I(Deb) will never forget the first time I shook hands with a man with AIDS. It was in my own country in the basement of a cold, stone church. His face was a mottled purple with cracked and swollen lips. His hands and arms were riddled with marks and scabs like I remembered chicken pox looking on my brothers and sisters. I could hear my mother saying when my sister lay limp with fever, "Don't get too close. You might get it."
Everything in me stepped back. I was repulsed. What if I get it? What if I give it? Perhaps this volunteer work is going a bit too far. It's one thing to expose myself, but what about exposing my husband and my children?
I wasn't asleep to helping people in need. I had chosen a nursing career to guide me toward others, not away from them. But there was a kind of indifference in me I didn't know I had - a self-protection that meant I recoiled when pushed to the edge of suffering myself. I was willing to see suffering and maybe to help alleviate it. I wasn't willing to suffer myself. I didn't realize then that helping those who suffer from AIDS would invite a vulnerability that would shape my own struggle to suffer with them.not in getting the disease but in becoming so affected by AIDS that it would change my life.
It shocked me to consider how conditional my concern for others was. I was a pastor's daughter; throughout my childhood my father brought home drunken men to dry out and homeless families who wandered into the church. My lifelong journey with my physically and mentally handicapped twin brother taught me how to care for the defenseless. I was prepared for the world even though I lived sheltered from it.
The purple-faced man gentled me with a smile, exposing a thick tongue and rims of frothy white sores on his lips and gums. His dark eyes glistened.
"Thanks for coming," he said, as a hint of strength pressed through his fingers to my hand cradling his.
I thought I knew how to give. This man taught me how to receive. He gave me the opportunity to understand more of his suffering - to explore deeper lessons of suffering and receive lessons about my own frailty, ambivalence, conditional love and sometimes impatient faith.
That was seventeen years ago. I've come to realize AIDS - not the people with AIDS - is still mysterious. In 1988 it looked confined, almost manageable. Most public health professionals thought changed behaviors within the homosexual community would turn things around. We believed we could apply the best of medical science, technology and epidemiology to a shrinking world and control it.
In the early years of the epidemic, the international AIDS conference convened every year to share and debate the most recent advances in the molecular configurations and DNA of the virus that causes AIDS, convincing us that keys to unlocking a cure were within reach. The virus seemed contained within the homosexual community and pockets of cities with offbeat bars and alleys.
Most people felt immune. "If we don't get close, we won't catch it," we told ourselves.
Christians didn't bother to get involved. In North America we thought it was a gay disease - a justifiable gay disease, in fact, that showed the consequences of sexual sin. So the bands played on. Our worlds never intersected, and we liked that. We wouldn't catch it that way.
We couldn't have been more wrong. AIDS isn't confined and never really was. It's just hidden much of the time. The virus copies itself, disguises itself and, with new configurations of viral parts, strengthens itself to do the sinister work of destroying the very system the body uses to defend itself from such invasions. The body withers, defeated by a particle sixty times smaller than a red blood cell.
AIDS is a disease that brings death to people in the most productive stage of life - teens and adults between fifteen and fifty. Most people get it by having sex with someone whom they don't know is infected. The tiny virus. passed through sexual fluids, fresh blood and sometimes breast milk. cycles from aggressive attacks and periods of rapid multiplication to sinister games of hide-and-seek within the body. Its effects may tarry, but it will never leave. Usually affected people have no idea that they've been attacked or that they have the potential to infect others. Years later, the virus surfaces with vile vengeance and oscillating destruction. Short periods of fever, cough and diarrhea give way to months and years of illness. Common infections, including tuberculosis (TB), fail to yield to treatment, becoming death traps, joined by cancers, neurological problems and sometimes blindness and deafness.
AIDS is most often caused by sex, bringing one of the most troubling paradoxes of the disease. How is it that the most intimate act designed by God to be enjoyed by two married individuals has become the conduit of death for many millions? How can the pinnacle of pleasure become the promoter of pain?
Some questions are best not answered. Not because there aren't answers, but because answers are incomplete. As soon as we are categorical about AIDS resulting from adultery, we learn the risk of infection is greatest in Africa among women who have done nothing but be faithful to their husbands. As soon as we hide from homosexuality issues, we learn that the struggle for sexual purity is deep within our own soul, and our own pointing fingers forbid an honest look. As soon as we are unforgiving toward those involved in sex before marriage, we discover hidden Internet accounts of pornography among those we deeply trust.
Lim's thick, dark hair and petite frame were moneymakers, and she used them well. She made a living selling her body.
Every night before making her way to the low end of town near the river, Lim made food for her daughter, Chrub, then got herself ready for work, adorning her dark eyes with precise streaks of black liner. After splashing herself with perfume, she left the house. Her silken hair flowed freely behind her as she took the motorcycle taxi to her business on the other side of Phnom Penh, Cambodia.
Men came all night long, some of them bringing boys.twelve, thirteen, fourteen years old. Lim was paid to introduce boys to sex. They were to practice and have fun with her so they could be experienced and restrained with their wives when it was time to get married. It is a kind of initiation, widely practiced and accepted, though not talked about except among the boys themselves.
As Chrub grew older, Lim prepared her daughter to learn the job, introducing her to clients. A young, beautiful virgin would produce a fat income.
There was little choice for Chrub. She soon became part of the routine, sleeping during the day and working at night. She hated her job, and she hated herself. In fact, she wondered if anyone loved her. She felt trapped. With little education, no available jobs, and surrounded by others who were selling sex, she had little choice. Many girls and women in her business did not have a choice.
She never used a condom.
Only one person in her family understood her - her grandmother, Sivon. Chrub often fled to her during the day, just to talk and be who she really was - a person, not a body. Her grandmother talked about her own childhood and the dreams she had for Chrub to have a different life.
Less than ten years after the killing-field era of the Khmer Rouge that Sivon had lived through, a new era of death began. Fueled by the sexual exploits of the military, commercial sex workers and injecting drug users, the killing fields shifted from the countryside to the bedrooms, street corners and heroin hideouts - this time through a virus. "AIDS is even more serious than war," Cambodian Prime Minister Hun Sen warned in 1999. "In some cases whole families have been wiped out - the father is dead, the mother is dead and later the children die of AIDS too."
Throughout this book, we are going to be introducing you to real people who have AIDS. In particular you will learn more of Chrub's story. She was found by a church in Cambodia who scoured neighborhoods looking for people living with AIDS, many of whom were rejected by their family members.
Chrub, a young, strong, beautiful woman, had a horrible sickness. It had started like any other illness. She had improved after a couple of days. Life had proceeded as usual. In fact, years had passed. Sickness had come and gone but now came more frequently. As coughing and fevers, diarrhea and weight loss set in, treatment failed to bring lasting results. Chrub grew weaker. There were days she could not manage to climb the few wooden-plank stairs to her platform living space tucked above the marshy muck of Phnom Penh's streets. She no longer went to work or carried water. She lay limp and pencil thin, her striking dark eyes piercing sleepless nights.
People began to talk. There was only one explanation for a sickness that doesn't go away no matter what you do, especially when it comes to someone so young, they thought. Few spoke about it, but everyone stayed away.
Sukunthea, a member of the Way of Hope Church in Phnom Penh, completed a workshop on basic care for people living with AIDS, and she set out to put her knowledge into practice. She discovered Chrub, abandoned in her home with only Sivon to watch over her.
In her classes, Sukunthea had learned how to approach homes with politeness and respect. She explained who she was and why she had come.to help people in the neighborhood too sick to help themselves - to Chrub and Sivon. "What might I do for you?" she asked.
She began with simple tasks.fetching water, making rice gruel, washing diarrheasoaked clothes. Day after day she came, and day after day Chrub grew weaker.
The neighbors kept talking, but from a distance. Doesn't the visitor know that home is cursed? Why does she come? And why isn't she getting sick, too?
Sukunthea's hope in the face of AIDS rested in her faith and her lack of fear. Sukunthea did not fear transmission from Chrub, because she knew and believed the facts about the disease. Many in Cambodia believe AIDS is a curse. To go near it is to fall under it. Because it is so feared, signs are sometimes posted near the door - not an AIDS red ribbon pledging support, nor a red cross symbolizing help, but a skull and crossbones warning of evil and death.
Unlike Chrub's neighbors, Sukunthea knew that AIDS is not spread through airborne transmission such as coughing or sneezing. It's not passed through handshakes, food preparation or consumption.even when sharing the same bowl or chopsticks.
What does transmit HIV is the mixing of sexual fluids through sexual intercourse - vaginal, anal and sometimes oral - where one member's body harbors the human immunodeficiency virus, HIV. This crafty virus invades and kills white blood cells that our bodies need to fight infections (including HIV). We are still discovering the mechanisms of how it operates. It attaches itself to receptor molecules on the outside of the white cell and fuses its own viral membrane with the cell's membrane. Then, through a series of extremely complicated and well-studied gyrations, it incorporates itself into the cell's blueprint, eventually resulting in the host cell's death. We still do not know exactly how it destroys.
Once inside the cell, the virus' blueprint becomes integrated into the cell's blueprint through a process known as reverse transcription. The virus becomes part and parcel of the host cell's nucleus. There it replicates, creating more viruses, as well as disabling the host.
The virus has a profound ability to survive inside the body, and so far nothing stops it. We cannot kill every single virus hiding inside an HIVinfected person, and so there is no cure yet. However, scientists have made enormous strides in limiting the replication of the invader. Antiretroviral medicines (ARVs), especially when used in combination, suppress the growth of HIV, most often preserving a person's immune system for a prolonged period of time, and resulting in many years of extended life. (A more detailed discussion of ARV treatment is in chapter eight.)
After a twenty-five page description of HIV and the process it goes through to destroy the body, Dr. Stephen Goff, researcher for the Department of Biochemistry and Molecular Biophysics at Columbia University, claims that the AIDS epidemic will go down in history as one of the greatest pandemics of all time. He concludes that because the virus "has evolved an efficient life cycle and a profoundly insidious lifestyle, it is likely that HIV will continue to be the cause of enormous human suffering throughout the world for many years to come."
HIV is unstable outside the body where it is quickly destroyed by heat, drying and detergents. Though HIV may be detected in any body fluid including tears, sweat, saliva and urine, it needs white blood cells found in sufficient amounts in fresh blood, sexual fluids and breast milk to be transmitted to others.
This means it is hard to get HIV from others except through sex or fresh blood-to-blood contact. The virus may also be passed from an HIV-positive mother to her infant while pregnant, at birth, or after birth through breastfeeding.
The HIV virus is not easy to transmit, but the nature of the epidemic assures its spread. Up to ten years can pass between the time of infection and the onset of clinically recognizable AIDS. During that entire period, infected people can spread the virus to others and not even know they have it themselves.
As the authors of this book, we share our collective reflections and experiences over twenty years of wrestling with this virus, the trail of destruction left in its wake and the challenges in directing behavior to avoid new infections. We tell the stories of men, women and children affected not only by illnesses related to AIDS but also by the compounded sufferings of deeper poverty, broken relationships and abandonment. Some faces never leave our minds, nor do the sacrificial acts of kindness and dedication by caregivers, trainers, researchers and church members.
Our purpose is to press you not only to understand more as a concerned global citizen, but also to act.to examine your own life, attitudes and behaviors; to renew your lifelong covenants in your own families; to reach out to those in your community who wrestle with life itself as they live with AIDS; to become involved globally with prevention and care efforts; and to join many others in prayers for the alleviation of suffering and for a cure.
The impact of AIDS may frighten you or even overwhelm you. But what will stick with you long after you finish reading this book are the many examples of grace. Discover them. Reflect on them. Imitate them. And seek out God, the one who will always make sure there is enough grace to keep going.
TAKING THE NEXT STEPS
Imagine that you discover through a routine physical that you are HIV positive.
1. Who would you tell about your infection? Who would you choose not to tell? What does that tell you about the nature of this disease and of your relationships with those people?
2. Make a list of the questions that you would want to ask - to God, family members, friends, clinicians and others who have HIV.
1. If you know people who are HIV positive well enough, gently open the door in private conversation for them to tell their stories.
2. If you do not know anyone who is HIV positive, read some firsthand accounts or blogs written by people who are infected. What similarities and differences do you find in their stories? What seems to have made a difference in how well they have coped with the disease?
3. Pray for the thousands of men, women and children who will discover today that they are HIV positive.