I first learned about HIV when I was eleven, years before phrases such as “interest in global health” and “tired medical student” were tucked into my daily dialogue. Our health teacher showed us a documentary which demonstrated that the virus is transferred through bodily fluids. I folded that piece of knowledge away, unaware that it would visit again.
Fourteen years later, on a trip to Africa, I met Hakunya*, a 35 year old woman who had recently been diagnosed with HIV.
“Do you know how you got it?” I asked as I soaked in her appearance. Her collarbone was sharp with defined edges. Though she was covered in a long, faded green dress, she still seemed exposed and vulnerable.
Instead of saying anything, she motioned to her husband. As I asked more questions, I learned that Hakunya’s husband was diagnosed with HIV one year before. He was unsure about how he became infected.
Unfortunately, Hakunya’s case is far too common. Men get HIV most commonly by sexual intercourse with other men. Women, on the other hand, are more likely to become infected through intercourse with heterosexual partners. 60% of people in Africa with HIV are women (1). There are multiple factors contributing to this. The female genital tract has a larger, more susceptible area for the virus to occupy. Gender inequalities permit men to have multiple sexual partners and spread the infection (2). Fear of violence, rape, and low socioeconomic standing make it difficult for many women to protect themselves from unsafe sex (3).
As medical students, we learn that a large component of prevention is education. I talked to Hakunya about condom usage and the way certain prophylactic medications worked. She learned about a nearby women’s clinic. Hakunya asked me about what she should expect. Would she become weak, the way others in her village had? Would she die young? Would she unknowingly spread it to someone else? I noticed that the unknown worried her the most. I told her some symptoms she might experience as her illness advanced and how she could prepare.
While I spoke to her, I noticed that the physician and social worker I was with were busy talking to her husband. It occurred to me that the story rarely ends with the patient in front of us. Often, many people are actively influencing an individual's health. I also saw that as clinicians in training, it is important to work with people in other fields to provide better care.
Although many organizations have made progress with HIV prevention, there is still a long way to go. Sometimes we underestimate how much ability we have to help, how the lessons we learn in the classroom can comfort a patient. Treatment can come in multiple forms; sometimes it’s a drug that eradicates an illness. Other times, it’s an answer to the unknown. Through prevention, collaboration, and reassuring our patients about their futures, we have the ability to reduce suffering on a global scale.
*Name has been changed
1. Tigawalana, David Why African Women are More Vulnerable to HIV/AIDs Rwanda News Agency 19 September 2010
2. Gender inequalities and HIV World Health Organization 28 August 2012
3. Muula, Adamson HIV Infection and AIDS Among Young Women in South Africa Croatian Medical Journal 2008 June; 49(3): 423-435