{"id":8713,"date":"2021-12-21T14:05:00","date_gmt":"2021-12-21T14:05:00","guid":{"rendered":"https:\/\/www.cordaid.org\/en\/?p=8713"},"modified":"2024-12-30T14:17:55","modified_gmt":"2024-12-30T14:17:55","slug":"the-battle-against-hiv-aids-and-the-lessons-for-covid-19","status":"publish","type":"post","link":"https:\/\/www.cordaid.org\/en\/news\/the-battle-against-hiv-aids-and-the-lessons-for-covid-19\/","title":{"rendered":"The Battle against HIV\/AIDS and the lessons for COVID-19"},"content":{"rendered":"
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The HIV\/AIDS crisis started 40 years ago. As did the long and laborious battle against the virus. Two Cordaid experts were there in the \u201980s in the epicentre: the African continent. They take us back to the frontline and draw parallels with the COVID-19 pandemic.<\/strong><\/p>\n\n\n\n

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With the support of the Global Fund, Cordaid supplies AIDS medication in all corners of the Democratic Republic of Congo. \u00a9 Cordaid\/D Productions<\/figcaption><\/figure>\n\n\n\n

In the 1980s, the Netherlands still sent hundreds of healthcare professionals to Africa every year to work in hospitals and train doctors, nurses, and paramedics. Memisa, a Catholic health NGO and one of the predecessors of Cordaid was well known for this, just like ICCO, Cordaid\u2019s Protestant counterpart, which has now merged with Cordaid. Times have changed. Today, mission hospitals and other African health facilities are mostly run by African professionals.<\/p>\n\n\n\n

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‘Gloves and surgical clothes were still washed, syringes were recycled.’<\/p>\n<\/blockquote>\n\n\n\n

Jos Dusseljee, Cordaid’s senior health expert, works closely with hospitals and governments in countries such as Zimbabwe and Uganda to improve healthcare systems. He is now based in The Hague, but in the ’80s and ’90s, he was a medical advisor in Kenya, Uganda, and other East African countries. In the same period, senior sexual and reproductive health expert Christina de Vries trained staff and worked as a tropical doctor for ICCO\/Kerk in Actie in various hospitals in Africa, notably in Nigeria.<\/p>\n\n\n\n

\u2018Weird things are happening\u2019<\/h2>\n\n\n\n

In the early ’80s, Memisa started receiving disconcerting messages from its doctors abroad. \u2018Weird things are happening. Death rates are skyrocketing, and we don’t know why.\u2019 At one point, the medical director of Memisa, Tom Puls, decides to take a stock of blood samples from Uganda to the Netherlands. Test results are irrefutable. It\u2019s this new disease, AIDS.<\/p>\n\n\n\n

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‘I can still see the bits of coloured toilet paper fluttering and blowing away in the strong wind. That’s how they decorated the graves. You were covered in toilet paper.’<\/p>\n<\/blockquote>\n\n\n\n

It took time for doctors to deal with the new disease. A lot of time. ‘There was a course at the Tropical Institute in 1985. That was the first time we were taught about HIV and AIDS,’ Jos remembers. It was also the year in which Jan van den Hombergh, a Dutch doctor in Tanzania, reported the first two AIDS patients in Memisa\u2019s newsletter.<\/p>\n\n\n\n

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Nigeria, 1988. Christina de Vries at work as a tropical doctor. ‘Here I am with Ayuba, one of my operating assistants. We didn’t have disposable masks and gloves yet. Our surgery clothes were washed, sterilized, and reused again and again. We also had shutters for the operating room windows, which we opened for fresh air between operations. Yet somehow, I had fewer post-operative infections there than in the Netherlands.’ Image: C. de Vries<\/figcaption><\/figure>\n\n\n\n

‘It felt suffocating and risky, in those years, to work abroad as a tropical doctor. HIV tests either didn\u2019t exist or were far too expensive. There was no treatment. We had to wait until 2000 for a combination of drugs that worked,’ Christina recalls. ‘Gloves and surgical clothes were still washed, syringes were recycled,’ Jos adds.<\/p>\n\n\n\n

Harsh Conditions<\/h2>\n\n\n\n

Just how risky becomes clear when Henk Engel, a Memisa doctor who had been running a hospital in Kenya for years, gets infected during an operation in 1987. He accidentally cuts his hand. His patient was later found to have HIV. It\u2019s a workplace accident. Treatment in the Netherlands, with the then-just registered drug AZT, is not working. In 1992, Henk Engel dies of AIDS.<\/p>\n\n\n\n

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In countries such as Malawi, Uganda, South Africa, and Nigeria, infection rates among adults reached up to 30%.<\/p>\n<\/blockquote>\n\n\n\n

Jos, who worked with him at the mission hospital in Kenya: ‘That fatal incident during the operation did not happen out of the blue. The work pressure of doctors in understaffed and underfunded African hospitals is extreme. Doctors often did ten deliveries daily, in addition to operations, in dire circumstances.’<\/p>\n\n\n\n

Christina, who had studied with Henk Engel: ‘When ill, Henk fought a very important battle against stigma, discrimination, and humiliation of HIV-positive people. He was one of the first who dared to talk openly about his own illness. Who put HIV-related occupational risks in the hospital on the agenda? He insisted on more safety and protection of healthcare workers. He fiercely campaigned for better medical insurance because tropical doctors at that time could not insure themselves against HIV\/AIDS.’<\/p>\n\n\n\n

It takes 15 years before well-functioning and affordable AIDS medicines are available on the market, also for patients in Africa. 15 years. And while the medical world is grappling with the new disease, \u2018coping in the dark\u2019 as Jos calls it, HIV and AIDS, stigma and exclusion strike mercilessly.<\/p>\n\n\n\n

Infection Rates<\/h2>\n\n\n\n

The world has no answers. In Malawi, Uganda, South Africa, and Nigeria, infection rates among adults reach up to 30%. The virus is decimating a part of the population, mostly young adults. In the late 1990s, in Malawi, 10% of the households were orphan-headed. In Southern Africa, large-scale Granny Programmes supported grandmothers in carrying the burden of caring for their grandchildren.<\/p>\n\n\n\n

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‘Newspapers were full of obituaries of young people. But not a word about AIDS.’<\/p>\n<\/blockquote>\n\n\n\n

AIDS-related death rates cause burial congestion. ‘I can still see myself standing in a cemetery in Lusaka, Zambia. Surrounded by fields full of fresh graves of people under thirty. Dozens of funeral processions, queueing, waiting. I can still see the bits of coloured toilet paper fluttering and blowing away in the strong wind. That’s how they decorated the graves. You were covered in toilet paper.’<\/p>\n\n\n\n

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Cordaid health expert Jos Dusseljee (far left) visiting a health centre in Tapourou, in the Central African Republic. Image: Cordaid<\/figcaption><\/figure>\n\n\n\n

In 1996, Christina funded a freezer project in Kenya. ‘That was for mourning centres, to keep conserving corpses for a longer time and to have burials take place on one day of the week. People had to go to a funeral almost every day. They couldn’t do their job anymore. Newspapers were full of obituaries of young people. But not a word about AIDS.’<\/p>\n\n\n\n

In some African countries, life expectancy plummets by 10, sometimes 20 years. Mortality among the working population completely undermines already weak and understaffed systems in health care and education. It shakes entire economies. When Christina returned in 2005 to the hospital in Nigeria where she had worked in the 1990s, she only met older colleagues. ‘All the young people I had trained had died of AIDS.’<\/p>\n\n\n\n

Sin, Disease, Denial<\/h2>\n\n\n\n

For a long time, the Catholic Church denies what is happening. The link with sexuality is a great embarrassment to religious leaders. In their eyes, \u2018true Christians are faithful and cannot get HIV\u2019, or \u2018good Muslims cannot get AIDS\u2019. ‘They were at loggerheads with sin and disease and didn’t want to do the right thing in disease prevention,’ Christina says. ‘The number of funeral masses priests had to perform was a real burden and kept them from doing other things they wanted to do. It was a cause of burnout among many young priests. Still, they continued only preaching abstinence.’<\/p>\n\n\n\n

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A member of staff at PASCO carries out a free HIV test at a bar in Kinshasa that sex workers frequent. Image: Lisa Murray\/Cordaid<\/figcaption><\/figure>\n\n\n\n

ABC was the mantra at the time: abstinence, be faithful, and, ultimately, condoms. ‘Often it was ABCD, with the D for ‘or death will follow’. But for the Church, the only real protection, condoms, was out of bounds. That total denial has caused a lot of damage,\u201d says Jos. \u201cIt was only much later that the Church began to devote itself to AIDS patients in their final phase of life, to AIDS orphans and other surviving relatives.’<\/p>\n\n\n\n

A Chronic Disease<\/h2>\n\n\n\n

The harrowing AIDS pandemic peaked in the \u201880s and \u201890s. The great shock wave is over. True, after 40 years, there is still no vaccine. But combination therapy works well, prolongs life and prevents HIV infections. Drug prices dropped sharply, making them affordable not only for the rich. Treatment of AIDS has become part of regular care, also in Africa. Today, AIDS is a chronic disease you can grow old with.<\/p>\n\n\n\n

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Patients turned their individual struggle for survival into a collective struggle against stigma and a struggle for fellow sufferers.<\/p>\n<\/blockquote>\n\n\n\n

So yes, the world did find answers. Also, in Africa. Thanks to thousands of African doctors, nurses, and tropical doctors from abroad, they kept going against the grain, sometimes until the bitter end. Thanks also to major investments from the UN and the Global Fund of Bill and Melinda Gates. Thanks to people like Joep Lange, the leading Dutch AIDS expert who died in the flight MH17 disaster. And thanks to millions of AIDS patients themselves, who turned their struggle for survival into a collective struggle against stigma and a struggle for fellow sufferers. Like Clarisse Mawaki in Kinshasa.<\/p>\n\n\n\n

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Kinshasa, July 2018. Clarisse Mawaki coordinates a ‘distribution post’ in one of the poorest parts of Kinshasa. HIV-positive persons come here for their medication and support. Image: Cordaid\/Frank van Lierde<\/figcaption><\/figure>\n\n\n\n

Yes, answers did come. But it took years. And in those years, AIDS took the lives of 36 million people.<\/p>\n\n\n\n

People still die from AIDS, especially in African and Asian countries. 680,000 last year. That is why Cordaid continues to work on preventing the spread of HIV and making AIDS medication accessible to everyone who needs it. In DR Congo, a country as big as Europe, we do this with the generous support of the Global Fund<\/a> against Aids, TB, and Malaria. The drugs we distribute and the health facilities we support in even the remotest corners are a lifeline to many.<\/p>\n\n\n\n

As you can see in this video.<\/p>\n\n\n\n

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