The HIV/AIDS pandemic engulfed Africa, including my native Kenya, in the late 1990s and early 2000s. As young healthcare practitioners, we faced a difficult reality right out of medical school: the epidemic was widespread and we lacked resources.
When we would get together for ward rounds at the local hospital, our professors would usually announce that, because of the large number of end-stage AIDS patients, they would only review the two or three non-AIDS patients with us because there was nothing we could do for the others, who we would have to cover.
Young physicians like me were therefore faced with the task of caring for a large number of end-stage AIDS patients who had essentially come to the hospital ready to die.
It was an agonizing encounter that would change my views on healthcare for all time.
The diagnosing process presented the biggest obstacle. Pre- and post-test counseling was essential for patients. Every test is required to be conducted at a medical facility. The lack of qualified counselors—often simply the hospital matron in a 400-bed facility—posed a significant obstacle to testing.
Then, patients had to wait a week or longer for the results of the intricate and time-consuming diagnostic tests. Worse, counseling patients after testing came up positive almost felt like giving them the death penalty.
HIV/AIDS was also associated with a great deal of stigma. I’ve known surgeons who, in the case that a patient tested negative for HIV or had clinical AIDS, would outright refuse to operate on them. Regretfully, it was common in the community for people to avoid shaking hands or even exchanging utensils with family members or those who were diagnosed with clinical AIDS.
My decision to open one of the earliest HIV Comprehensive Care Clinics in government service before the development of life-saving antiretroviral medications (ARVs) was driven by the circumstances. We were based in the Kilifi District Hospital, which at the time was a very rural facility on Kenya’s coast. I decided to lovingly refer to it as “The Family Clinic,” and the Kemri-Wellcome Trust Malaria Research Center was a little bright spot of optimism.
My employer provided a little pharmacy of medications and my time to treat opportunistic illnesses. As a result, I could operate an HIV clinic one day a week. Even though it was straightforward, that was among my best professional decisions to date.
I spoke with people who frequently experienced depression after receiving a diagnosis for a large portion of my time. But I do recall one young woman. She went as MC and was a 27-year-old local woman.
MC made his money as a moonshine salesman. He frequently showed up at the clinic inebriated, exuberant, and full of optimism—the kind of patient one never forgets. She was always upbeat and joyful despite her condition, and I recall having a lot of laughs with her.
I counseled her to reduce her alcohol use and to prioritize her well-being and her kids. We grew close friends over time. It was astonishing that even though she was aware of the seriousness of her illness, she never gave in to depression.
With no effective medication, many of my patients who had advanced to clinical AIDS passed away as my patient count increased. I started second-guessing my career. I eventually packed up and moved to London to finish my education, where I later started a career in the pharmaceutical sector. I was asked back to the Kemri-Wellcome Trust Research Unit for an anniversary celebration ten years after I had left.
The Family Clinic had entirely changed into a well-run, professional establishment when I got back, from a small, run-down room next to the TB clinic. It was much larger and more advanced, so even though I felt a little rusty, I accepted the invitation to see a few patients again.
My first client entered the room. She appeared joyful and in good health. Did I remember her, she asked. I sketched nothing. But I knew it was MC when she gave me an embrace! Because ARVs were developed a few years after I left, she survived. I was reminded by this poignant reunion that, despite how hopeless things may appear, there is always hope. Start now, even if you’re not sure where it will finish.
Diagnoses and treatments are now available to even the most marginalized groups. Thanks to early identification and the development of ARVs, clinical AIDS cases have decreased and are now practically nonexistent. Additionally, the stigma has lessened because knowledge and education are widely accessible.
In the long run, the virus still exists, therefore we need to protect the progress we have accomplished. We must keep up our dedication to community-led projects, research, and development.
The member nations of the World Health Organization (WHO) decided to adopt a resolution this year on “Strengthening diagnostics capacity.” More people in the continent have access to therapy since early diagnosis is prioritized.
Given that diagnostics have previously received incredibly little funding, this is a huge breakthrough. However, a settlement is not legally enforceable, and financing is never certain. Local governments have to acknowledge the necessity of strategically reallocating finances.
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), one of the most well-known supporters committed to eradicating HIV/AIDS by 2030, is facing an uncertain future. We cannot yet let up, particularly in light of the criticism leveled at our major funders.
The financial distribution of resources for public health should balance spending on both diagnosis and treatment. Governments can use public-private partnerships to harness private resources to treat more patients by working together to find the optimal formula. Continuous investments in human capital with a medical focus are essential, and when all these foundation elements fall in place, an end to HIV/AIDS might be approaching.
Cheers to survivors who, like MC, permit themselves to live with optimism. While we are proud of our accomplishments thus far, let’s keep working together to improve healthcare systems, promote patient access, and end stigma.