The Magnitude of the Problem

The problem of HIV in subsaharan Africa is mind-boggling. I am starting to realize it now.

As an example: I was all excited on Monday when we diagnosed this guy with malaria. 29 year-old Botswana resident, had traveled to Namibia about 3 weeks ago, presented with fevers and chills, low platelets. We got a blood test called a malaria smear (basically you just smear blood on a slide, look at it under the microscope, and look to see if there are any malaria organisms living in the blood) which came out positive. I was ecstatic! A potentially lethal disease which we know how to treat, completely reversible. Before the malaria test came back, an HIV test had also been sent in the ER.

Mere moments before discharging him, the HIV test came back positive.

It's not the worst news in the world. We can still help him with the malaria, and now that Botswana has a comprehensive HIV treatment program, there are medications available (free for all citizens...one way in which this African nation is more advanced than the good ol' US of A!). But it's sad.

In the past two days we've also found +HIV tests on patients who presented with complaints as diverse as right leg cellulitis and subarachnoid hemorrhage--which are likely completely unrelated to the HIV status. It's gotten to the point where if somebody comes in with a broken pinkie--I'm coming to expect that the HIV test will come back positive...