In 2011, I worked in a remote part of Tanzania for six months in a hospital where HIV/ AIDS was a major issue.
The word in Kiswahili for HIV/ AIDS is Ukimwi as they don’t make a distinction between the two stages of the virus. There is an HIV epidemic in Tanzania, with 6% of the population being known to be HIV+; the actual number is thought to be twice that.
Tanzania is a relaxed country, with religions split between 1/3 Muslim, 1/3 Catholic (so no condoms) and 1/3 “other” which includes Anglicans, and tribal beliefs.
Diagnosis is usually with a rapid test but this has a problem of giving false-positive results, so any positive result is done three times and you need two of the three to show a positive for HIV to be confirmed. Consent has to be given for a test, and most expectant mothers are encouraged to test for HIV as they are known to have had unprotected sex and it can help prevent transmission to the baby.
If diagnosed, a paper file is started to track the patients progress. They are asked to come to the Ukimwi clinic every four weeks. Although literacy was low in the population the hospital served, most patients can understand numbers. So they knew which day they were to attend. The hospital doors opened at 8.00am although patients would start to queue from 6.00am on their day (there are no appointment times).
The Ukimwi clinic is out of the way of the main inpatients, and most patients attend alone as they do not want to identify themselves. There is a large social stigma attached to being HIV+ in Tanzania, with all government organisations having to publish an HIV mainstreaming policy to show how people living with HIV will be treated and to ensure that all aspects of the organisation encourage HIV+ employees to participate.
Large queues form outside the clinician’s rooms, which have only an ill-fitting curtain for a door, a mesh window, desk and examination bed. So privacy is minimal. The next patient is frequently sticking their head around the door to find out what is happening. The clinician (usually not a fully trained doctor and with minimal HIV knowledge) will prescribe ARVs as we have in the UK, and as long as these drugs are taken regularly then as in the UK, life expectancy may not be shortened. The problem in Tanzania is that many people sell their drugs to people who cannot be seen to attend a hospital.