Stigmatization is more fearful than AIDS This trip was my first mission with MSF to work in the HIV/AIDS project in Xiangfan, Hubei, China. MSF and local health authorities jointly run the project, which was launched last May. The clinic treats HIV patients with ARV drugs and also focuses on the treatment of opportunistic infections that frequently attack during the full onset of AIDS. There are 2 cases impressing me very much: Kuen was infected with AIDS during the blood transfusion she received after her cesarean section in 1997. Her child was tragically drowned by accident. Her relatives refused to eat with her for fear of getting infected with the virus. She even wanted to run away from her husband for the same reason. But her husband supported her greatly. Unfortunately, their second daughter was infected with the virus and tested HIV positive. The parents were devastated. They sold everything in order to send her to Wuhan, where the child was seen at an infectious disease unit at a university. Kuen brought her daughter to the MSF clinic in Xiangfan. It was surprising and heartbreaking for a 3-year-old girl to told our counselor in the clinic, " I know I will die soon. I have AIDS." Also, it is not so easy to start people on AIDS treatment. Even you have both patients and drugs here, it's not the whole picture. A farmer who is on the road to late-stage AIDS had not shown up for 3 months. He was likely to be busy during the harvest season, which probably is the reason why he never showed up all the time. Sadly, he only knew that he was infected with HIV, but he did not know anything about the evolution of the disease. I arranged some blood tests to prepare him for the treatment, and I also asked the counselor to speak to him. Then we said goodbye. Five minutes later, the nurse came to the consultation room telling me that the man had just ran away, without having his blood taken. What could have been on his mind? I certainly hope he will come back again. Our patients often live far from the clinic and a lot of them don't have the money to travel to our clinic for follow-ups. We try as much as we can to help them by reimbursing them. But once they are in the clinic, HIV, AIDS and treatment are not on the top of the list of things on their minds. There is a lot of stigma attached to the disease. What if their neighbors and relatives find out about their disease? What will happen to their children and partners if they become too ill, or even pass away? As doctors we tend to look at providing treatment, but there's a lot more than that in reality.

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