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  • Print publication year: 2017
  • Online publication date: November 2017

1 - Misaligned Priorities: How Disconnect between Donors and Citizens Doomed AIDS Intervention in Africa

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Summary

Even the group that is looking after sick people in this village do not really know everyone who has HIV … I feel it is important that the village headman and other people should know because say if you want to marry someone, you have an idea of what is going on with them. If you get sick, other people will have an idea of how to address your sickness.

Headman Interview #155, Balaka District, August 27, 2009

He repeated his question, “Why won't you list the names of everyone who tests positive?” He went on, suggesting the list could be kept by a respected elder in the village who would advise others on how to avoid infection. Glory, my Tanzanian teaching partner, retranslated the question, trying even simpler English words the second time to convey what the mzee (elder) at this community meeting in a rural village in Arumeru District was asking. But I understood his question perfectly the first time he asked it. My silence was not because I did not understand the question. My silence was a manifestation of my not understanding how we had failed to convince the most powerful people in this community of the importance of confidentiality in human immunodeficiency virus (HIV) testing.

After completing my first year in graduate school in 2004, I volunteered with a small nongovernmental organization (NGO) that coordinated partnerships between American university students and recent graduates of Tanzanian secondary schools to provide HIV awareness education in schools, and at large community gatherings. The village meeting where this mzee asked his question was a culmination of our efforts in the area following weeks of working in the local schools teaching HIV epidemiology and the current best practices for avoiding HIV infection. Previous volunteers were positive about these village meetings, characterizing them as celebrations marked with community acceptance of the knowledge imparted by well-trained volunteers. Of course, it is easy today to see the warts of this NGO's approach to HIV/acquired immunodeficiency syndrome (AIDS) intervention and the naïvete of its volunteers, myself included.