Kampala, HIV and TB

First and foremost, I love Kampala. And I love Mulago hospital.

We have had two weeks of teaching on HIV and TB and I couldn't have wished for a more up to date, cutting edge set of talks, from world leaders.

Some highlights for me were:

- Hearing Barre-Sinoussi herself, give the opening address to the HIV symposium at Makere University
- Seeing patients on the wards and having to think how differently we need to act in resource poor settings compared to at Chelsea and Westminster
- Going to Africa's only Persian Restaurant in Kampala
- Meeting one of Kampala's six female taxi drivers
- Having quite interesting talks about what has caused HIV to spread in Africa like nowhere else (and yes, the issue of sexual networks / polygamy / beliefs about the acceptability of sex outside a relationship)
- Going to see Kampala's free circumcision program
- Arguing with colleagues about the appropriateness of research and trials in Africa, and the ethical considerations


I really should have written this bit contemporaneously, as its not easy to do it justice this way. Needless to say it has been amazing, especially as someone who wants to pursue a career in HIV and Infectious Diseases.

What, if any are my take home points?

1) women, once again have a raw deal, and will continue to do so unless more investment goes into prevention of HIV that they can be in control of (eg PrEP and microbicide gels)
2) behaviour is hard to change, but if we are going to try, it shouldn't just be a medical model, but a complete sociological one that looks at self-esteem, stigma, disclosure, and an overall sense of being well with HIV
3) as a UK trained physician, i've really only seen a fraction of what this epidemic means to the world
4) TB will hopefully, be picked up more readily with the help of technology such as GeneXpert, but we need ideally a version that is less reliant on electrical power and cheaper, before it can be a true point-of-care, rapid diagnostic test
5) Africa needs a plan for the future in terms of getting more people on treatment - currently there is a massive deficit in terms of those who need treatment and those who are getting it. The problems aren't just financial or supply related. Ideally, we need to follow in the footsteps of Kenya, who has just had one of its local drug companies approved by WHO to produce ARV's, which will account for a significant cost saving compared to having to source external products.

Once again, I quote Paul Farmer, who stated that we do not just need an equal option, but "a preferential option for the poor".