Tim Mah

"My initial job was to make people believe HIV was real," said Mah, now a master’s degree student at HSPH, at a Global Chat on September 29 in Kresge 213. "People generally did not talk about it." He later spoke with HPH NOW in a follow-up interview.

The Gambia is one of the smallest and one of the poorest African nations. When he arrived there, Mah, a native of Canton, Massachusetts, lived with a couple and their five children in a small village on the Atlantic coast. It took nine months for him to learn the language and figure out how he would approach the work he was sent to do.

Over the course of two years, Mah set up several small-scale HIV-prevention and education programs, working mainly in schools. When he initially coaxed young people into discussions about HIV/AIDS, he discovered a tangle of conspiracy theories and worries that reflected issues of culture, religion, and the legacy of Western colonialism. Some youth flat out denied that HIV existed. Some wondered why more Africans were dying from HIV/AIDS than Westerners if the virus was "discovered" in France and the U.S. Others challenged how a virus initially so closely associated with gay men in the West could be spreading in Africa since, the youth asserted, there are no homosexuals in Africa. Some charged that community-based AIDS prevention programs–with their emphasis on safe sex and abstinence–were veiled plots to reduce the population of Africa.

The anxieties over the origin of HIV/AIDS were compounded by a number of issues. Nearly seventy percent of adult women in the country are illiterate, said Mah. People infected with HIV generally are reluctant to discuss their status because infection carries a heavy social stigma. Testing at the time was only done at a handful of maternity clinics scattered across the countryside, so few people knew their status. There was virtually no treatment available to those who tested positive. The only way to get condoms was through clinics set up by the national health system, and the lack of availability led to sexually active young people reporting they had washed used condoms or turned them inside out so they could be re-used, he said.

Mah decided to focus his efforts on small groups of young people, using schools as a means to reach them. He conducted workshops, inviting HIV-positive Gambians as speakers. "My hope was that seeing truly would mean believing," he explained. "Some kids had heard you could get AIDS by stepping over dog urine or sharing a food bowl or cup with someone who has the disease." For many of the students, the HIV-infected speakers represented the students’ first opportunity to knowingly interact and question fellow Gambians living with the virus.

At a soccer training camp for teenage boys, Mah delivered a basic peer health education program, which included a strong HIV/AIDS prevention component. Among the skills he wanted to the boys to develop were those necessary for decision-making, negotiating, and good interpersonal communication. "In a lot of schools, boys have little experience speaking directly to elders or their girlfriends about using protection during sex," said Mah. "Developing these life skills will help them bridge those gaps."

After graduating from HSPH, Mah would like to continue focusing on AIDS prevention through field-program development work for an NGO and hopes to return one day to The Gambia.

--PHC