Living to die. Dying to live.

Ever since we arrived at site, my fellow PCV Elayna and I have been coordinating the logistics of a PEPFAR funded mobile HIV testing unit that is set to begin operating in September 2007. In order to make the project a success, we've relied heavily (which any good community-based project should) on the input of both new and established stakeholders. One of our stakeholders, a major mining cooperation, liked the idea of a mobile HIV testing unit so much, they decided to provide funding for my organization to set up a mobile testing unit specifically to attend to the needs of people living in the informal settlements popping up around their areas of operation. "Hotspots" (the most under served areas) were identified and a running schedule was constructed. Due to the lack of time between being asked to start the project and the project's start date, there wasn't much time devoted to advertising (Shame)! So, what do you do when something doesn't work out just the way your want/need it to? You improvise! During the first few weeks of operation, VCT counsellors assigned to work on the van walked around the various informal settlements announcing the van's presence in the multiple languages spoken in the area (isiXhosa, Setswana, isiZulu, Venda, Shangan, etc.) Additionally, the van was driven around while counsellors announced the VCT schedule for the respective locations using loudspeakers.

Well, thus far, the project has been a success! The mobile unit is testing more people in one day than any other testing site (i.e. The Department of Health clinics and hospitals, private clinics, NGO-based clinics, etc.). The mobile is even out-pacing my organization's office-based testing service! Clearly, in this case at least, providing alternative testing options is useful when encouraging people to test, particularly when attempting to reach out to people living in economically resource poor communities, who may be unable to afford the cost of transportation to an office-based VCT site. This sounds cliche, but I'm going to say it any way: If people can't come to the service, bring the service to them. (There, I said it!)

So, you're probably thinking to yourself: So where does the title to your post fit into the story? Well, one of the most interesting bits of feedback provided by counsellors is the issue of clients and community members wanting to know more about the "HIV grant (Disability grant)". The South African government has provided a grant for people who are unable to work because of a mental/physical disability. In the case of HIV infection, if one is unable to work because of an HIV-related issue and the CD4 count is below 200, one is eligible for the grant. From my understanding, when the CD4 count rises over 200, the grant is stopped, because theoretically, you will be in a better state to work. So here's the missing link to the story: counsellors have noted that many people stop them to ask about how to get the grant money. People have come in for testing, and when testing negative, become upset because they don't qualify to get the grant money. When testing positive, some people are actually happy, because this means they have an extra income. I'm going to give you time to think about that one .........................................................................................................
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Sad and scary, huh?! I'm sure that many of these people have some level of understanding in terms of the possible implications of what one faces after testing positive: stigma, discrimination, failed health, isolation, being so weak that you can't stand up...and the list goes on. I say this, because the majority of people within South Africa, I would argue, know someone who is or was HIV positive. They've probably seen first hand that HIV in South Africa is not a pretty picture.I guess that it's difficult for me to understand on a deeper level, because I've never been in a situation where I felt the only way I could bring money into the house (to pay the bills, eat, seek medical treatment, put clothes on the backs of me or my family members, etc.) was to contract a disease. It is a level of desperation that I would never want for myself or anyone...but unfortunately, it is someone's...

Poverty, desperation, low self esteem, low self efficacy, oppression, misinformation, gender inequities, and a whole bunch of other issues compound on each other, creating a distorted reality whereby contracting HIV becomes an income generating disease........