Trip Start Mar 01, 2006
Trip End Jul 25, 2006

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Flag of Botswana  ,
Thursday, May 11, 2006

I've wanted to write this message for a while.  We all wonder why the HIV situation is the way it is here.  Now I still can't explain this but I can give you some insight into my experiences thus far. 
I find that the environment very judgemental.  At a recent workshop, participants working in the field of HIV (usually at a government level) felt that clothing increases risk behaviours as do the promotion of condoms, sexual education and alcohol.  In fact, yesterday I got in an arguement with the participants at this workshop because there was a case of a woman who was involved with a married man and she had an STI.  Everyone focused on trying to get the woman out of the relationship without any consideration of his/her feelings (which, if strong - the relationship won't end so it would be a waste of time) or the economic reasons behind the relationship - she was dependent on him to support herself and her children.  People were so judgemental that I would hate to be her trying to get medical help from our group.  I really doubt that she would meet a receptive environment to get medical help.  It is actually quite common to be turned away from services or to be condemned for previous behaviours.  It would be difficult for anyone to seek help inf they are only going to be judged.  In this case, she never got medical treatment (she was turned away).  Think of the implications of this - her STI goes untreated, she is experiencing painful symptoms, she can become infertile, she can pass the STI onto her partner and/or her unborn children and it dramatically increases her risk of contracting HIV.  I argued that we, as service providers, can't make the decision for her of whether or not to be in that relationship.  We can however provide information, medical assistance and support but she is the only one who can make the decision to stay with her partner or not.  By pushing/forcing her to end the relationshjip we end up pushing her away from the services she needs immediately by passing judgement and trying to get her to adopt our ideals and not hers.  We aren't being realistic of the situation she is in or about the culture of the country. 
These kind of judgements have continued throughout the training.  I got into another arguement regarding multiple partners.  It is very common for both males and females to have multiple partners.  This practice is normal and encouraged.  Today my counterparts said that we should stop people from having multiple partners.  I don't understand how we can do this, if there are other factors influencing this behaviour (i.e. cultural, economic, social). This statement concerns me because I think that HIV service providers preach one thing and it's not necessarily appropriate to the culture.  I worry that we aren't focusing our efforts on the real concern.  It's not multiple partners but rather the lack of consistent and proper use of condoms.  From what I see, people agree with what the service providers are saying "Yes, it's bad to have multiple partners" but no one is changing.  They still go out and have these types of relationships.  This in turn causes them to worry about being judged and then they don't go to get the free condoms that are available or the services that they need.  It's also very evident that service providers themselves are just as guilty of this behaviour.
For example, we had the head of an International AIDS agency here.  Some of my colleagues took him out one night.  One of my other friends happened to be there and told me the next day what happened.  The head of this agency (male) hit on many people, including my friend and eventually went home with someone.  Another colleague (female), who happens to be married, also hit on my friend and tried to go home with him.  She has a reputation of having slept with numerous people despiter her marriage and 2 children.  And the story goes on for all my colleagues.  It's overwhelming. 
It really hit home one night after I went out dancing.  There was a guy that started to bother me so I told him that I'm married and my husband was over there (pointing ambiguously in one direction).  The man got so angry.  He said that because I'm married I should not be going out.  Men will want to go home with me and my husband will get angry.  Then he said that I'm not giving my husband his freedom to have fun.  Since I'm there he's not able to meet other women.  I sadi that he shouldn't be meeting other women because he's married.  But the guy said that he should and I should believe him because he knows.  My colleague also told me the same thing a few weeks later, saying that she never goes out with her husband..."she sees enough of him during the week".  This is absolutely accepted behaviour.
How do we make a difference when the people who advocate for change are themselves engaged in (what is considered) high risk behaviours and they are the ones judging others?  Is it not okay to say that people should protect themselves - use a condom regardless of lifestyle?  Furthermore, are you going to listen to someone that tells you one thing but does the complete opposite?
I feel that we need to start being honest witho ourselves about the real situation in Botswana.  Why don't we admit that multiple partners are the norm?  Is it not okay to say that?  I really feel that we need to make programs that reflect the local culture (and aren't judgemental).  If we do this, then the desired behaviours are more likely to be adopted and I think we would have a real chance of reducing the incidence of HIV in the country.
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