Pacific pandemic: Combating the spread of HIV and AIDS in the Pacific
By, Sujata Gupta, Honolulu Weekly, January 31, 2007
Prevailing attitudes, lack of funding speeds the spread of HIV and AIDS across the Pacific
There are two things Angel Cruz can’t live without: tobacco and caffeine. “If you take away my cigarette and my iced coffee, I’m a goner,” she says. But, according to the doctors, there’s something else Cruz needs to survive: immunosuppressant drugs. Twenty-two pills a day to be exact. That’s because Cruz has HIV.
Not that she is complaining. “You know those drugs I’m on, those must be good drugs,” Cruz quips. “If you were to see my picture, you wouldn’t even think I have AIDS because I’m pleasantly plump.”
Cruz’s good cheer is striking considering that at age 33 she has lived with HIV for more than 10 years, has suffered four bouts of meningitis, lost a husband five years ago and can no longer work due to complications from her various illnesses. But Cruz is on a mission. “I just want people to know if you know somebody who has AIDS…don’t shun them away because they’re human beings, too.” And if sending that message means shedding her anonymity, so be it, says Cruz, who told her friends and family about her status within months of her diagnosis.
Now, she’s appeared in media outlets throughout her hometown—an openness that makes her own mother squirm. Family, says Cruz, can be the least understanding when it comes to dealing with HIV. “Before when we were younger, I always kissed my aunties and uncles, but when I got [HIV], there were aunties and uncles who wouldn’t allow me to kiss them anymore,” she adds. “It really hurt me.”
But, Cruz has seen too many of her friends die alone. “I know people who have passed on with HIV and AIDS which is really sad because their family and their friends had abandoned them.”
But if Cruz’s struggles sound similar to HIV-positive individuals in the United States, there is one marked difference: She lives in Guam. “It’s not like on Hawai‘i and everybody’s scattered,” she says. “We’re a small community here on Guam and everybody knows everybody’s business.”
When Cruz was diagnosed with HIV about a decade ago, the disease was relatively unheard of in the Pacific Islands, including Guam. Even though considerable medical advancements had already been made on drugs that could stall the disease’s progress, Cruz viewed her diagnosis as a death sentence. She thought that “once a person gets HIV or AIDS, that’s it. That’s how it was when it first came out—start writing your living will now.”
Cruz’s lack of knowledge about HIV reflects how low the disease has registered on the Pacific Islands’ radar. While the first documented case of HIV in the region occurred in the early 1980s—soon after the disease was first discovered in the United States—the number of actual cases has remained relatively small, especially when compared to other areas of the world, according to the Pacific Island AIDS Foundation website. Now, however, this modern-day disease is slowly working its way into this 22-nation island conglomerate, an area of about 8 million people loosely bordered by Hawai‘i to the east, New Zealand to the southand Australia to the west. Official statistics compiled by the World Health Organization set the current number of documented cases around 8,000 people, with an estimated 7,000 to 15,000 undocumented cases.
Even though the data surrounding HIV and AIDS rates in the region remains murky, most experts agree that the Pacific Islands have reached a tipping point. “Where epidemics are going is not an easy thing to predict,” says Peter Whiticar, chief of the state Health Department’s STD/AIDS prevention branch. But, he adds, without some sort of intervention, it seems likely that HIV transmission rates in the area will continue to rise.
The reason behind the disease’s rapid rate of transmission rests, at least in part, on many islanders’ assumption that HIV is either a foreigner or gay man’s disease, says Dennie Iniakwala, HIV & STI section head at the Secretariat of the Pacific Community, an organization that works with all 22 Pacific Island nations to develop economic, health and social initiatives for the future. But, says Iniakwala, not only is HIV now spreading from within the community, “almost 90 percent of the mode of transmission of HIV in the region is heterosexual.”
And, as Whiticar adds, more and more islanders are contracting HIV while traveling abroad, whether for personal or work-related reasons. What’s more, travelers often engage in riskier sexual behavior than they would at home. “When people go to different countries and there are completely different norms, they act differently,” he says. “They may put themselves at greater risk in their new environment.”
When native Pacific Islanders who have contracted the disease abroad return home, the results can be catastrophic, says Xuan-Lan Doan, the deputy director of program and planning at the Life Foundation, a Honolulu-based organization working to stopping the spread of HIV and AIDS in Hawai‘i and the Pacific. Because the islands are so small, a single infected individual can perpetuate a crisis. For example, she says, on “one of the small islands they saw that [HIV] spread because one person had 22 contacts.”
How bad is the problem?
Assessing HIV and AIDS rates in the Pacificcan be extremely challenging, Iniakwala says, because of inconsistent data collection procedures across the region. While some governments have stepped up surveillance efforts, by far the best data collection is still in the territories owned by the United States. (Six of the 22 nations are U.S. territories.) “What we are seeing is that more…cases were reported in the territories—Guam, for example—than other countries in the region,” he says. That means countries with higher documented rates of HIV and AIDS might actually have a lower prevalence of the disease than countries with weaker data collection practices.
Moving forward, Iniakwala explains, the SPC has been conducting what’s called a second-generation surveillance of HIV and AIDS in the entire region. “In each country there is a surveillance team that has been trained using the instruments that are used for the surveys,” Iniakwala says, adding that questionnaires have been printed in a myriad of local languages and dialects. Observers should be aware that if data collection methods continue to improve, there will appear to be an initial spike in the number of AIDS cases in the region. But the numbers are crucial to assessing who is at greatest risk for contracting AIDS and what needs to be done to protect those individuals.
The World Health Organization set the current number of documented HIV cases in the Pacific at around 8,000 people, with an estimated 7,000 to 15,000 undocumented cases.And even if a lot of the numbers are hard to analyze, it is clear that for at least one Pacific Island nation, crisis has already struck: Papua New Guinea accounts for 80 percent of the region’s reported HIV and AIDS cases, according to the Pacific Island AIDS Foundation website. Papua New Guinea, says Whiticar, “is truly a society in incredibly rapid transition.” Couple that intense development with high rates of sexual violence against women and poor public health, and the reasons behind the crisis become frighteningly clear.
When it comes to stopping the spread of the disease, however, the islands have one key advantage: hindsight. The Pacific Islands, explains Iniakwala, can look to other nations to see how they have addressed the threat of HIV and AIDS in the decades prior and learn from their successes and mistakes. Whether or not the Pacific Islands can—or will—do that, however,
remains to be seen.
Barriers to care
The logistics of providing care in the Pacific Islands can be extraordinarily challenging, in part, because of the region’s geographic and linguistic diversity.
A strong determinant on whether or not one receives care is the amount of government money allocated to HIV and AIDS care and prevention programs, says Iniakwala. That funding, however, varies from nation to nation. The six U.S. territories typically provide better services than the other countries. That situation can be particularly confusing in places such as Samoa, which is part independent and part American. But Iniakwala says it is unfair to criticize all non-U.S. jurisdictions. Some countries such as Fiji have “allocated substantial funding to HIV programs.”
Cruz counts herself among the lucky ones. Her medications would cost between $2,000 to $3,000 a month without state support. Comparing levels of care, however, can be somewhat arbitrary. For example, even though individuals have greater options than those in many other Pacific Island territories, they typically have fewer options than individuals here in the United States, says Ed Tepporn, HIV program manager for the California-based Asian & Pacific Islander American Health Forum. Health departments on the mainland, he says, receive significantly more federal funding that health departments in the Pacific Island territories.
Moreover, federal support has been dwindling in recent years. Following the Sept. 11 terrorist attacks, the United States government put a lot of money into preventing bioterrorism attacks, such as anthrax and tuberculosis. HIV and AIDS service providers, however, also use those facilities as clinics or laboratories to process patient samples. “The money’s drying up federally,” Doan says.
Not only do Pacific Island countries receive less funding, they also have greater needs than other countries in the world. For example, Micronesia is composed of four states, each with their own language. Finding medical staff and translators to meet these populations needs can be extraordinarily difficult, Doan says. And, because most clinics and hospitals are located in urban areas, those in rural areas often face greater logistical barriers to care. In Chuuk for example, it is a one-hour boat ride from the main island to the outlying ones.
But the onus is on Pacific Island countries to not just expand their care options, but also to improve patients’ quality of life, says Keith Wolter, executive director of the Maui AIDS Foundation. Here in the United States, he says, we have finally “shifted from helping people die to helping people live.”
Fear
Even if the Pacific Island countries managedtoovercome all the logistical barriers to care, however, they still would need to address the single greatest reason why Pacific Islanders are foregoing both diagnoses and treatment: stigma.
In many ways attitudes toward HIV and AIDS patientsin the Pacific Islands resembles attitudes here in the United States several decades ago. “I remember 25 years ago when the first article came out in the [Los Angeles] Times saying that five gay men had something funny going on and two had died and there was seven or eight or nine years of not knowing. The government didn’t want to do much. Ronald Reagan wouldn’t even say AIDS in public,” recalls Wolter.
While the stigma associated with AIDS has lessened here in the United States, the same cannot be said for the Pacific Islands. Judy, a 39-year-old Guam woman whose name has been changed to protect her identity, has yet to tell her family or friends about her status. Just diagnosed a few weeks ago, Judy is frightened and confused. She’s scared to go public because there might be some who “don’t understand what it is and they might hate me and don’t want to be around me anymore.”
Judy claims she was infected by her own partner of two years. He knew he had the disease, she says, but never told her. She only learned of his status when he was hospitalized from AIDS-related complications a few months ago. “When I first found out, I was so shocked,” Judy adds, whose partner later revealed that he was too “ashamed” to tell her he was infected. Nonetheless, Judy is trying to maintain a relationship with her partner. “I love him already,” she says simply.
Sadly, Judy’s situation is not unique. “Women make up the fastest-growing group of new HIV infections,” according to the GUAHAN project, Guam’s only nonprofit AIDS organization. Females are particularly at risk in the Pacific Islands, Whiticar says, because they don’t have “control of their sexuality meaning that men really have their way.”
According to Iniakwala, research that has looked at the second-generation of HIV and AIDS in the Pacific, indicates that high numbers of people in the Pacific Islands have multiple partners or engage in extramarital affairs.
“Here in Guam it used to be that you don’t have sex until you get married, but of course things have changed. You have to try the merchandise before you buy it,” Cruz jokes before taking on a rare moment of seriousness. “For me, when somebody tells me they love me, it’s really like, ‘Oh wow, this person loves me.” But all women, she says , even those in love, need to stay strong. Women, Cruz adds, are sometimes too “easy to manipulate.”
Danger of stigmas
The stigma associated with AIDS, moreover, makes it difficult to forge links among doctors, patients and others involved in testing and treatment process.
According to Iniakwala, part of the reas< \h>< \h>< \h>on HIV and AIDS is spreading in the region is because it has not been contained among sex workers. Prostitutes provide a particularly vulnerable group in society because they are often denied medical care, he adds, noting that medical staff are wary of treating patients who might garner the disapproval of friends and family members. Educational initiatives to halt the spread of AIDS must target everyone from medical staff, to patients to religious leaders. “We need to better understand our situation,” he says.
But medical staff aren’t the only individuals creating barriers to care. Patients, such as Judy’s partner, are often reluctant to seek medical attention for fear of losing their anonymity. Because the islands are so small, says Doan, in many cases “your aunty is your nurse.” Due to that fear, however, many patients who could have stalled the disease’s progression receive medical care only during the last stages of their life.
Wolter hopes that the Pacific Islands tap into recent technological trends that could provide a much needed shield between doctor and patient. For example, telemedicine would allow health care providers and patients to speak through an electronic medium. It’s not ideal, he adds, but it’s better than patients waiting until its time to die.
Stigmas, however, impact more than just doctor/patient relationships. Prevailing attitudes also strongly affect the logistics behind providing care, Doan says. For example, there are not that many facilities in the Pacific that can process lab results. For that reason, patient samples must often be flown hundreds, if not thousands, of miles to the nearest processing center. But patient samples have limited life spans and therefore maintaining logistical routes remains paramount to HIV care and prevention in the Pacific.
However, for a long time, regional pilots refused to carry patient samples on board their airlines. “It has to be labeled ‘infectious’ which scares everybody,” Doan explains. Whether or not samples got off a given island became very dependent on the individual pilot. “We worked on it for years. It would get better, and then one specimen wouldn’t get off the island,” she recalls, adding that the concern then became how to preserve the sample until the next plane arrived. “Planes don’t come in every day. It comes in one day, one direction.”
Doan says that it is only recently that pilots have begun consistently carrying samples. And that, she says, is progress.
Progress: not quite soon enough
But for people like Judy, progress chimes a slow tune.While Judy would like to teach others about HIV and AIDS before it is too late, she’s scared to sacrifice her identity.
Telling people about her status, she says is always “on my mind.” She adds, “It’s just that I’m not there yet, but I have that thought that I will open up and tell my children and also tell some of my friends and especially I would like to teach the ladies where I come from because they don’t understand it and they don’t know what happens to them.”
Judy says she would like to tell women, “Always use condoms when they’re having sex with partners because they never know what’s going to happen. Most men probably don’t like to use it, but…that’s the important thing to do.”
In the meantime, however, Judy feels totally alone, save for the people at the GUAHAN project, who helped her find work and provide counseling when she needs it. But Judy still isn’t sure when and how to tell her four children, who range in age from seven to 18, about what she is going through—or how to make sure they don’t go through it themselves. Referring to her oldest daughter, she says, “I want to keep it to myself until it’s the right time to tell her. She and I are very close. We really love each other so she’ll be really sad.”
Judy’s biggest fear is that she’ll die before her children reach adulthood. I always hope for the day I will read the magazine [and it will say] that there is a cure for … HIV,” she says. In the meantime, however, people like Cruz and Judy must figure out how to survive in a region that is just beginning to realize the enormity of the disease in its midst.
Source: http://honoluluweekly.com/cover/2007/01/pacific-pandemic-combating-the-spread-of-hiv-and-aids-in-the-pacific/
Prevailing attitudes, lack of funding speeds the spread of HIV and AIDS across the Pacific
There are two things Angel Cruz can’t live without: tobacco and caffeine. “If you take away my cigarette and my iced coffee, I’m a goner,” she says. But, according to the doctors, there’s something else Cruz needs to survive: immunosuppressant drugs. Twenty-two pills a day to be exact. That’s because Cruz has HIV.
Not that she is complaining. “You know those drugs I’m on, those must be good drugs,” Cruz quips. “If you were to see my picture, you wouldn’t even think I have AIDS because I’m pleasantly plump.”
Cruz’s good cheer is striking considering that at age 33 she has lived with HIV for more than 10 years, has suffered four bouts of meningitis, lost a husband five years ago and can no longer work due to complications from her various illnesses. But Cruz is on a mission. “I just want people to know if you know somebody who has AIDS…don’t shun them away because they’re human beings, too.” And if sending that message means shedding her anonymity, so be it, says Cruz, who told her friends and family about her status within months of her diagnosis.
Now, she’s appeared in media outlets throughout her hometown—an openness that makes her own mother squirm. Family, says Cruz, can be the least understanding when it comes to dealing with HIV. “Before when we were younger, I always kissed my aunties and uncles, but when I got [HIV], there were aunties and uncles who wouldn’t allow me to kiss them anymore,” she adds. “It really hurt me.”
But, Cruz has seen too many of her friends die alone. “I know people who have passed on with HIV and AIDS which is really sad because their family and their friends had abandoned them.”
But if Cruz’s struggles sound similar to HIV-positive individuals in the United States, there is one marked difference: She lives in Guam. “It’s not like on Hawai‘i and everybody’s scattered,” she says. “We’re a small community here on Guam and everybody knows everybody’s business.”
When Cruz was diagnosed with HIV about a decade ago, the disease was relatively unheard of in the Pacific Islands, including Guam. Even though considerable medical advancements had already been made on drugs that could stall the disease’s progress, Cruz viewed her diagnosis as a death sentence. She thought that “once a person gets HIV or AIDS, that’s it. That’s how it was when it first came out—start writing your living will now.”
Cruz’s lack of knowledge about HIV reflects how low the disease has registered on the Pacific Islands’ radar. While the first documented case of HIV in the region occurred in the early 1980s—soon after the disease was first discovered in the United States—the number of actual cases has remained relatively small, especially when compared to other areas of the world, according to the Pacific Island AIDS Foundation website. Now, however, this modern-day disease is slowly working its way into this 22-nation island conglomerate, an area of about 8 million people loosely bordered by Hawai‘i to the east, New Zealand to the southand Australia to the west. Official statistics compiled by the World Health Organization set the current number of documented cases around 8,000 people, with an estimated 7,000 to 15,000 undocumented cases.
Even though the data surrounding HIV and AIDS rates in the region remains murky, most experts agree that the Pacific Islands have reached a tipping point. “Where epidemics are going is not an easy thing to predict,” says Peter Whiticar, chief of the state Health Department’s STD/AIDS prevention branch. But, he adds, without some sort of intervention, it seems likely that HIV transmission rates in the area will continue to rise.
The reason behind the disease’s rapid rate of transmission rests, at least in part, on many islanders’ assumption that HIV is either a foreigner or gay man’s disease, says Dennie Iniakwala, HIV & STI section head at the Secretariat of the Pacific Community, an organization that works with all 22 Pacific Island nations to develop economic, health and social initiatives for the future. But, says Iniakwala, not only is HIV now spreading from within the community, “almost 90 percent of the mode of transmission of HIV in the region is heterosexual.”
And, as Whiticar adds, more and more islanders are contracting HIV while traveling abroad, whether for personal or work-related reasons. What’s more, travelers often engage in riskier sexual behavior than they would at home. “When people go to different countries and there are completely different norms, they act differently,” he says. “They may put themselves at greater risk in their new environment.”
When native Pacific Islanders who have contracted the disease abroad return home, the results can be catastrophic, says Xuan-Lan Doan, the deputy director of program and planning at the Life Foundation, a Honolulu-based organization working to stopping the spread of HIV and AIDS in Hawai‘i and the Pacific. Because the islands are so small, a single infected individual can perpetuate a crisis. For example, she says, on “one of the small islands they saw that [HIV] spread because one person had 22 contacts.”
How bad is the problem?
Assessing HIV and AIDS rates in the Pacificcan be extremely challenging, Iniakwala says, because of inconsistent data collection procedures across the region. While some governments have stepped up surveillance efforts, by far the best data collection is still in the territories owned by the United States. (Six of the 22 nations are U.S. territories.) “What we are seeing is that more…cases were reported in the territories—Guam, for example—than other countries in the region,” he says. That means countries with higher documented rates of HIV and AIDS might actually have a lower prevalence of the disease than countries with weaker data collection practices.
Moving forward, Iniakwala explains, the SPC has been conducting what’s called a second-generation surveillance of HIV and AIDS in the entire region. “In each country there is a surveillance team that has been trained using the instruments that are used for the surveys,” Iniakwala says, adding that questionnaires have been printed in a myriad of local languages and dialects. Observers should be aware that if data collection methods continue to improve, there will appear to be an initial spike in the number of AIDS cases in the region. But the numbers are crucial to assessing who is at greatest risk for contracting AIDS and what needs to be done to protect those individuals.
The World Health Organization set the current number of documented HIV cases in the Pacific at around 8,000 people, with an estimated 7,000 to 15,000 undocumented cases.And even if a lot of the numbers are hard to analyze, it is clear that for at least one Pacific Island nation, crisis has already struck: Papua New Guinea accounts for 80 percent of the region’s reported HIV and AIDS cases, according to the Pacific Island AIDS Foundation website. Papua New Guinea, says Whiticar, “is truly a society in incredibly rapid transition.” Couple that intense development with high rates of sexual violence against women and poor public health, and the reasons behind the crisis become frighteningly clear.
When it comes to stopping the spread of the disease, however, the islands have one key advantage: hindsight. The Pacific Islands, explains Iniakwala, can look to other nations to see how they have addressed the threat of HIV and AIDS in the decades prior and learn from their successes and mistakes. Whether or not the Pacific Islands can—or will—do that, however,
remains to be seen.
Barriers to care
The logistics of providing care in the Pacific Islands can be extraordinarily challenging, in part, because of the region’s geographic and linguistic diversity.
A strong determinant on whether or not one receives care is the amount of government money allocated to HIV and AIDS care and prevention programs, says Iniakwala. That funding, however, varies from nation to nation. The six U.S. territories typically provide better services than the other countries. That situation can be particularly confusing in places such as Samoa, which is part independent and part American. But Iniakwala says it is unfair to criticize all non-U.S. jurisdictions. Some countries such as Fiji have “allocated substantial funding to HIV programs.”
Cruz counts herself among the lucky ones. Her medications would cost between $2,000 to $3,000 a month without state support. Comparing levels of care, however, can be somewhat arbitrary. For example, even though individuals have greater options than those in many other Pacific Island territories, they typically have fewer options than individuals here in the United States, says Ed Tepporn, HIV program manager for the California-based Asian & Pacific Islander American Health Forum. Health departments on the mainland, he says, receive significantly more federal funding that health departments in the Pacific Island territories.
Moreover, federal support has been dwindling in recent years. Following the Sept. 11 terrorist attacks, the United States government put a lot of money into preventing bioterrorism attacks, such as anthrax and tuberculosis. HIV and AIDS service providers, however, also use those facilities as clinics or laboratories to process patient samples. “The money’s drying up federally,” Doan says.
Not only do Pacific Island countries receive less funding, they also have greater needs than other countries in the world. For example, Micronesia is composed of four states, each with their own language. Finding medical staff and translators to meet these populations needs can be extraordinarily difficult, Doan says. And, because most clinics and hospitals are located in urban areas, those in rural areas often face greater logistical barriers to care. In Chuuk for example, it is a one-hour boat ride from the main island to the outlying ones.
But the onus is on Pacific Island countries to not just expand their care options, but also to improve patients’ quality of life, says Keith Wolter, executive director of the Maui AIDS Foundation. Here in the United States, he says, we have finally “shifted from helping people die to helping people live.”
Fear
Even if the Pacific Island countries managedtoovercome all the logistical barriers to care, however, they still would need to address the single greatest reason why Pacific Islanders are foregoing both diagnoses and treatment: stigma.
In many ways attitudes toward HIV and AIDS patientsin the Pacific Islands resembles attitudes here in the United States several decades ago. “I remember 25 years ago when the first article came out in the [Los Angeles] Times saying that five gay men had something funny going on and two had died and there was seven or eight or nine years of not knowing. The government didn’t want to do much. Ronald Reagan wouldn’t even say AIDS in public,” recalls Wolter.
While the stigma associated with AIDS has lessened here in the United States, the same cannot be said for the Pacific Islands. Judy, a 39-year-old Guam woman whose name has been changed to protect her identity, has yet to tell her family or friends about her status. Just diagnosed a few weeks ago, Judy is frightened and confused. She’s scared to go public because there might be some who “don’t understand what it is and they might hate me and don’t want to be around me anymore.”
Judy claims she was infected by her own partner of two years. He knew he had the disease, she says, but never told her. She only learned of his status when he was hospitalized from AIDS-related complications a few months ago. “When I first found out, I was so shocked,” Judy adds, whose partner later revealed that he was too “ashamed” to tell her he was infected. Nonetheless, Judy is trying to maintain a relationship with her partner. “I love him already,” she says simply.
Sadly, Judy’s situation is not unique. “Women make up the fastest-growing group of new HIV infections,” according to the GUAHAN project, Guam’s only nonprofit AIDS organization. Females are particularly at risk in the Pacific Islands, Whiticar says, because they don’t have “control of their sexuality meaning that men really have their way.”
According to Iniakwala, research that has looked at the second-generation of HIV and AIDS in the Pacific, indicates that high numbers of people in the Pacific Islands have multiple partners or engage in extramarital affairs.
“Here in Guam it used to be that you don’t have sex until you get married, but of course things have changed. You have to try the merchandise before you buy it,” Cruz jokes before taking on a rare moment of seriousness. “For me, when somebody tells me they love me, it’s really like, ‘Oh wow, this person loves me.” But all women, she says , even those in love, need to stay strong. Women, Cruz adds, are sometimes too “easy to manipulate.”
Danger of stigmas
The stigma associated with AIDS, moreover, makes it difficult to forge links among doctors, patients and others involved in testing and treatment process.
According to Iniakwala, part of the reas< \h>< \h>< \h>on HIV and AIDS is spreading in the region is because it has not been contained among sex workers. Prostitutes provide a particularly vulnerable group in society because they are often denied medical care, he adds, noting that medical staff are wary of treating patients who might garner the disapproval of friends and family members. Educational initiatives to halt the spread of AIDS must target everyone from medical staff, to patients to religious leaders. “We need to better understand our situation,” he says.
But medical staff aren’t the only individuals creating barriers to care. Patients, such as Judy’s partner, are often reluctant to seek medical attention for fear of losing their anonymity. Because the islands are so small, says Doan, in many cases “your aunty is your nurse.” Due to that fear, however, many patients who could have stalled the disease’s progression receive medical care only during the last stages of their life.
Wolter hopes that the Pacific Islands tap into recent technological trends that could provide a much needed shield between doctor and patient. For example, telemedicine would allow health care providers and patients to speak through an electronic medium. It’s not ideal, he adds, but it’s better than patients waiting until its time to die.
Stigmas, however, impact more than just doctor/patient relationships. Prevailing attitudes also strongly affect the logistics behind providing care, Doan says. For example, there are not that many facilities in the Pacific that can process lab results. For that reason, patient samples must often be flown hundreds, if not thousands, of miles to the nearest processing center. But patient samples have limited life spans and therefore maintaining logistical routes remains paramount to HIV care and prevention in the Pacific.
However, for a long time, regional pilots refused to carry patient samples on board their airlines. “It has to be labeled ‘infectious’ which scares everybody,” Doan explains. Whether or not samples got off a given island became very dependent on the individual pilot. “We worked on it for years. It would get better, and then one specimen wouldn’t get off the island,” she recalls, adding that the concern then became how to preserve the sample until the next plane arrived. “Planes don’t come in every day. It comes in one day, one direction.”
Doan says that it is only recently that pilots have begun consistently carrying samples. And that, she says, is progress.
Progress: not quite soon enough
But for people like Judy, progress chimes a slow tune.While Judy would like to teach others about HIV and AIDS before it is too late, she’s scared to sacrifice her identity.
Telling people about her status, she says is always “on my mind.” She adds, “It’s just that I’m not there yet, but I have that thought that I will open up and tell my children and also tell some of my friends and especially I would like to teach the ladies where I come from because they don’t understand it and they don’t know what happens to them.”
Judy says she would like to tell women, “Always use condoms when they’re having sex with partners because they never know what’s going to happen. Most men probably don’t like to use it, but…that’s the important thing to do.”
In the meantime, however, Judy feels totally alone, save for the people at the GUAHAN project, who helped her find work and provide counseling when she needs it. But Judy still isn’t sure when and how to tell her four children, who range in age from seven to 18, about what she is going through—or how to make sure they don’t go through it themselves. Referring to her oldest daughter, she says, “I want to keep it to myself until it’s the right time to tell her. She and I are very close. We really love each other so she’ll be really sad.”
Judy’s biggest fear is that she’ll die before her children reach adulthood. I always hope for the day I will read the magazine [and it will say] that there is a cure for … HIV,” she says. In the meantime, however, people like Cruz and Judy must figure out how to survive in a region that is just beginning to realize the enormity of the disease in its midst.
Source: http://honoluluweekly.com/cover/2007/01/pacific-pandemic-combating-the-spread-of-hiv-and-aids-in-the-pacific/
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