HIV and AIDS- The Moral Dilemma

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In the photo, Retired President, Ali Hassan Mwinyi (in the center) lights a candle on World AIDS Day

TUMAINI, a pretty young lady of 22, who has bright eyes, a wonderful smile, and a charming disposition, is a Person Living with HIV and AIDS (PLHIV).

No, Tumaini did not get HIV infection through sexual contact. She got HIV before she was born.  Her parents are PLHIV, and Tumaini got the virus from her mother, while still a feotus. This was before the program of Prevention from Mother to Child Transmission PMCT, was introduced in Tanzania some 10 years ago. In fact, Tumaini has not yet started having sexual relations. She is waiting to complete her education on Business Management before she starts dating and of course, get married and start a family of her own. Her friends do not know that she is a PLHIV, neither does the young man who has begun courting her and who is hoping at taking their relationship to the next level, that of intimacy.

The young man looks at Tumaini as a symbol of purity and dignity because rumours are; Tumaini has never been ‘involved’ with boys throughout her young adult life which is true because Tumaini has never been intimate with boys. In fact, she is a virgin.

Zawadi is a vivacious girl of 20. She has completed her studies at the Vocational Training College where she learnt embroidery work and dress making. She is a bon vivant. She is always cracking jokes with a wonderful sense of humour. You should see her imitating her friends’ foibles. She also makes fun of herself by declaring that “I’m who I, am”.

Zawadi too is a PLHIV, having been born with the virus. She often gets sickly with fever and was recently put on ARVs. Zawadi tells herself ‘I will live. I will conquer HIV’. Boys keep asking her out to discotheques. She gets dressed in trendy clothes and goes to discotheques with her friends. She recently fell in love with a young man of 21 who is not aware that Zawadi was born with HIV.

Faraja recently found out that she is a PLHIV when her aunt who has been her foster parent since Faraja was born, and after her mother died in child birth, told her that “She was a HIV baby, having been born with the virus”. Faraja who is 20 took the news quietly, but told her aunt that she had suspected her mother had died from complications while giving birth to her and she suspected the complications were caused by AIDS. “What I did not know is that I was born with the virus”, Faraja told her aunt. She went on to say “I thought people only get HIV through sexual contact? I have never had any sexual contact in my life, and it never occurred to me that a baby, me, could be born with HIV”.

Faraja is a studious young woman. She visited HIV and AIDS websites to learn more about the disease and found out that hundreds of thousands of babies had been born with HIV before the PMTC Program was introduced in Africa. She searched the internet and found there are no support groups of people born with HIV in Tanzania. She then contacted this writer and enquired about starting such a group and hotline for people who were born with HIV. She is now in the process of starting a support group but does not know how to make contact with others who were born with HIV in Tanzania because most of them are not open about their HIV status.

She has not given up hope and believes once the projected support group kicks off, others like her, might decide to join in order to get psychosocial support. “It is not our fault”, says Faraja, “In fact, people like us need compassion”, she added.

In 2008, Tanzania enacted the AIDS Act which has clauses about disclosure of being HIV status in order to protect the Rights; Security; Dignity; Employment; and Confidentiality of PLHIV.

The clauses in the AIDS Act are a milestone in the protection of the dignity; the well being; the employment – both formal and informal; of PLHIV. Prior to that, we had conducted massive public education programs to sensitize the public to do away with stigma and discrimination against PLHIV and their families.

The National HIV and AIDS Policy (amended 2010) have well articulated clauses and formulae to avoid stigma and discrimination against PLHIV.

Both the AIDS Act and the National HIV and AIDS Policy have underlined the importance of confidentiality of a person’s HIV status between a doctor and a patient; between counselors and PLHIV; among family members; and in places of employment.

In the photo, a group of Youth Peer Educators on HIV and AIDS who had undergone a two week training on peer education in Dar es Salaam. In the center in striped shirt is the trainer, Leila Sheikh.
Amani found out he is a PLHIV at age 20 when he was diagnosed with HIV related diabetes. He told his father that he has always used a condom with his girlfriends upon which, his father congratulated him for being ‘thoughtful and caring’.

His father then told him that he was born with HIV which he had been infected with while in gestation in his mother’s womb. “Your mother lost her life during the birth, but you survived”, his father told Amani. This made Amani furious and he blamed his father for not telling him about his HIV status. His father said he was waiting for him to reach the age of 21 before he sat down with him and discussed HIV ‘Man to Man’.

Amani then asked about his younger brother and sister who were borne by a different mother, his father’s second wife, and his father told him “By the time they were conceived, the PMCT Program had been introduced in Tanzania, and the younger children are HIV free”. He went on to say that he had met his current wife, Amani’s stepmother at a peer support group. She is a PLHIV and was a widow when they met. They became friends and a year later, decided to marry and add children to the family when the PMCT Program started.

Amani had liked his stepmother the moment he met her when he was a child and he is grateful that his younger brother and sister are HIV free, but keeps asking himself “Why me?” He does not get any answers, but he does need psychosocial support to deal with his HIV status, although he intends to keep it a secret and never tell any of his friends or girlfriends.

If we calculate that 5.1 percent of Tanzanians are PLHIV, mostly infected through sexual contact then assuming (just an assumption because we do not have the correct data) that 0.5 percent would be PLHIV who became infected with HIV during the gestational period, that would make around 20,000 young adults, between the age of 19-23 who were born PLHIV.

These young adults have reached the age of sexual relations and if they are not told by their parents or guardians about their HIV status, they might get into relationships thinking they are HIV free, only to find out later, that they are PLHIV. Imagine the repercussions.

What needs to be done is for parents or guardians to inform these youths about their HIV status from the age of 16. Waiting for them to reach the age of 21 might be putting their lives and the lives of their sexual partners at risk. Being PLHIV should not be a source of shame to them, or to other PLHIV who became infected with HIV through sexual contact.

Informing these youths about their HIV status early, and encouraging them to join PLHIV youth support groups would give them life skills on surviving with HIV, from their diet habits, to other habits like keeping away from alcohol and cigarettes.

It would make them responsible people in their sexual behavior if they are informed about protective sex, not only protecting their partners, but also protecting themselves from other sexually transmitted diseases.

At age 16, it is also their Right to know about their HIV status in order for them to plan about their education and careers. Being an Mkwavi, a cart pusher is not a healthy career option because it requires stamina and energy. Being a Boda Boda driver is also not a healthy option for them. They need to be made to know their options in their choice of employment which would be consonant with their health. They also need to be told that ‘It is not their fault’. This would affirm their sense of responsibility; make them reclaim their dignity; and fight to survive. It is called ‘Mind over Matter’.

There was an incident in Tanga where a family near our house was abused and threatened by another family living down the road, whose son of 16 was infected with HIV by the niece of our neighbors. There was a big fracas and verbal abuse. It even got to kicks and punches. Other neighbors had to intervene and that was when the uncle of the girl of 15 years of age told the boy’s parents that his niece is not cheap, nor a slag. She was born with HIV and her parents died soon after that, and he had gone to Moshi to get his niece when she was six months of age and was being taken care of by friends of her parents.

This case is a glaring example which illustrates the need for Tanzania to map and design a public education campaign targeted at youths who were born with HIV; their parents or guardians; and the other group of youths who do not have HIV, but who see potential partners from among the youths who were born with HIV.

The Right to confidentiality of a person’s HIV status should be adhered to, at the same time, parents or guardians of youths who are not PLHIV have the duty and the moral obligation to inform their non PLHIV children that there are youths who were born with HIV.

It is not their fault. They deserve all basic rights and respect, however, protective sexual practice is needed while embarking on youthful affairs.

“Together We Can Make it Happen”

Leila Sheikh