He was a professor from a neighbouring country, intelligent, suave and well read. He knew about HIV/AIDS very well and unfortunately turned positive on being tested. He refused to go to the HIV clinic and insisted that he should be tested and treated in one separate room of the office portion. ‘Annet’- a 24-year-old female was in 7th heaven, when she found a man of her dreams and married him. In spite of being HIV-positive, she did not tell her husband about it and avoided taking her antiretroviral drugs regularly. Unfortunately, she fell very sick, when her husband decided to take her to U.S. for treatment. He needed her medical reports to show to doctors in the U.S. . But she was very upset about it and pleaded with the treating doctors to not to mention her HIV status in the reports. A young man requested his doctor to give him a fake HIV negative certificate, to be married in church as he had not disclosed his HIV status to his girl friend. These are not isolated stories but many such stories exist.

The root cause for such behavior by HIV patients is the stigma associated with HIV infection. People think that since it is mainly spread by sexual intercourse or worse still due to promiscuous sex, people tend to look down upon infected people. In the era of advancements in scientific knowledge regarding HIV/AIDS, many caretakers avoid taking care of the sick in their family, if they are HIV positive. Stigmatization of a disease prevents effective preventive and treatment measures used for it. People avoid being tested, if tested positive, they tend to hide it. Even if they go to a health facility, they avoid taking anti retroviral drugs. After being consulted once in a health facility, they avoid going for regular follow up. I have personally come across 2 HIV positive patients, who shared their ARV drugs with a friend or partner at home, since the partner was unwilling to come to the HIV clinic, for fear of, "being seen”, by people. Worse still, due to the stigma, many persons become depressed, following a positive result.

Little do these people realize that by hiding their HIV status and avoiding treatment, they jeopardize their own health. By avoiding ARV drugs, they make their bodies vulnerable to repeat or even serious infections. When taking them irregularly, they let drug resistance build up, so that the drugs tend to be ineffective. Same thing happens when instead of taking prescribed drugs, a person shares them with his friend/partner. Due to lack of proper compliance and follow up, the body’s immunity is gradually lowered, making him vulnerable to serious infections and even cancers. HIV positive children become most vulnerable due to such stigmatization. They do not receive the necessary physical and psychosocial support needed in their growing years.

Extensive education is needed in the society regarding modes of spread of HIV. People should learn to accept the fact that HIV is a disease like any other disease and those affected need as much care and support as people sick due to any other illness. They can easily nurse a sick person without the fear of being infected. Only thing they need to be vigilant about is avoiding direct contact with the patient’s body fluids. Caregivers also need to be educated about the importance of taking ARV drugs regularly and regular follow up for measurement of CD4 counts and taking drugs. An alert caregiver can always motivate a patient for being more compliant with the treatment. Affected persons themselves should accept that they are infected.

The Government of Rwanda has put in appreciable efforts to educate people in general about HIV/AIDS. Counselling in groups, talks and discussions about HIV in radio and print media, counselors and community health workers, working on the ground, trained and sympathetic nurses, mental health workers, vigilant and experienced doctors, efforts of all these has brought results that more and more people are coming forwards for voluntary counseling and testing. The prevalence of HIV in Rwanda has remained stable at 3% since the past decade or so, which is in spite of constraint of resources.

Dr Rachna Pande,

Specialist, internal medicine

rachna212002@yahoo.co.uk