Pitted against AIDS

I belong to the first generation who has not known a world without AIDS. I cannot remember when I first learnt about the disease, but I do remember being asked, in my 5^th Standard General Knowledge class, what the letters in the acronym stood for. I hadn’t a clue. But then again, HIV seroprevalence among pregnant women in India in the mid-90s was much less than 1%. Today that number averages around 1% for India, and around 25% for South Africa. (To keep things in perspective, a 1% of a population the size of India’s is about 10 million people, about the same as 25% of SA’s population.)

It is easy to get lost in the numbers associated with the disease. 40 million are living with HIV today, 25 million have died since 1980, 4 million new infections occurred in 2006 alone. At some point the numbers cease to make any sense, until you are confronted with someone who is a statistic themselves. Last week, at the PMTCT phone helpline centre that I help run, I overheard one of our counsellors (phone mentor mothers, as we call them) explain to a HIV+ woman what her options were if she were to get pregnant. Calmly, she read out the statistics: with proper PMTCT adherence, seven in eight children of HIV+ mothers test negative. What of that one positive baby, the woman must have asked, because the mentor explained that ARVs make it easy for children to live upto 20 healthily. That must have satisfied the caller, because she moved on to questions of disclosure.

20!! That isn’t even enough time to finish college, or to marry or have children or contribute in any meaningful way to society. I would not have been able to tell a woman that her baby won’t live past his/her teens. I would have fudged the stats, or left out the gruesome details. I admire these women I work with so much for being able to give it straight, for being able to put a human face to the statistics, and most of all, for proving that HIV does not have to be thought of as a death sentence. The head phone mentor in our call centre, Babalwa, is an articulate woman who has talked about living with HIV in both Khayelitsha and the White House. And as she puts it, there is a difference between acceptance and resignation. By accepting the virus, she says, you make sure that it doesn’t run your life.

And what a virus it is. I have to say this—HIV is an unbelievably good virus. It is fantastically well evolved to work well at what it does: infecting people. Ok well, scientifically speaking, it has evolved to make more copies of its genome. But allow me to take an anthropocentric view: HIV infects people. It attacks the immune system, which is designed to protect everything but itself. It takes almost ten years to kill a healthy human, so the infected person functions as an efficient transmitter for all those years. And if all that wasn’t enough, it is transmitted through the most basic of all human functions: sex and pregnancy. Taken out of context, all this sounds like something out of a plot of a horror-sci-fi flick. Sadly, nature kicks fiction’s butt. Again.

And pitting against nature isn’t easy. Recently, Merck announced that its HIV vaccine trials (MRK-Ad5) had to be stopped because they were ineffective in lowering viral loads in patients. A cure for AIDS is still far from reach, though it has become a manageable disease for the few who can afford constant medication. I know I belong to the first generation of children who have not known a world without AIDS. But, I also belong to the first generation of children who have known a world without smallpox. Perhaps we shall overcome yet.