Any boy or girl is willing to tightrope along the curb on the side of the road, heel to toe and arms outstretched, and any kid can do it for nearly any distance without wobbling. But if the same stretch of curb spanned the Grand Canyon, the lithe kid who skipped from one end to the other blindfolded suddenly would be terrified to take the first step. The challenge is not any greater, but the consequences of a misstep are terrifying.
Getting tested for HIV is always a little frightening, no matter how confident you are the test will come back negative. For no rational reason, getting tested in Africa – in popular conception the disease’s evil lair – is especially nerve-wracking. It is the tightrope across the Grand Canyon.
My behavior in Africa has been no different than anywhere else. It’s not exactly risk-free, but it’s also nothing that would alarm any HIV expert. The difference is that it’s sometimes hard to avoid the perception that HIV is floating on the African air or swimming gaily in Africa’s streams. The virus is so prevalent in Africa that it must be impossible to spend any length of time on the continent without bumping into it repeatedly. An infinity of chance encounters is statistically guaranteed to yield the right combination of open wounds and cold soars at some point. The math may be wrong and the reasoning irrational, but after three years of living in Kenya I couldn’t escape the thought as I ascended the stairs to a Voluntary Counseling & Testing center in downtown Nairobi.
I hadn’t planned on getting an HIV test that day, but I had been thinking about it for a few weeks. Strangely though, once I had resolved to take the next opportunity to get tested, VCTs became much harder to find. Kenya has an impressive network of them, some in absurdly remote locations where the population density would not seem to justify any public services. I remember passing one on the sand track to the west coast of Lake Turkana, in the far northwest of the country. For over an hour we had been driving through the same grey desert scrub; the only people we had seen were camel herders. Finally, we passed a village of maybe a dozen stick huts, housing for not even a hundred people. There was exactly one concrete structure in town, a VCT. Back in Nairobi, though, I had been struggling to find one; I hadn’t been actively looking, but I had been keeping my eyes open for their trademark purple and yellow signs.
The center was reminiscent of any public service office. It occupied half of the fifth floor of a downtown walkup. The stairwell was grey concrete with flickering florescent lighting, disconcertingly like a horror film set in a psychiatric hospital. Inside the VCT a slightly better effort had been made to present a warmer, more reassuring décor. There was brown carpeting, some wood paneling on the walls, and a water dispenser. The focal point of the waiting room was a coffee table surrounded by the cheap, white, plastic chairs so ubiquitous in Africa. A television in the corner played the local news.
The receptionist gave me a numbered card that became my surrogate identity: 10804. Everything was completely, rigidly anonymous. Every paper I signed, every health survey I completed, every administrative record they kept used only my number to identify me. When, later, the nurse who would administer my test introduced herself, saying “Hi, I’m Jane,” I instinctively started to reply “I’m Martin.” But before I could utter my name she cut me off, clearly a little vexed at my breach of protocol.
I paid the receptionist 100 shillings, not much more than a dollar, and I sat down to wait for my number to be called. On the coffee table were a few small, neat stacks of brochures, all printed by the government of Kenya with financial support from the United Kingdom. The subject of each brochure was “Talking About…” a particular aspect of HIV: The Facts on AIDS, Living with HIV & AIDS, AIDS with Our Children, and Antiretroviral Therapy. On the cover of each brochure was a cartoon portrait of a happy Kenyan family. As in America, where being politically correct and market savvy requires advertisers to feature a mix of white, black, Asian, and Latino Americans, the cartoon families – though all black – highlighted the diversity of Kenya’s population, from urbanites in suits to Masai cattle herders in tartan robes. One family appeared to have a Muslim father and a daughter wearing a Christian cross pendant on her necklace. In addition to the locally produced brochures, there was an outized pile of one edition – number 110, from June of 2000 – of a newsletter called WORLD – Women Organized to Respond to Life-threatening Diseases – out of Oakland, California.
Like the VCT program in general, the brochures are surprisingly well done. They are honest and blunt, which seems like exactly what they need to be if they are meant to encourage dialogue. They are carefully phrased to destigmatize HIV and AIDS, persistently reiterating that “people who have the AIDS virus can still be productive citizens of society” and people with AIDS “should be treated just like anyone else.” The brochure about living with HIV and AIDS is largely aimed at the infected person’s family: “the care and support provided by family and friends is extremely important in keeping loved ones alive and preventing anyone else from getting infected. If a person becomes sick with AIDS they should be given the same love, respect, and care as any other person in the community.” The one about talking to your children repeatedly stresses the importance of discussing the dangers of prostitution and “sugar daddies.” All of them make informative, nonjudgmental references to homosexuality, a topic rarely discussed with any candor in Africa. In a uniquely African passage, the reader is warned about the use of “uncleaned sharp objects for tattooing, circumcision, scarification, initiation, and other cutting of the body.” Anyone considering ART should first ensure access to clean drinking water.
The nurse called my number from a clipboard she had in her hand and led me to a cold, clean room that contained only a small table and two chairs in one corner, where we sat, and another smaller table in another corner. It felt very clinical, but there was a large window over my shoulder which let some warmth and light into the room. The tabletops had nothing on them; everything she needed was on her clipboard. An empty wastebasket was tucked under our table.
As the name of the place suggests, there was some counseling to be done before getting to the testing. She ran through a survey of behavioral questions about what I had and had not ever done. It was oddly like the drinking games played by many teenagers – and, embarrassingly, some adults – looking for a script to facilitate flirtation. As teenagers my friends and I had given ourselves something called a purity test that asked one hundred yes or no questions and then tallied our responses to determine how relatively pure or impure we were. At that stage in life it was hard to discern the point at which cool became weird and degenerate, but before an HIV test every affirmative answer felt a little shameful – and was followed immediately by a short, scripted lecture from the nurse.
The counseling over, she pricked my finger and milked two drops of blood from my nervous, constricted blood vessels. She smeared them on to opposite ends of the testing swab, and then she got up from the table where we were sitting and walked my incubating HIV test to the far corner of the room and put it on the table there. It looked like a scrap of old parchment alone in museum display case.
“It’ll be ready in about 15 minutes.”
She returned to her seat at the table we had been using and continued her counseling, now telling me about the type of test she was administering and the odds of a false positive or negative. I’m sure it is all fascinating information if you’re reading it online and undistracted, but at the time all I could focus on was the number of pinkish lines forming on my test swab across the room. I sat up straight and craned my neck, but it was too small and too far away for me to resolve whatever was going on with my test results. Noticing my distraction, the nurse checked her watch and said, “It’s probably ready now.”
When she brought my test back to the table, she made me read the results to her. “It’s negative,” I said.
“Yes, it is. But I think you knew it would be, didn’t you?”
I have had exactly three HIV tests in my life, in three different cities. One was given by a white American woman, one by a black American man, and one by a black African woman, and every one of them said something similar suggesting that I just don’t look or sound or act like the sort of person who would contract HIV. For all of the industry’s talk about how anyone can get the virus, every one of its practitioners I have met has made the same superficial judgment about me.
Maybe I don’t look so fearful as the kid who has to tightrope across the Grand Canyon. Maybe I’m confident enough that it’s just like balancing on the curb on the side of the road. And maybe it shows.
Or maybe, as a form of encouragement, they say that to everyone whose test results are negative. Maybe, in Africa, they don’t get to say it as often as they would like.