The Gambia’s Unfinished Battle: The Presence of HIV

WORLD AIDS DAY EDITION

Originally published in The Point Newspaper, Health Column ,Gambia.

(2023, December 6th)

A Cautionary Tale of Power and Propaganda in Medicine

Consider a chapter in Gambian history where the intersection of authority, faith, and vulnerability gave rise to a phenomenon that baffled the world. It was a period when a leader, wielding considerable influence, announced a purported cure for HIV/AIDS — a cure shrouded in secrecy and ritual, claimed to be effective only on certain days of the week.

This ‘cure’ involved peculiar rituals where patients were treated with a green herbal concoction, all under the solemn intonations from a sacred text. They were also given a yellow potion to drink, the components of which were as mysterious as the treatment’s alleged efficacy. The specifics, zealously guarded by the leader, were never disclosed, fueling both hope and skepticism across the nation and beyond.

This episode serves as a stark illustration of how easily a desperate and uninformed populace can be swayed by the promise of healing, especially when it comes from a figure of authority. It’s a sobering example of how propaganda can take root and flourish, especially when it plays upon the fears and hopes of those grappling with a devastating disease like HIV/AIDS.

The repercussions of such events are profound, underscoring the necessity of anchoring medical practices in evidence and transparency. It is a reminder of the enduring battle against misinformation and the importance of maintaining a vigilant stance on behalf of science and truth in the face of alluring yet unfounded claims.

Understanding HIV and AIDS: A Simple Explanation

Imagine your body as a country, and your immune system as its army, protecting it from invaders like germs and viruses. HIV (Human Immunodeficiency Virus) is like a spy that sneaks into your body and tricks your army, making it weaker. It attacks and destroys important soldiers called CD4 cells, which help your body fight off sickness.

Now, when someone has HIV and doesn’t get medicine to fight it, their immune system can become really weak. That’s when HIV can lead to AIDS (Acquired Immunodeficiency Syndrome), which is like the army being so weak that it can’t protect the country anymore. With AIDS, the body has a hard time fighting off diseases, even ones that a strong army would usually beat easily.

But here’s some good news: with the right medicine, someone with HIV can keep their immune system’s army strong and live a healthy life. They can prevent HIV from turning into AIDS, like a superhero stopping the bad guy before it’s too late. So, HIV is the virus that can make you sick by attacking your immune system, and AIDS is the name for the serious health problems that can happen if HIV isn’t treated.

Gambian Medical Research: A Beacon of Progress Amidst Historical Scars

In the annals of The Gambia’s public health narrative, a dichotomy exists — between the blemishes of historical misjudgments and the remarkable strides in medical research, particularly in the arena of HIV/AIDS. The efforts of Gambian medical researchers, notably those from the Medical Research Council (MRC), have not only contributed to national well-being but have resonated on a global scale, echoing the commitment of international health bodies like the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

These researchers have worked tirelessly, often under the radar, advancing the science of HIV treatment and prevention. Their dedication has been instrumental in the progress of initiatives such as the Prevention of Mother-to-Child Transmission (PMTCT) programs, which shine as a model within our antenatal services. These programs have significantly reduced the incidence of HIV transmission from mothers to their newborns, safeguarding the health of future generations.

Complementing these efforts, the National AIDS Secretariat has been pivotal in coordinating and galvanizing the nation’s response to the HIV epidemic. Their work in overseeing and implementing various strategies has been invaluable in stemming the spread of the virus and supporting those affected.

It is essential to recognize and commend these silent contributions that form the backbone of The Gambia’s healthcare system. The successes of these programs and research initiatives bear testament to the resilience and dedication of the Gambian medical community, rising above the challenges of the past to forge a healthier future for all citizens. Their work, though not always in the limelight, is a beacon of hope and progress, deserving of our collective recognition and gratitude.

The Paradox of Modern HIV Realities in The Gambia

With a general population HIV prevalence of 1.9% among adults and 1.82% among pregnant women attending antenatal clinics, the advances in antiretroviral therapies (ARTs) offer a glimmer of hope. Today, a single pill can suppress viral loads to undetectable levels, turning what was once a death sentence into a manageable chronic condition — provided there is access to consistent healthcare and medication.

Despite the promise of antiretroviral therapies (ARTs) that convert HIV from a potential death sentence to a manageable condition, The Gambia grapples with widespread stigma. This stigma pervades from urban streets to rural pathways, creating a barrier to the open management and control of HIV.

The paradox of The Gambia’s HIV situation is one where scientific progress in ARTs clashes with lingering social stigmas. As the prevalence of HIV among high-risk groups remains high and ART coverage is suboptimal, the nation’s challenge is to bridge the gap between medical advancement and social acceptance. Targeted interventions are required to dispel myths, increase access to ART, and shift societal attitudes that perpetuate stigma.

The reality of modern HIV in The Gambia underscores the need for comprehensive strategies that tackle the virus both medically and culturally. The country’s future efforts must focus on eroding the stigma through education and information, ensuring that HIV becomes a condition that can be openly managed without fear or prejudice.

Personal Reflections: Untold Stories of the Past

In the privacy of family whispers, my late aunt’s affliction was always just an ambiguous illness. The reality of her HIV status and involvement in MRC’s clinical trials never surfaced in our conversations. In our family’s eyes, she was simply “sick,” a term that carried a weight of unspoken truths. Her passing, attributed to fate’s cruel hand, was a lost opportunity to shine a light on the reality of living with HIV.

This silence in my family starkly contrasted with my later experiences managing a community pharmacy in North Carolina. There, I was immersed in the lives of countless HIV-positive patients, providing me with a sobering perspective on the comprehensive medical and psychosocial support HIV individuals require. These experiences revealed the stark difference between hushed family secrets and the openness needed for effective HIV management and support.

The contrast between my family’s silence and the proactive community support in North Carolina underscored the dire need for openness and education about HIV. It became clear that hiding the truth does more harm than good, preventing meaningful conversations that could empower and inform those affected. It’s a poignant reminder that understanding and support can transform the HIV journey from one shrouded in secrecy to one embraced with compassion and knowledge.

The Present Challenge: The Nexus of Youth, Education, and Gender Dynamics

In The Gambia, a nation pulsating with the vigor of its young populace, the average age of 16.6 signals a demographic poised for progressive health initiatives. This youthful energy presents a unique opportunity to revolutionize HIV prevention strategies. The necessity to bolster mass screening programs, comprehensive education, and widespread availability of antiretroviral therapies (ARTs) cannot be overstated. It’s a call to dismantle the patriarchal structures that stifle women’s health autonomy and to educate men, who are often given a societal pass for risky sexual behaviors, on the gravity of preventative health practices.

Our society, especially in urban areas, is evolving with more liberal attitudes towards sexuality and health. Yet, this liberalism must be matched with pragmatic actions. It’s imperative to double down on efforts to make mass HIV screening a norm, not an exception, and to dispel myths around the modern medical management of HIV. ARTs have transformed HIV from a fatal diagnosis to a chronic condition manageable with strict medication adherence, allowing individuals to live full, productive lives without developing AIDS.

However, the societal narrative that governs the behavior of men towards women’s bodies must shift. The entrenched notion that men have the right to dictate women’s health choices is a vestige of insecurity and a denial of women’s inherent agency. This control mechanism has significant ramifications, as men, often engaging with multiple sexual partners, face less stigma and are more resistant to health screens, potentially becoming unwitting vectors in the spread of HIV.

The prevailing “condom and safe sex” rhetoric, while important, often fails to account for the complexities of human behavior. The fear of unintended pregnancy may indeed be a more potent motivator for safe sex practices among men than the risk of contracting a sexually transmitted disease like HIV. This reality necessitates a more nuanced approach to sexual health education, one that acknowledges the limitations of human willpower and the need for comprehensive strategies that go beyond simple directives.

A United Stand Against the Silent Epidemic

As we stand at the crossroads of progress and tradition, it’s vital to recognize that HIV hasn’t retreated into the shadows of the past — it walks among us, unseen but ever-persistent. It’s a call to action that we must answer with vigilance and courage. Regular HIV testing should become as routine as any other health check, and it’s imperative for government bodies and international donors to harness the dynamism of the private sector to expand the reach of testing, education, and antiretroviral treatments.

We’ve seen that HIV/AIDS can be subdued, that it need not be a death knell but a condition to live with, provided we’re armed with knowledge and medicines. Let’s cast aside the veils of denial and face this challenge head-on, ensuring that no one’s future is written off by HIV. It is a collective responsibility, an act of willful defiance against a virus that has taken too much from us. By standing united, we can safeguard our collective health and dismantle the stigma, one test, one treatment, one conversation at a time.

In peace, love, and good health,

Dr. IDB.

For more information, follow the work of Dr. Badjie and his Innovarx WOW team on www.igh.gm and on social media @innovarxglobal @drIsmailBadjie. Ismail is also the author of newly released book “LIFE AS A HYPHEN” available at Timbooktoo Bookstore and Kairo Café (Fajara).

Disclaimer: The information provided in this article is for general understanding and does not constitute a diagnosis. For specific concerns or detailed health advice, always consult your designated healthcare professional.