My buddy Tim knows I’m not in Africa, so he asked me where exactly I’m blogging from. The answer is a cabin in the upper peninsula of Michigan, with a beer in one hand and a pickle in the other, looking out on Lake Chabeneau. Suck it, cubies!
As long as I’m breaking out of this week’s dreary AIDS-sure-does-suck voice, let me extend a hail fellow well met to folks I met at Greg Frasca’s wedding who told me they read the blog. You are more welcome than biscuits at an all-gravy party.
Now back to the zombie Newsweek material. If you pick up this week’s issue, on page 27 you’ll see a picture of Dr. Philippa Musoke stethoscoping a kid. Musoke is the director of the MTCT-Plus program at Mulago Hospital in Kampala. As explained in the Newsweek article, MTCT-Plus chooses HIV mothers from around the city, and offers treatment to them and any HIV-positive members of their immediate family.
MTCT-Plus was preceded by a program that used a drug called nevirapine to stop mother to child transmission of HIV. The program worked, but since it did nothing to help the baby’s parents, sooner or later the kid was left orphaned. MTCT-Plus goes down the list of mothers that went through this earlier plan, and offers drugs and counseling to those women and their family.
Making the mother the entry point for treatment brings up a lot of sticky questions. One: when word gets out about this system, will HIV+ women link getting pregnant to getting free drugs? Musoke says she’s not worried. She was worried it might happen with the original treatment that blocked mother to child transmission. If HIV+ women thought they could now have healthy children with nevirapine, would there be a rush to the clinics? There never was any spike in reported pregnancies, Musoke says, and that makes her think there won’t be one now.
Question two: Uganda’s a pretty horribly sexist place, and it’s better than most places in Africa. In the magazine article, you can read about Margaret Lubega, the first woman introduced into Mulago MTCT-Plus. What’s not mentioned is that Margaret said she found out she was infected in l999, but her husband knew he was positive in 1992. He said nothing until she came home from being tested and forced the issue. Lubega’s HIV+ sister is also mentioned in the article. Lubega told me, “Her husband kept quiet, too.” Such dereliction is typical: Many husbands get treatment or try to have kids without notifying their wives that they’re even positive.
Enter Dr. Musoke, who talks with passion about how she happens to be one of the 1% of African women who have control over their lives and livelihoods. From the start of the MTCT-Plus program, Musoke has seen it as a tool to empower women. To get MTCT-Plus, qualifying women are required to go home and disclose their status to their husbands—a position of power African women are almost never in. Families without mothers can’t qualify for Musoke’s MTCT-Plus program (at the MTCT-Plus program across town, directors said they would admit father-only families if the father had been widowed by a woman who would have qualified).
She admits this isn’t completely fair, but says something has to be done to help out women in Africa. I said I agreed, but I asked what she could say to the people who would inevitably argue that she was politicizing a life and death issue that ought to remain above politics. I was expecting a gooey answer that essentially apologized for the arbitrariness of singling out women as the vessel of awarding treatment. Instead she said: “If you don’t politicize life and death situations, you don’t get any progress. I think politicizing it makes people know it’s a problem. It’s important to give women a special opportunity. You want to empower women.”
I don’t disagree with any of this, but I worry whether most people in Africa are ready to hear it. Macro-prediction: as solutions actually become possible, battles over HIV programs in Africa are only going to get more forward-leaning, with both sides increasingly embracing social engineering. Yee-ha!
