HIV and RZHRG

Hey campers,
I dont really have too much exciting to report. I spend most of my time either at work, grocery shopping, walking around, or cooking and cleaning. I've actually started enjoying cooking since I have to do it. There just aren't too many local eateries around here with a wide array of vegetarian dishes. Or really too many eateries with a wide array of anything. But what I did want to write about was HIV in Rwanda and my employer, the Rwanda Zambia HIV Research Group (RZHRG). I realized that for many of my family and friends, HIV and AIDS may not be quite as familiar as for students of public health. You see, for MPH students, we spend more of our time learning about HIV than many of us would like because it is one of the greatest, and certainly one of the most sensational, public health problems of the present. And although the epidemic is much too difficult to explain in one blog, I wanted to try to explain a little more about what is happening and give a couple links to sites that have information on AIDS, particularly in Rwanda.

The first is UNAIDS, the program of the UN which deals exclusively with researching, preventing, and combating HIV and AIDS. Specifically, I have provided a link to the country specific report for Rwanda. The link is http://www.unaids.org/en/CountryResponses/Countries/rwanda.asp. However, unaids.org will bring up their larger site and provide much more information on the state of the epidemic worldwide and current efforts.

Rwanda, as in much of East Africa, has a fairly low prevalence rate, which is the percent of people living with HIV or AIDS compared to the total population. In Rwanda, it is estimated that about 2.8% of the population between the ages of 15-49 has HIV. Compared to South Africa, where almost 30% of the population has HIV or AIDS, that number is extremely low. But compared to the United States, which has a prevalence of about .28%, that number is pretty high. And in Zambia, the other country where the particular study that I am working for is located, the prevalence among 15-49 is 15.2%.
http://www.unaids.org/en/CountryResponses/Countries/zambia.asp

Although there is much debate about why Southern Africa (not South Africa specifically, but the region in general) is particularly hard-hit by the AIDS epidemic, while East Africa remains less affected, no one really knows. Perhaps its issues of prevention compliance (e.g. using condoms, delaying sexual debut) , gender inequity, polygamy, access to health services, or poverty. Likely its these reasons and more. But no one knows for sure why the AIDS epidemic is so bad in Africa and no one really knows the best way to prevent it.

However, people are trying. Many people and organizations, and one of them is RZHRG. Dr. Susan Allen started doing AIDS research in Rwanda in 1986, very shortly after HIV was "discovered". Dr. Allen is a proponent of couples voluntary counseling and testing, wherein couples are counseled about HIV in general together, are tested and given their results together, and are counseled regarding their results, whether they be positive or negative, together. Currently, almost 67% of new HIV cases are spread between married or cohabitating parters. This is not specific to Africa. The world over, the largest risk group for HIV transmission, is married women. Yet, until recently, HIV testing and prevention efforts focused primarily on testing only one person. Get one person in, test them, give them their results. Better than nothing, yes of course. But if that man or woman chooses not to tell their partner their results, and that is extremely common, then that testing doesnt really do much. How will a man explain to his wife that he needs to wear a condom if he doesnt want to tell her he has HIV? How will a woman explain that she shouldnt have any more children at the risk of passing on the virus without explaining why? These are the issues that direct couple counseling avoids. Couples come together and are tested together with the understanding that they will develop a prevention plan together, that they will live with the virus if one or both of them has it together, and that all decisions must be made together. Its pretty common sense, but has only recently been accepted as the standard for prevention among the public health world. Anyway, that is what Dr. Allen pioneered. The website for RZHRG is www.rzhrg.org. There are several publications on the website, in addition to general information, site photos, and information about the impact of AIDS on children, an entirely different ballgame.

I know that that was a quick and dirty discussion of HIV and RZHRG. If people have more questions, please let me know. As someone pointed out to me recently, I tend to talk about stuff without realizing that a lot of the time, other people dont have the background to really know what I am talking about. So please, if anyone wants to know anything about HIV, Rwanda, RZHRG, anything, please ask. If I dont know, I will at least post or email a link. And Im sure I didnt come close to providing enough information, so please let me know what other information would be useful.

On that note, I hope that everyone is doing well and is safe, happy, and healthy. Care packages appreciated (particularly including books, nuts, dried fruit, cheese if thats possible somehow, cereal, and cereal bars) and Go Obama!

Hashing... but not the way youre thinking

Yesterday, I went with some of the other interns here, Jeri, Kate, Leigh, and Marta (I just realized their names are alphabetical) to an event called the hash. A hash, at least the way we did it yesterday, is an event where people meet at a bar and then run or walk a pre-marked course through the city and end at the same bar and then celebrate their athleticism by drinking beer. Although hashing is apparently a popular event the world over (there is a hash in Atlanta every week), this was my first time. Im not sure that I see much of a point to it as as legitimate sporting event or club, but it was a great hike and way to see the city. All in all, I think we walked about 3 to 5K through Kigali and saw some sights and neighborhoods that we probably would not have had a chance to see. And we gave the neighborhoods a chance to see a muzungu parade, something that I know they appreciated based on the laughs and number of children we acquired throughout our hike. And when I say hike i mean HIKE. I think that I have said that Kigali is built on a series of hills? Well these arent bluffs gently rising from the plains. These are straight up moutainous hills. And I mean straight up. At one point, we were scrambling up a hill covered in scrub, grabbing onto whatever bush or tree we could find and attempting not to slide back down to the bottom of the hill and do it all again. It wasnt dangerous, although there was a point where we were going one by one across a small ledge above someones yard. She was just standing in her doorway looking at us like we were crazy (not far from the truth). In fact, it was really fun and entirely exhausting. Although you wouldnt know that by the 5 year old, Ben, and 7 year old, Maurice, that came with us and kicked everyones butt. Ben was at one point hiking up hills holding his nose and demonstrating how he could constrict his breathing and then about ten minutes later sprinted to the end destination. He also decided that he wasnt dirty enough at some point and sat down to play in the dirt while we all caught up to him. I assure you, we were all plenty dirty enough. Finally, we got back to the bar and enjoyed some beers and much needed water and those of us who had never hashed before, including Marta, me, Jeri, and Leigh were officially inducted into the club. You see apparently you cant just show up to a hash. You have to be a member, a devotee. There was one man (I think he may have been INSANE) who apparently travels all over the world doing hashs. And accordingly, he has a sacred hash vessel (an orange plastic hat) that is the only thing out of which he will drink his beverages. And when you ask why he is drinking out of an orange plastic hat (a legitimate question I think) he only replies, why would you drink out of anything other than the sacred hash vessel? ...Right... This man later told Ben after he had touched the aforementioned vessel "When you walk with the big dogs, you have to piss in the tall grass". And then repeated it several times because Ben didnt understand. Can someone please explain it to me? Because I didnt want to ask this guy a legitimate question after the vessel incident and I certainly didnt want to ask what the hell he was talking about! Anyway, it was a great, dusty, exhausting day and one that will hopefully be repeated (hashs are every week and they follow a different course each time). Attached are some of the photos I took along the way. Scenic tour of Kigali!

First Few Days... and some blatant plagarism

Well its been a few days longer than expected. Even though we have internet here, it isnt always the most reliable. It might take five minutes to load before finally just giving up in an exhausted unable to locate server message, despite the person next to you having full access. Aahh... the mysteries of Africa.

All in all, things are going well here. I am really enjoying Kigali and am constantly surprised by the people and the city. As many of you know, when you live in Africa or Asia, there is a certain mystery to being white. Something that is so intriguing that people will stare, yell, touch, or generally make a scene. Its not the most comfortable feeling by any means, but you get used to it. But here, there is really very little of that. It seems that most Rwandans just go on about their daily lives, and though there is some small notice taken of us (we do stick out), we just arent interesting enough to really point out. I even went running with one of my roommates, Leigh, yesterday and hardly anyone made fun of us or even took notice. Granted, most people do speak Kinyarwanda and could have been saying things I dont understand, but running certainly wasnt the show that it was in Uganda. And the city is nice! I mean really nice. The three main streets are lined with trees with medians in the middle, also lined with trees. There are streetlights and sidewalks, and although the street is crowded it isnt an overwhelming push of people by any means. Despite its size, 700,000, for the most part, the city feels like a large town. There are no huge buildings, few concrete walls, and you can usually look across the hills and see another part of the city or just deep green trees. And... AND... there is regular garbage pickup. Every Friday! Thats pretty amazing.

Activities have been pretty slow around here. I have gone to the project the past two days and been introduced to dozens of people I have already confused or forgotten. Carey, my friend from Emory, is great and knows everyone and everything. Our first attempt at a tour ended up with us drinking coffee on her couch and catching up and then her showing me off to the study. Yesterday, we had a series of management meetings (yep Im management) which was both interesting and tedious. The meetings seemed to primarily consistent of people avoiding blame for small problems that really could have been solved in two seconds. But these were my first meetings and I had very little knowledge of what was going on, so perhaps these impressions will change as I become more involved in the project. Yesterday I also signed up for French classes, two hours a day, three days a week. Yikes. There is another girl, Marta, who also just arrived for one year who will be taking them with me. Marta is here to help produce a movie about the project as well as do law and advocacy work regarding the extradition and trial of the people responsible for the genocide who continue to have political asylum in the states. Marta's job is cool.

Im still dealing with jet-lag and continue to wake up at 4 in the morning. Last night I passed out at around 9 and woke up at 230. Hopefully I will adjust soon. Oh and I got a phone. My number is
011 250 037 53835. If that doesnt work try taking the 0 out after the 25. But I think thats right.

Finally, the plagarism bit. I wanted to take a bit out of Carey's blog and from wikipedia regarding the history, culture, and because it is unavoidable the genocide.

Brief history via Carey Spear
"It is the one place I have lived in Africa where the colonialism thing just didn't stick, like they just laughed at it and kept moving forward. Their government is and has been stable (ok, bar the genocide planned by the govt), this country lacks beggars, theives, squatters, shanty towns (they actually don't exist here), has policy in place and is actually enforced. All the backwards things i fully enjoy about Africa just don't exist here. Turns out that since time immemorial Rwanda has had hierarchical organization that has been respected. Of course, one cannot ignore its small size and the fact that there has always only been two or three tribes (as opposed to South Africa's twenty something tribes, 11 official and as many unofficial languages, beliefs and "political systems").......anyway, I am still trying to suss this one out but it is amazing to me how clean, organized and "westernized" Rwanda is.
It has a fairly simple history compared to even some of its neighbors (i.e. the DRC), the "hills" (aka: 5,000-10,000 foot hills) really kept people out! the Germans tried to colonize it for a while but the Belgians kicked them out. The only lasting memory of the Belgians is their french language - even that is being overtaken by English (now one of the official languages along with French and Kinyarwanda); Rwanda "gained" independence in July of 1962 and has carried on just fine without their colonizers ever since. They export loads of coffee, tea and bananas and import nearly everything else (thus the prices); petrol is $7.50 a gallon which is reflected in the cost of taking a taxi, but not in the number of vehicles on the road in the city! Crazy.".

Finally a bit on the genocide. Many of the people that worked for the study were killed and many that work for it now where opponents of the genocide, many suffering heavily for that. Almost everyone had a family member or all of their family killed. It is impossible to be here without feeling the effects of the tragedy. However, Rwanda and its people are committed to avoiding anything similar in the future. Here is a little bit on the history of the genocide courtesy of wikipedia.

"

The Rwandan Genocide was the 1994 mass killing of hundreds of thousands of Rwanda's minority Tutsis and the moderates of its Hutu majority. Over the course of approximately 100 days, from April 6 through to mid July, at least 500,000 people were killed.^[1] Most estimates are of a death toll between 800,000 and 1,000,000.^[2]

The genocide was primarily perpetrated by two Hutu militias, the Interahamwe, the militant wing of the MRND, and the Impuzamugambi, the militant wing of the CDR. It was an eruption of the ethnic and economic pressures ultimately consequential after Rwanda's colonial era and the fractious culture of Hutu power. The Rwandan Civil War, fought between the Hutu regime with support from Francophone nations of Africa, as well as France itself, and rebel Tutsi exiles with support from Uganda, after their invasion in 1990, was its catalyst. With outside assistance, in 1993, the Hutu regime and Tutsi rebels were able to agree to a cease-fire, and the preliminary implementation of the Arusha Accords. The diplomatic efforts to end the conflict were at first thought to be successful, yet even with the RPF, the political wing of the RPA, and the government in talks, elites among the Akazu were against any agreement for cooperation between the regime and the rebels to solve the ethnic and economic problems of Rwanda and progress towards a stable nationhood.

A resurgence in the civil war and the French government's support for the Hutu regime against the Tutsi rebels compounded the genocide. The situation proved too difficult and volatile for the United Nations to handle. The invaders successfully brought the country under their sway, although their efforts towards a conclusion to the conflict were brought to a contravention after the French, under Operation Turquoise, established and maintained a "safe zone" for Hutu refugees to flee to in the southwest. Eventually, after the UN Mandate of the French mission was at an end, millions of refugees left Rwanda, mainly headed to Zaire. The presence among the refugees of the genocidaires (see Great Lakes refugee crisis) on the border with Rwanda was the cause for the First and Second Congo Wars with clashes between these groups and the Rwandan government continuing.^[1]

The UN's mandate forbids intervening in the internal politics of any country unless the crime of genocide is being committed. The United States government did not recognize the genocide. The governments of Belgium, the People's Republic of China, and France in particular still receive negative attention for their perceived complacency towards the Hutu regime's activities and the potential for UNAMIR to save Rwandan lives. Canada, Ghana, and the Netherlands provided consistent support for the UN mission under the command of Roméo Dallaire although it was left without an appropriate mandate for the capacity to intervene from the U.N. Security Council. Despite emphatic demands from UNAMIR's commanders in Rwanda, before and throughout the genocide, its requests for authorization to end it were refused and its intervention-capacity was even reduced." The full link is at http://en.wikipedia.org/wiki/Rwandan_Genocide. Please read it

This weekend I think that I will be going to two of the memorials to the genocide. I am sure that I will more impressions and photos to share as a result. In the meantime, I hope that everyone is healthy and happy and I miss you all!

Welcome to Rwanda

Bonjour! I've been in Rwanda for a little over 24 hours now. My first impressions, though minimal because I have been sleeping most of the time, are good. I arrived at around noon on the 16th after about 27 hours of travel and was almost immediately through immigration, baggage claim, and customs. A driver from the study picked me up and brought me very slowly to my house. The first thing I noticed is that people do not seem to drive like maniacs around here. In both Uganda and India, it seemed like traffic laws were really more traffic suggestions. One way streets were only one way if going around the long way would result in a higher fare and lights were mostly for decorative purposes. But here, at least so far, it seems that people obey traffic signals, stay on one side of the road, and stay somewhere around the speed limit! And I saw a traffic cop (which was, other than the city center, the only thing pointed out to me by the driver).

My house is about a half an hour drive from the airport so I was able to see some of the city, which seems pretty orderly (sidewalks!) although a little confusing. Kigali is built on a series of hills so the roads run around the hills rather than up and down which makes it hard to figure out any sense of direction. It is beautiful though. The hills are a deep green and the roads, which are mostly unpaved, are a deep orange red. The roads circle around the hills and as we drove higher, I could see down into the valleys, onto the silver rooftops of the houses.



My house is very nice. Four bedrooms, two bathrooms, and oh wait for it... a washing machine. Oh yeah! We have a porch in the backyard that looks out over an adjacent hill behind which the sun sets and I imagine I will be taking quite a few leisurely sits, watching the sun and listening to whatever random songs the hotel next to us chooses to jam (last night I heard a pretty great selection of African music supplemented by Pat Benetar and Bruce Springsteen. There are some pretty banging club beats right now.)







Unfortunately, when I arrived yesterday the house was empty. This past Friday was a holiday which apparently means that everyone gets out of town. So Saturday evening I puttered around the house, read, and watched some movies. I wont lie, I was a little bummed that no one was here. As excited as I am to be here, a year seems like a very long time right now and to arrive in a country with no one here to talk to made me pretty lonely. I missed people like crazy. But today my housemates came back and having other people around was very cheering. One of the women, Jeri, is here only for another month but the other, Leigh is an admin intern and, like me, will be here until next summer. Not much else to say quite yet since I just met them, but they are both friendly, get along well together, and seem like they will be easy to live with.

Well, there isnt too much more to write just yet. I'm pretty tired despite sleeping almost 18 hours today. Tomorrow is my first day of work, which Im pretty excited about and I will be sure to update more once I actually know what I do!