The waiting area is full. Children are running up and down between the benches, their mothers (and some fathers) watching them as they wait to be called into a consulting room to see a nurse or counsellor. A woman stands in front of them talking loudly in Xhosa. She bangs her palm with the edge of the other hand, as if emphasising her point. She appears to be delivering a lecture. As I get closer I recognise her as the sister in charge of the HIV clinic.
I slip into one of the consulting rooms used by one of the clinic Sisters. “Molo Sister Sibisi”
“Molo Doctor. Ninjani?” She has just given a vaccination to one of the anti-retroviral patients – a flu jab. She applies a dressing, and the man thanks her and slips out.
“Sikhona,” I exhaust my meagre Xhosa. “What is Matron talking about out there Sister?”
“She is giving them a talk on disclosure.”
“Disclosure to their friends?”
“No doctor, to their children. This is parent-child clinic day so the HIV positive parent comes with their positive child and we see both at the same time. The thing is, many of these parents do not tell the child that they are positive.”
“That the parent is positive?”
“No doctor, they do not tell the child that the CHILD is positive for HIV.”
“But how?! The child is on tablets and has been coming to clinic for years.” Most of the children here will have become HIV positive as a result of infection during, or shortly after, birth. Whilst there are treatment regimes that can reduce the rate of infection in pregnancy dramatically the mother needs to know she is positive (and many do not - or do not act on the result) and drugs need to be available at the right time.
She shakes her head sorrowfully. “Yes doctor, but there is a lot of stigma still. And they tell the child that they are taking the tablets for flu. And then one day when the child is 11 or 12 they want to know why do they take the tablets when their friends do not. And then it is very bad, because when the child finds out they often get very cross, and they stop taking their tablets, and then the virus comes back and they can get very sick. So Matron is telling the parents they must tell the children they are positive.”
“But that must difficult as well. A very young child will tell their friends and then might get into problems at school.”
“Yes doctor – both ways have their problems. But we think that the truth is the better way. Nothing good can come from secrets.”