I got up the courage to ask for an HIV test on Monday.
“Who is the person you wish the test for? Are they an adolescent, a patient of yours?”
“No, no, actually, it’s for me…”
A rapid-fire exchange in Setswana followed between the social worker and the receptionist — the only words in English were “Rapide” and “teste” (the ‘e’s on the end are my approximation of the Setswana accent.) Phones were called, people were consulted, a to-do was made.
“They are out. They ran out. Come back tomorrow morning and find a nurse, OK? Maybe they’ll be back in stock.”
For the next few days, though, every time I went down to ask for a test, the waiting room was stuffed full of patients — little kids and their parents. Everybody was running around with clip-boards and things were generally hectic.
The Baylor-Botswana Clinical Centre of Excellence, where I work, is solely a paediatric HIV clinic. That’s its mandate, why it is funded — and it is a safe bet that every one of those little kids I see in the clinic waiting room every day has HIV, or is sick and probably has HIV but doesn’t know it yet. But HIV is still so taboo here that these little kids already face stigma and discrimination.
My co-worker Vera told me a story about Baylor. She’d mentioned to a guy she was chatting with that she worked at the clinic…
“Oh, I take my little brother there sometimes.”
“Oh, yes, he has HIV?”
“What?! NO! It’s something else, he’s just sick sometimes.”
“Well, the clinic is an HIV clinic.”
“No it isn’t.”
Vera is very soft-spoken, but firm. “Well, I mean, I work there, and…”
“It is not an HIV clinic. They do other things.”
Finally it quieted down in the lobby, with only a few patients left waiting, so I went through the rigamarole again at the front desk. Things were yelled across the lobby, individuals consulted, querying looks deliberately-not-exchanged, and eventually the right person was located, the person with the keys to the storage room containing the tackle box in which the rapid HIV tests are kept.
Rapid HIV tests are fairly new, and very convenient: like a home-pregnancy test, except that instead of peeing onto a stick, you prick your finger.
I stood waiting for swipe-cards to be procured and things to be written on sheets. I really had the feeling that it was
actually unusual for them to do a test on an adult, or a staff member, or a foreigner — couldn’t really tell what it was that was unusual, honestly, but I’m sure it was one of those things. But by that time I was committed, so I couldn’t mumble something and fade away; so I just stood there and tried to look, I don’t know, healthy? There is an HIV clinic for adults on the sprawling hospital grounds I could have gone to, but it can take hours to get a test there — although HIV testing is thankfully free, in Botswana — so my coworkers all agreed I should just get it done at Baylor for expedience’s sake.
Given the rigamarole, I was starting to wonder…
Finally we went into an exam room. Ok. Here we go. I asked if I could take pictures.
That was another odd request, it seemed, but why not? Ok. So we got to it. As she was preparing, the nurse asked if I needed counselling. “Maybe you counselled yourself?”
“Well, please tell me, how does this all work?”
The nurse explained that there are two tests, for accuracy — sometimes they return false-positives, so it’s better to be sure. Although, she said, if one does show a positive result, they’ll draw blood and send it for further testing, even though you’d likely be negative. Hopefully.
“What name would you like to use?”
“For the records. Because you work here and everything…”
Then I realized: she was offering me the opportunity to put down a false name, so that if the test was positive, my co-workers wouldn’t inadvertently find out my status.
I’ll admit that I wasn’t brave enough to insist on using my real name — but once I saw that the result was negative, I told her to go ahead and put it in anyway (although the fact that I was tested at all, even that could be prejudicial elsewhere; but not amongst this staff, at least.)
She lined everything up, grabbed my hand, and pricked my finger. “I like lady’s hands!” she said. “They are so much easier to get blood from. Men’s hands are so hard.” Translation? My soft life spent being lazy and never doing an honest day’s work has finally and unexpectedly paid off!
(… my finger hurts.)
She squeezed my blood into the little receptacles on the tests, and then put a few drops of liquid on each one. I didn’t see clearly if they were saline solutions, or something reactive that mixed with the paper test material; she wasn’t sure, but each one belonged to a specific test-brand.
Then we waited.
And I felt nervous.
Something about sitting there watching the liquid move up the paper towards where the “positive” line is — and then pass it without leaving a mark — makes it much more real than when you go for a physical and the doctor takes your blood away and then just doesn’t call.
Melissa, the HIV Specialist at WUSC, warned us that this would happen — no matter how sure you are that you live a boring, low-risk lifestyle, and haven’t accidentally slashed open your hand reaching into a bag of sharps, or that all your partners have been honest, or that your wild youth wasn’t really all that wild… still, you worry.
Imagine the worry of a person living here in Botswana, where insisting on using condoms is perceived to be admitting you have HIV, where the problem is minimized and scorned, and where admitting to your partner that you have HIV could get you ostracized from family and friends forever? That is how HIV spreads, as it has done here, and continues to do.
Two lines means positive; one is negative.
One in five people here have walked into a room like the one I sat in, had their fingers pricked, and seen two lines instead of one.
I can’t imagine.