and Zambia have accrued the largest couples’ VCT cohorts in the world. RZHRG continues to research the best ways to deliver CVCT and to provide leadership in the dissemination of best practices in VCT for couples. RZHRG’s researchers have led by example as they have developed and tested interventions and, as a result of their findings, have directly impacted public health practice. It has also been the privilege of Dr. Allen and the rest of the RZHRG team to develop collaborative relationships with colleagues from all over the world, to provide internships to more than 85 US and European trainees and to bring 19 African colleagues through Masters in Public Health degree training in the United States and England. Although the majority of the project’s research has been sponsored by the U.S. National Institutes of Health, over the years RZHRG has also been funded by a dozen other international, bilateral and non-governmental development and research organizations.

About PSF

Since 1986, Projet San Francisco (PSF) has been conducting HIV/AIDS research, as well as providing clinical care and counseling for HIV-infected persons, in Rwanda. PSF works closely with the Centre Hospitalier Kigali (CHK), the National HIV/AIDS Reference Laboratory and the Ministry of Health’s Treatment and Research on AIDS Center (TRAC) to improve clinical care available for HIV-infected persons. PSF runs three couples’ voluntary counseling and testing facilities in Kigali as well as a medical clinic, laboratory and pharmacy. The project employs over 150 Rwandan medical and support staff and 5 to 10 expatriate interns and project coordinators. With CHK and TRAC across the street from PSF, physicians from the CHK rotate every afternoon in the PSF outpatient clinic. This ensures continuity of care when hospitalization is required.

In addition to providing clinical care since 1986 for 95 long-term survivors of the project’s original HIV-positive cohort, PSF also provides HIV voluntary counseling and testing for couples, with over 17,000 couples tested, 8,000 people provided with screening for sexually transmitted infections and 940 HIV discordant couples receiving general outpatient care at the PSF clinic.

The challenge ahead

On my flight from Amsterdam to Nairobi, I sat in the window seat next to two Kenyan businessmen living in the U.S. They were returning to Nairobi so that one could run for a seat in the senate. (I still don’t quite understand, but that’s not the point of my story.) While we were talking over dinner, I explained that I was in Africa to work in HIV research, and one of the men began to tell me about a book he read that explains the origin of AIDS. He told me all about the lab in California that created the disease, the men who came to Africa to test it on monkeys and those who later began testing it on humans. I was shocked. How could these men – these well-educated men who have lived abroad for over twenty years – believe such a myth? I of course did my best to explain to them the true origin of HIV/AIDS, but I don’t know that either of them was convinced. I’m sure they still believe the disease was invented by a group of scientists in California. The previously light conversation turned into a serious reality check for me. It was a reminder of the challenges to come working with a disease that is so seriously misunderstood.

The misconceptions and myths surrounding HIV/AIDS are almost endless. Some, such as the idea that HIV/AIDS in Africa is a conspiracy from the U.S. government or that having sex with a virgin can cure HIV/AIDS, seem almost absurd. It's easy to blame these misunderstandings on a lack of education or a lack of understanding. But the myths surrounding HIV/AIDS are just as common in developed countries like the U.S. as they are anywhere else in the world. Check out http://www.amsa.org/global/aids/aidsfacts.cfm for a summary of ten common myths from the perspective of the developed world.

A smooth trip

Any time you travel more than twenty-four (or in this case, more than forty-eight) hours around the world, there's at least one story that comes from the trip.

As I was checking in for my flight from GSP, I handed the woman at the Delta counter my passport. She quickly flipped through it, then looked up at me and said, “I need to see your current visa,” to which I of course replied, “Rwanda does not require a visa.” As it turns out, she was referring to Kenya, where I was scheduled for an overnight layover and which does in fact require a visa. Now I'm sure I checked this at some point (since I never applied for a visa, I’m sure whatever I found said I didn’t need one), but I’m also sure it was long enough ago that I couldn’t remember the details of what I found. Could they have changed the rules? Or did I somehow check the wrong country? Hiding the fact that I was in a slight panic, I gave the most logical answer I could to this woman who was set on not allowing me to leave GSP without a valid visa for Kenya – “I’ll just stay in the airport.” Spending 16 hours in the Nairobi airport was certainly not at the top of my list of things to do on this trip, but so long as I didn’t leave the airport, I didn’t need a visa, so I thought this might convince her to let me get on the plane. I think she was so confused by my slightly-absurd suggestion that she started looking for an alternative option and finally decided I could get a visa upon arrival at the airport.

Of course I couldn’t get off to a smooth start quite yet, so I had to try to get myself in trouble while going through security. Just remember, “Careful, it might explode” is not the right phrase to use when trying to warn the security guard that clothes, Kleenex, pens, gum, books, earphones, and who knows what else are liable to go flying in every direction while he searches your bag. Thankfully he knew what I meant (probably even before I started backtracking) and didn’t suspect me of being a terrorist. I have to admit, though, I did have flashes of having to call my mom on the other side of security to have her bail me out of the airport jail.

I finally boarded for Atlanta and fell asleep immediately, waking up just in time for my five-hour layover at ATL. Thankfully two friends came to entertain me while I waited, which made the time pass much more quickly. Before I knew it, I was going back through security (which was smooth this time, no bag searches or mention of explosions) to get on another flight. Then, after two movies, half a book, two crossword puzzles and a couple hours of sleep, I arrived in Amsterdam. With an airport full of smokers and an airline that makes you run from one end of the airport to the other to check in, only to run all the way back to the gate right next to the one where you arrived, I actually looked forward to getting on the next flight. Round three of security was also smooth, and eight hours later I was in Nairobi, where it only took about five minutes and twenty U.S. dollars to get a visa.

I spent the night in a hotel, and it felt so nice to take a shower (rather than splashing my face with cold water in the airplane bathroom) and sleep in a real bed (rather than twisting into some semi-comfortable position to sleep for a few minutes until the next snack cart came by). I left for the airport early the next morning to avoid Nairobi traffic and flew from Nairobi (where round four of security was a breeze) to Bujumbura. Then it was only a 40 minute flight to Kigali.

Finally, I made it.