HIV / AIDS in Guyana

HIV / AIDS is a huge problem in Guyana. Though statistics can be unreliable here, the general guesses place the HIV infection rate in Guyana around 3% or so, placing it second behind Haiti in this hemisphere. That's in a country of about 750,000. So we are looking at about 23,000 people infected with HIV here. But with such a small population, and the quickness with which the virus can spread, this country is on the brink of a huge national disaster. The infection rate could easily jump in five years to a range known only in Africa.

But one problem with this statistic is that nobody really knows what the true rate is. There are many parts of Guyana where there are no numbers. And some of these places would seem to likely have high rates. Also, there are no regional numbers. For instance, the Essequibo Coast compiles their raw data and sends it into Georgetown, but never gets any analysis of it's own situation - we only hear the national rate. This, incidentally, is something my Peace Corps friend is working on. So we guess, using the national rate and being conservative, that there are around 2,000 HIV positive people here on the coast, out of a population of 70,000.

But there is another problem with the numbers. People don't want to get tested in Guyana. So without large numbers of people testing (or even representative numbers), it's hard to have anything more than an educated guess on the true infection rate here.

Regardless of what the rate is exactly, it is apparent that HIV is the elephant in the room here. And everyone knows it. There is an amazing amount of money pouring into this country to fight the disease. We are one of fifteen countries (and one of two outside of Africa) that are part of the US government's PEPFAR program. This is a federal program started by the Bush Administration to fight HIV / AIDS. For Guyana, they poured in about US$21 million last year, which is an amazing amount for such a small country. Basically, if you have an idea related to HIV, you can get money for it. Additionally, it allows for all medicine for HIV positive patients to be free here. So it's a good thing (though there are some drawbacks, which I don't have time to get into).

So why is the rate not dropping (and probably growing, though who knows?)? Well, this country suffers from a few unfortunate things that, coupled, produce a terrible environment to fight HIV. First, there is immense stigma and discrimination against people with HIV / AIDS here. Not only are people shunned who are positive, but so are people just suspected of being positive. And how is one suspected? Well, if it becomes known you got tested, then people assume you are positive. If you lose weight quickly, then people assume you are positive. If you even just go by one of the testing places, people assume you are positive. And you are never going to be able to do anything to change people's minds. Of course, some people won't care. But there are so many people that love to point and gossip about whoever. And word spreads quickly here. Everyone knows everyone; no use trying to keep a secret here. So what's the rational reaction to this? Don't get tested. People are loathe to even appear to get tested.

A second problem is both the fatalistic attitude towards HIV / AIDS and the misinformation. People don't know that they can get free treatment from the hospital, that there are support groups, that you become eligible for public assistance and micro-loans, etc. But people have at least heard of the disease. However, they have a lot of misconceptions about it. Some of the reactions I've heard after being asked if they want to be tested: "The stress of knowing I was positive would kill me so fast." "I would be so angry that I would go infect 10 people right away." And so on. It's so frustrating when you know it's a manageable, chronic disease. You don't need to die from it, especially when the treatment is free.

So that's why people don't know their status, even though there are testing places which are free. But why does the disease spread so much here? Again, two main factors tend combine to push the disease. First, men don't like to wear condoms. Either it doesn't feel good, you can't "draw energy from the girl," or it's not natural. For whatever reason, guys would rather not wear a condom. And women don't feel empowered enough, generally, to force a guy to wear one. And let's not even discuss abstinence. That's not happening here. So condoms are the best way to control new infections, but men won't wear them.

Secondly, men feel they have impunity to have multiple partners. It's ingrained in the culture almost that a man should have both his wife and a "sweet woman." It's directly related to his manliness, it seems. I've had many conversations with men who openly talk of how they cheat, like it's normal. And they are right here - it is normal. Many men live on the coast but work in the interior. So they will be gone for months at a time. During that time, many men cheat on their wives, often with commercial sex workers (speaking of, most bars have at least one girl who performs that duty here). So men are cheating. And like I said earlier, they won't wear condoms.

So what happens, as I'm sure you can imagine, is that a husband goes off for work, contracts HIV from a sex worker, and then brings it back and infects his wife. And then he might also infect another sweet woman he might have around his home. And a man who does know he is HIV positive, having contracted it from a sex worker or whoever, won't want to wear a condom with his wife, knowing she will suspect him of cheating. So instead he infects his wife, thinking this is better for the marriage (or at least him). It's very sad.

Anyways, it goes on and on. But as sad as this situation is, this isn't the first country in the world to face it. So I know we can make headway. And not everyone is like what I just talked about. I just talked to taxi driver who has been married for 12 years, never cheats, and has been tested. And same with his wife. Unfortunately, he is the exception to the rule. But if there are enough like him, especially among the youths, there is hope. But until then, I'm here, with a whole lot of international aid and other organizations, trying to turn the tide.

Happy 4th of July!

Well, I'm winding up my 4th of July weekend in Georgetown. We went to the US Ambassador's house on Saturday, swimming in his pool and getting baked in the sun. Basically, it was reunion of my training class, GUY17. It was fantastic to see all of my friends who I have not seen for the past two months. Of course, talk centered around work and how useless we feel a lot of the time. People are working only 15 hours a week at a lot of places, just like me. Lots of us are hitting the same barriers to working effectively. Some people have worse situations than other, of course, but it was good to compare all of our experiences so far.

It also made me realize how much I like the Essequibo Coast, where I live. The coast has just one road that drives along the coastline, with all the towns on the main road. With the taxis or mini-buses, the conductors are nice and not too pushy. But wow, the contrast is amazing to Georgetown. In the capital, there are seemingly millions of people. The conductors are pushy, grabby, and often rude. The relative hustle and bustle (I mean, this is nothing compared to a US city) makes me feel like a country bumpkin. But I like it. I like the relative quietness and slow pace of the Essequibo Coast. I like the safety - I feel fine being out late at night, whereas I don't want to be anywhere but inside after dusk in Georgetown. I just really like the coast. That's one of the reasons this weekend has been good for me - it make me realize how lucky I am with my site placement. The freedom we have out there, coupled with the beauty of the coast and the friendliness of the people, has got to make the Essequibo Coast one of the best places in Guyana.

Anyways, it's been a good 4th of July weekend in Guyana. I think we might try to do a BBQ tomorrow for the proper holiday. And maybe we can get some explosive materials and try to make some fireworks? That sounds like a good secondary project.