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Temporary Miracle

Online Extras: Elegy for Yosam

Elegy for Yosam

I met Yosam Katongole only once.

We spoke for just 25 minutes or so, sitting beneath a tree outside a drab cement building near Lwamaggwa, Uganda. Katongole had just received his first antiretroviral (ARV) medications. He hoped they would stave off the human immunodeficiency virus that had been slowly killing him. His wife was HIV positive too, and he had seen her health rebound in just a few weeks since she began taking ARVs.

With a Rakai Health Sciences Program employee translating for us, Katongole graciously answered my questions, even the difficult ones like how he became infected with HIV. (He said he didn't know, that he didn't have so many sex partners.) He was rail-thin, had a dry cough that he muffled in his hand and spoke softly. His face had that pinched expression of someone worn down by pain. He impressed me as a kind, gentle man. A farmer and a father, Katongole talked a lot about the future he wanted for his children. When we parted, I thanked him for his time and wished him the best. Then I moved on to the next interview.

After I returned to Baltimore and began sifting through mounds of notes for the story on antiretrovirals in Rakai, Katongole surfaced as a prime source for the article. His story made real the on-the-ground, day-to-day needs for ARVs in Africa. As I wrote the first draft, Katongole exemplified the hope that ARVs bring to the AIDS epidemic. Then on March 22nd, I received an email.

I had been asking more questions, checking more facts with Gertrude Nakigozi, the coordinator for the Rakai Program's mobile ARV clinic. Replying to one of my emails, she mentioned that Yosam Katongole had died a few weeks previously. The news shocked me. He was a kind man and an obviously loving father. His wife was pregnant. His child would never know him.

Though I was not his friend and had tenuous claims even to be his acquaintance, I mourned Yosam Katongole's passing. Another decent human being with a family and a future had fallen to AIDS. The disease's incomprehensible toll of more than 25 million had increased by one more.

I had this feeling that Yosam Katongole should not have died. He had started taking ARVs. They were the miracle drugs. They provided hope. They pulled people from their sick beds and back to productive life. But reality is never so simple. Nakigozi explained to me that men often arrive at the clinic when they are very sick and their CD4 counts are far below the threshold for commencing treatment with ARVs. He had waited too long.

While writing the story, I remembered how fervently researchers like Maria Wawer, Ron Gray and David Serwadda had reiterated that ARVs would not solve the AIDS epidemic. Preventing new infections and more research into the virus were the best hopes of stopping AIDS. As I rewrote the story's ending to include news of Yosam Katongole's death, I realized how imperfect the treatment is.

For many of us in the West, the existence of readily available ARVs has changed our perceptions of the AIDS epidemic. The drugs really are quite remarkable in their ability to hold the virus in check and allow people to return to mostly normal lives. But they do not always work.

I was reminded of this in late April. This time it was a phone call and it was not from Africa. It was from my mom in Texas. She relayed the sad news that a friend of mine who was HIV positive had passed away. Her words were a stark reminder that AIDS is not to be dismissed or underestimated. Its grim mortality statistics still climb not only in Africa but worldwide.

Prevention programs to keep people from ever becoming infected with HIV must be increased. Research to find new and better means of stopping the epidemic must be expanded.

Antiretroviral drugs can work wonders. They are keeping thousands of people alive right now and should be given to everyone who needs them. But they are temporary miracles. People like Yosam Katongole and my friend deserve better.

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