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Clarice sat in her chair on the side of the desk in my examination room, looking intently at the little test cartridge.  I was talking to her as the HIV rapid test result was developing.  I realized she probably wasn’t hearing much of what I said – she was concentrating on the test cartridge.  I think she already knew the result – most of our HIV positive patients have been tested before and come to us to confirm their fears.  “The test is positive,” I told Clarice.  “That means that you have the HIV germ in your blood.”  I watched her face as I gave her the bad news.  Her head jerked back as if she had been struck.  “It’s positive?” she asked.  “I don’t know how that could have happened.”  As it turned out both she, 52 years of age, and her 69 year old husband were HIV positive.  They had nine children together, and both denied having sexual partners outside their marriage.  We suspected that wasn’t quite the truth, but we’ll probably never know.

Fortunately for Clarice and her husband, there is a very comprehensive HIV treatment program here in Jérémie, funded by PEPFAR funds (President’s Emergency Plan for AIDS Relief).  Testing, consultation, medications and hospitalization are all free, and the program gives nutritional support and money for transportation when funds are available.  We have diagnosed and referred several patients to the program already, but we continue to follow them in our clinic for other medical problems.  They like the fact that they can continue to see us and stay in contact with “their clinic”.

Each Friday morning I make rounds at the government hospital in Jérémie with the physicians who are responsible for the HIV program.  They work at the hospital as hospitalists, responsible for all the patients admitted to the medical service, both those who are HIV positive and those who are not.  Rounding with them gives me a chance to get better acquainted with the way the hospital functions, allows me to act as a mentor to the younger physicians and gives me experience with the HIV program itself.  In our clinic in Gatineau, we offer testing to all our adult patients and find that most are very receptive to being tested.  We hope to be able to detect many who are in the early stages of the disease, so they can be enrolled in the HIV program and begin treatment when necessary; people like Clarice and her husband.

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