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.