Controversial soap opera

An interesting article was posted on the BBC today about a controversial soap opera in Rwanda that deals with sexual health issues.

Rwandan sex soap opera wins award
from: BBC News

A Rwandan radio soap opera that takes on controversial issues about sexual health has won a prestigious One World Media Award at a ceremony in the UK.

Urunana follows life in the fictional village of Nyarurembo and each week has an estimate audience of 10 million.

Narcisse Kalisa, Urunana's director, says the show is not afraid of taking on taboos by making people laugh.

"Our most controversial story was when a wife asked her [cheating] husband to use a condom," he told the BBC.

"People can laugh at the way the issues are addressed and the language we are using. It's an entertainment - a blend of education and entertainment," he says.

The show's writer Samuel Kyambagidwa says the main characters are Bushombe, a comic figure who has recently gone back to school at the age of 50, and Mariyana, a respected health worker.

Urunana, which means hand in hand in Kinyarwandan, won the One World Special Achievement Award for Development Media on Thursday night in London and takes on subjects from HIV/Aids to infertility.

"Before the programme it was taboo to talk about sexuality - and things like wet dreams and menstruation," Mr Kyambagidwa told the BBC's Network Africa programme.

"Now it gives people a starting point; for example, it gives a grandparent courage to discuss things with their grandchild that they have heard on Urunana," he says.

Figures from the World Bank last year put the prevalence of AIDS in Rwanda at about 3%, down from 11% in 2000.

The World Bank report suggested that education at a grassroots level played an important role in slowing down the spread of AIDS in the country.

The soap, which was started in 1999 by UK charity Health Unlimited, is broadcast twice a week in 15-minute episodes on the BBC's Great Lakes Service.

The current storyline is about a student who drops out of secondary school to marry a shop owner, but then discovers she is HIV positive.

Mr Kalisa says the audience has been kept on tenterhooks about whether the wedding would go ahead.

For those not tuning in...

"He did marry her at the end of the day," Mr Kalisa says.

My flat

I realized it was about time for me to post some pictures of where I live and work here in Lusaka. First off, the flats.

The project maintains four flats that each have three bedrooms. Right now, they're getting close to being full, with a total of twelve of us living here.
The first room you enter in my flat is the living/dining room. Unfortunately, since the three of us living in this flat are all only here temporarily, it's pretty bare.
Just off this room is the kitchen.
Between the kitchen and the living/dining room, there is a small hallway that leads to the bedrooms. There are two bedrooms on the right and one at the end of the hall on the left.
Where the hallway turns to the left is the bathroom. Further down the hall, the last door on the right is my bedroom.
And voila! That's where I'm living now.

Access to Life Exhibition

If you live in the D.C. area, I have to encourage you to visit the Access to Life Exhibition. It's going to be at the Corcoran Gallery of Art from 14 June through 20 July. Here's a description of the exhibition:

Eight extraordinarily engaged artists from Magnum Photos have ventured far from home to visualize some of the external aspects of individual lives marked by AIDS and its consequences. Supported by the Global Fund on the ground, Jonas Bendiksen, Jim Goldberg, Alex Majoli, Steve McCurry, Paolo Pellegrin, Gilles Peress, Eli Reed, and Larry Towell each embraced the responsibility to document with objectivity and compassion the role of medical intervention in the fight against a life-threatening illness. Their new work appears for the first time in Access to Life.

These photographers interacted with many communities throughout around the world. Their connections extended beyond those directly suffering from AIDS, to include loved ones, children, parents, and literal families, no less than families of affinity and choice. In bringing all these people together for this project, Access to Life proposes that these citizens of nine separate countries are united across political and geographic borders by their common struggle to forestall mortality and to participate in global networks of compassion and solicitude.

One important goal of this exhibition is to recognize the many individuals who participated in this project. Together they have allowed us a lyrical and bracing glimpse into the lives of people stirred to care for the bodies and souls of those they love.

The website for the exhibition is impressive too. It's: http://accesstolife.theglobalfund.org/exhibition

HIV tests and ARVs

I recently discovered two interesting cases among individuals enrolled in studies at PSF. I was working on a query for a publication and noticed that there were two individuals who were HIV-negative but reported a date on which they began anti-retroviral (ARV) therapy, the treatment used for individuals who are HIV-positive. I assumed an error had been made during data entry, but, as I investigated these cases further, I became really concerned.

The first individual tested positive at PSF's couples' voluntary counseling and testing center on two out of three rapid tests, which, according to the national algorithm for HIV-testing, identifies this individual as HIV-positive. (It is not at all uncommon for individuals to have different results on different tests.) For several months, this individual continued to test positive. When a CD4 count (the test used as a diagnostic for HIV treatment) was ordered, it was found to be very low, so the individual began ARV treatment. At this point there was no indication that something was strange, no red flag that something was wrong, no indication that a protocol that had been followed incorrectly. But then, the individual began to test HIV-negative, and with more sophisticated laboratory tests, it was resolved that the individual was indeed HIV-negative.

The second individual had a similar testing history.

Were these individuals were cured by ARV therapy? No. Had an error been made in their lab tests or results? No.

Both of these cases were what we call "seroreverters", individuals who test HIV-positive for some period of time before reverting to HIV-negative test results. It is a curious situation that is not yet well-understood, but false-positive HIV test results are not uncommon. In fact, it is fairly common for HIV-negative individuals to test positive on a single rapid test, somewhat less common to test positive on multiple tests. Yet there are individuals who have separate infections or cross-reacting viruses that cause positive results on HIV tests even though the individuals are not actually infected with HIV. When the individuals' immune systems later clear this cross-reacting virus, they revert to negative HIV test results. This is what happened in both of these cases.

As for these individuals' low CD4 counts that indicated a need to begin ARV therapy, it is purely coincidence. Some individuals just have naturally low CD4 counts.

Even though there have only been two individuals for which this has happened at PSF, I feel like the implications of these facts are significant.

While we follow a strict testing algorithm at PSF and ZEHRP that involves diagnosis based on three rapid tests followed by more sensitive ELISA tests in cases of discrepant results, we have seen in Rwanda that most health centers use only a single rapid test for HIV diagnosis. Nurses and counselors report that there are just too many clients and too little time to do even one confirmatory test. Yet the single rapid test that they use is one that has shown a particularly high number of false positive results at PSF. While we at PSF can identify these false positive results by use of confirmatory tests, if the health centers are not using any confirmatory tests, then how many HIV-negative individuals are receiving positive diagnoses? The numbers must be high. And how many of these then have naturally low CD4 counts?

A whole series of questions and concerns then fills my mind - How many individuals are on ARVs who are actually HIV-negative? What effects do intense ARVs have on the bodies of individuals who are not infected with HIV? What are the economic implications when expensive ARVs are wasted on individuals who are actually HIV-negative? How does providing ARV therapy to HIV-negative individuals contribute to drug resistance if these individuals are later exposed to the HIV virus? What effect does this have on the community's understanding of HIV and ARV therapy when these individuals later receive HIV-negative results? Does the community believe they have been cured or do they believe HIV is a myth made up by the Western world?

Chisholm

Data tech: “Is this your last name?”
Me: “Yes.”
Data tech: “Really?"
Me: "Yes."
Data tech: "It looks like an African name.”
Me: “Didn't you know that I’m African?”

And at that point everyone laughed. Though as soon as we had all regained our composure, my coworker who originally asked about my name spelled it out loud, "C-H-I-S-H-O-L-M", and everyone agreed that, when pronounced as they would pronounce it, my surname does sound like an African name.