Monday, December 7, 2009

HIV-prevention in Achuar villages

Puanch, our Achuar promoter in front of our private counseling booth in the village of Huangramona

The socio-cultural norms regarding sexual education that underwrite the Achuar communities (Wararai, Huangramona) bar us from conducting HIV-prevention public talks; therefore, we established a private, one-on-one counseling station at the clinic. Our Achuar HIV promoter did the counseling in the language of the community (he also gave out free condoms and demonstrated their proper use). For now, we have thus counseled only the village men who frequently travel to the bigger villages and towns on the river, and thus run a greater risk of infecting themselves and their spouses with HIV. However, we have selected some “opinion leaders” of the community who will continue privately disseminating information about HIV in our absence. This private and individualized strategy of HIV-prevention was not only accepted but appreciated by the Achuar men who—according to the information they provided us—had no knowledge of HIV and how to protect themselves from the infection prior to our arrival.



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Patient Stories

Juan: A Patient’s Story

During an Amazon Promise clinic in the village of Jerusalen, we met a desperate, emaciated man who was holding the hand of a four-year-old boy with cutely unkempt hair. Having been sick for some time, Juan had come to the village from Iquitos in the hopes of finding some healing in traditional jungle medicine. He was a very humble man who never looked into anyone’s eyes. His son was the shyest of kids. There was tenderness between them. The AP clinic doctors could not find the source of Juan’s fatigue, but suspected that he was in the end stages of HIV/AIDS infection. We offered to help him get back to Iquitos for HIV testing.

In Iquitos, Juan tested HIV positive and broke down. We counseled him about the free antiretroviral treatment he could receive from one of the hospitals. Still, he was convinced that an HIV diagnosis meant certain death. Juan then revealed he had a wife and another child. In fact, he was not afraid to die, but he was petrified that they too might be infected. At the San Juan Health Center in Iquitos, Juan’s wife and their children tested negative, while Juan’s tests confirmed his HIV infection. Again Juan cried, but this time with relief. Nevertheless, his joy was short-lived: he now perceived himself a burden to his family, and craved death. At that point, he could hardly walk. Together with his wife, we counseled him and finally convinced him to start treatment. His wife was very strong, forgiving and caring. They decided to make it together.

Juan entered the free antiretroviral treatment program at the Hospital Regional. Because he was too ill to work, his wife took on an extra shift at her job to make ends meet.

A year later, while we were visiting the same village, an elderly woman spoke without stopping about how fat her son Juan was getting. Then one day Juan rang the bell at the Amazon Promise house in Iquitos. He walked in with muscled arms and a protruding belly, holding his youngest child in his arms and the boy with unkempt hair by the hand. Juan has a full-time job now. He looks people straight in the eye, and talks with great concern about the growing number of HIV patients he sees in the hospital where he receives his treatment. At the moment, he is training to become a volunteer HIV-prevention counselor. Welcome back to the world, Juan.

(The patient’s name has been changed for the sake of confidentiality)

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