By Gbadegesin Alawode

As a young professional in public health, my fresh eye and enthusiasm was met with realism that bordered on the cynical; one that cast a shadow of soberness and unrest within me. This came as a result of completing my 24-week internship with a non-governmental organization providing preventive care and treatment services for those living with HIV/AIDS in Nigeria.

I had worked with the monitoring and evaluation unit, which allowed me to journey to both urban and rural health facilities to collect, validate, collate and analyze data of people tested monthly for HIV and the positive cases that were started on Antiretroviral therapy (ART). Every week, the ART clinic is filled to the brim with young people, women and children. Along the corridor of the data office are iron chairs bearing the weight of HIV/AIDS patients wearing the same stoic expression as they wait to see the doctor or for the pharmacist to dispense their drugs.

During this internship, I saw poverty, ill health and injustice coexist. They limited the growth, productivity and lives of people like myself. Sadly, Nigeria has over 3 million people living with HIV, making my home country the second-most affected country of the pandemic in the world.  

Monique* was a middle-aged woman whom I met at the clinic and had a chance to interact with; and whose story changed my life and shaped my career for the better. Taking a break away from my usual register count, I would ‘catch up’ with her once in a while.

She would travel a long distance away from her home to pick up her drugs for the month, depending on her drug pick-up date and months of ARVs refill. Initially, she would try to hide her face, afraid that perhaps someone who knows her could be within the vicinity. I could see the gloom and doom reflecting in her countenance. She would occasionally talk about her wish for magical healing in whatever way possible. Once, she had been inconsistent with taking the drugs, but was quick to return for a vital refill of her prescription when her health abruptly deteriorated. She and other patients would empty their drug packages right before they left the HIV clinic, discarding the exterior packaging in rubbish bins so people would not see them with the drugs. 

The fear of being discovered was not irrational. On a particular day, Monique recounted to me the maltreatment she received from her very own sister. The details were painful and personal, and it was clear that she hadn’t been getting the love and psycho-social support she needed from her family and other community members. She had been viewed as a burden rather than someone who needs respectful care and compassion to live a healthy life.

“They view me as a walking corpse, awaiting her death,” she said.

Her secrecy and anxiety at being recognised in the clinic was all too clear to me. I asked myself how, if her own sister could treat her like that, could I begin to imagine how much more discrimination and stigmatisation she was subjected to daily from the community?

As a cultural norm in Nigeria, diseases like HIV/AIDS and STI’s are viewed as a result of immorality with the burden of guilt laid solely at the doorstep of women. The societal lens is devoid of empathy and full of disgust, discrimination and stigma against people living with HIV. Monique explained this all to me with tears in her eyes. This, in addition to everything else she had to deal with: the effect of the drugs on her health, her poor mental state, poverty, and collective backlash even from close and trusted people.  

Powerless and heartbroken, I questioned my own reality and context. How could I begin to understand Monique’s pain from where I stood?

“Is this what it means to fight and live with HIV/AIDS in a low-resource setting?”

“Is this what it means to suffer and live in discrimination even from your own people?”

“Am I resilient enough to do this work?”

As I struggled with my own thoughts, I watched two HIV-positive children holding hands and playing in the presence of their mothers. One of the children was Monique’s son. The brightness of their teeth and innocence of their hearts gave deeper meaning to the injustice I felt for Monique, these children and people like them: how HIV/AIDS patients should be free to live their lives. I saw children who want to live robustly and achieve their dreams. This insistence of how life should be spoke softly to my subconscious, breaking the societal barriers placed before them in my mind.

These people living with HIV/AIDS have built bridges and provided the psycho-social support to one another that their community denied them. For them, their happiness and health is interlinked regardless of their status. They took me from my downcast moment and reinvigorated me to do my work with pride and commitment. If anything at all, at least for them, I realised that my work would forever have meaning. Their lives resonate around the quality of data I generate, which influences policies, program planning and resource allocation by the key stakeholders.

I felt as a young public health professional, my fresh eyes would have the ability to project solutions to the myriad injustices I see in my day-to-day work. Instead, I learnt from two children. And they taught me how those living with HIV/AIDS should rely on one another for support and friendship. They should build bridges and stand for one another, but they shouldn’t have to do it alone. Everyone had something to offer; some support to give… Even people like me.

I realised that I was born and raised up within my context; one where fear of contracting HIV/AIDS might be less, or public health awareness might be higher and I can choose to interact in this context without bringing my work home with me. And in this context, it’s possible to perpetrate or exhibit some of the injustices I so much condemn, even if I don’t intend to. Hence, I and other healthcare workers must be thoroughly cleansed of any form of prejudice that may hinder progress or put patients at risk. We must show compassion, respectful care and support the dignity of our patients – not just as patients, but as people.

I witnessed the lives of those behind the emptied packs, both before and after Monique’s stories; and the stories I heard during this internship became my most relevant journey. One that will always spur me to speak up and break unjust cultural or discriminatory barriers that make life and good health more difficult for people living with HIV/AIDS. With a long career path before me, I have committed to lifelong ethics of not judging or defining people by their status within or outside my country. This is a promise I hope to keep.