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An Ethiopian Love Story

This wasn't the love of sweaty palms, fluttering heartbeats and wet kisses exchanged in secret places, far from the prying eyes and disapproving looks of high-nosed adults. She knew better this time. Genet had first married young because of this kind of love. But, like most fires, the affection they shared had burned brightly at first, waned over time and eventually burned itself out. And, for years after her divorce, she had been far too consumed with the struggles of being a single parent to entertain the notion of a relationship with another person. Now approaching 40, she rarely attracted the attention of men, much less serious consideration from them as marriage material. Fish had changed all that. Fisseha, "Fish", as his friends called him, was more than just a practical solution to advancing age and loneliness. He loved her completely - the way a 38-year old divorced mother of grown children deserved to be loved. And, this time it smoldered, forging a deep between them. This was love.

She had met him at the local market in Adama, a southern city in Ethiopia, one Saturday morning as he was pulling in his truck to deliver goods to be sold. He owned his own trucking business and was himself a long-distance truck driver who spent many hours on the road and she, a successful shop owner who sold traditional, hand-made garments to local women and tourists. A chance encounter that began with him approaching her for directions, led to coffee, and then much more. Unlike her previous marriage, this time her love wasn't built upon naïveté, propped up with the demands of child-rearing, and glued together with co-dependency. Fish and Genet were like milk and honey. She neither needed him, nor he, her - but together, each enriched the other. They had been happily living together for several years when she decided to visit an old friend in Djibouti while Fish was on yet another long-distance delivery that would take him away from home for a week. As required, she reported to the local embassy in Addis Ababa a few weeks prior to leaving to complete the visa application. Dutifully she collected the necessary documentation and subjected herself for the required testing at a health clinic to ensure she was free of malaria, yellow-fever and other communicable diseases before traveling. This was how she found out. Mistakenly, she had also checked a box on a clinic consent form she had signed which had authorized them to test for HIV as part of her visa application. The test result had come back "positive". The news was devastating. Genet had only ever been intimate with two men in her life: her first husband and Fish, and knew she had been faithful to them both. This meant that she had been infected by one of them and may have even infected her own children at some point. Every possible scenario she considered didn't end well. She couldn't bear the thought of telling Fish that she might have infected him and possibly losing him. And, it could get much worse still if word of her diagnosis got out into the community. It was well known, after all, that HIV was the disease of female sex workers (FSW's) and "loose women". Whatever the scenario, she knew she needed more answers and, in order to protect her anonymity, called an AIDS/HIV Resource Center (ARC) hotline. Believing things could hardly get worse from this point, she was hardly prepared for her next discovery. For as long as she had known Fish, he had suffered from a heart condition that had required him to take various medications on a daily basis. There were many times that he neglected to or forgot to take this medication because of his hectic schedule. Out of concern, Genet had made it her duty to bring him his medicine every morning with breakfast, doting upon him the way people who love each other frequently do. He always accepted this affection with a smile and a tender "ameseghinalehu" - thank you. It was only when the ARC hotline worker was informing her of the anti-retroviral drugs available to manage her disease that she made the connection between the names of these drugs and Fish's "heart medication". The realization of how deeply he had betrayed her had descended upon her like a Greek tragedy. There were few things that he had insisted upon throughout their long relationship like his refusal to wear a condom - insisting that condoms were only for people who had casual sex and the clients of prostitutes. Aware he was HIV positive when he met her, he had manipulated her trust and infected her. According to Ethiopia's 2012 HIV Related Estimates and Projections Report, there are over 1.1 million people living with HIV/AIDS in the country. It is an epidemic that infects women at a rate twice that of men and is almost 20 times more prevalent in urban areas than in rural ones. There is good reason for this. A single "Fish" commonly transmits the disease to several different women; from the FSW's he regularly visits, to his mistresses and other loved ones, like Genet. Many FSW's infected with HIV are aware of it but engage in unprotected transactions anyways with clients, many of whom demand it. The women, lacking education and any other employable skill, find this work preferable to a life of begging. On the other end of the spectrum, divorced and widowed women are frequently preyed upon because of their known emotional vulnerability. Data from the 2011 Ethiopia Demographic and Health Survey (EDHS) confirms this: the groups with the highest prevalence of the disease in the country are FSW's and divorced and widowed women. The ease and frequency with which men like Fish travel from one urban area to another combined with a complete absence of moral accountability makes the transmission of the disease extremely difficult to contain. PSI/E has planned to utilize the same national distribution channel I am working to re-develop for their water purification project (described in the previous blog) to also help distribute Behavior Change Communication (BCC) materials and condoms to these Most-At-Risk Populations (MARP) across the country. The scope of this MARP project is enormous. In 2013 alone, PSI will distribute more than 70 million condoms and educational materials across Ethiopia. The results of this work could not be more rewarding. Execution on reach and frequency, in this instance, will mean so much more than winning a contest or a prize. Again, it will mean lives. Tomorrow morning I'll leave for Adama, where I'll spend Fasika (Ethiopian Easter), one of the largest holidays of the year, and where I'll also try to get a better understanding of the supply-chain and distribution challenges in smaller cities outside of Addis Ababa. As for Genet; unfortunately, her story is true. She was very brave to have shared it and I have altered both her name and Fish's and some small details about their lives to respect their anonymity. There is a silver lining to the cloud that hangs over her future. Since her diagnosis she has refused to accept the role of a victim and has been inspired to volunteer some of her time educating other vulnerable women about the need to insist on condom use. She is yet to reveal her own HIV-positive diagnosis because of the negative stigma that she would surely suffer because of it. But, given the context of recent experiences, she is learning to appreciate her life again and remembering to love herself most.

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