HIV was first identified in Africa in the mid 1980's. However, it was only in 2004 that the first person in the rural Tanzanian district of Makete publicly declared himself to be infected with the virus. His name is Kabuyu Kyando. Three years after his declaration, we have come to join him and the association of patient activists he's founded, PIUMA, in a Solidarity march through the country's Southern Highlands.

PIUMA, a Swahili acronym for "Test and Live in Hope", is made up of 250 HIV patients who have tested positive and are receiving anti retroviral medication. It is one of the first such associations in Tanzania. For both health and logistical reasons, only twenty five members have been selected to participate in the march.

Kabuyu has oft repeated that HIV doesn't kill, ignorance of the disease and its treatment do. The purpose of the march is to promote prevention, testing and treatment in the remote villages Makete, Bulongwa, Iniho, Ipelele and Ujuni. The very fact that ukimwi (HIV) infected persons can and will walk 90 kilometers over 3 days in very rugged and mountainous conditions is, literally and metaphorically, a moving symbol of hope for all Tanzania.

The timing of the March is ideal as it coincides with Tanzanian President's Jakaya Kikwete's announcement of a national testing initiative under the slogan "Defeat HIV through Testing". The battle will be exceptionally hard given a national infection rate of nearly 10% with some villages tracking at double and triple this level. The Southern Highlands where we are walking has the highest average rate in the country. The challenge is further compounded by very low enrollment rates in secondary schools (under 20%) and, as we will soon witness firsthand, brutal infrastructure (roads, water, energy) in the rural areas of the country.

To attract as many people as possible from the areas surrounding the villages where our march will end each day, Kabuyu and PIUMA staff members have arranged for onsite HIV testing as well as speeches from local officials, songs from local choirs and hip hop music for the younger crowd.

The District Commissioner gives the PIUMA marchers a courteous send off in Makete town on Day 1 of the March, even walking the first kilometer at Kabuyu's side. PIUMA members are wearing t-shirts brought from Austria bearing their logo (a red lion with an AIDS ribbon) and their slogan, "Kwa Pamoja Tutashinda" (Because together we shall succeed).

The marchers are singing hypnotizing Swahili songs along the way and waving to subsistence farming families which make up the great majority of the 100,000 population in Makete District. The singing doesn't stop for uphill marching. It seems to get louder. Young children bearing even younger ones on their backs either smile or cry uncontrollably as I, a mzungu (foreigner), offer him or her a PIUMA balloon.

We are at 2600 meters above sea level and by lunchtime, the Canadians are firmly in the rear of the march and catching their breath. I will discover that there's always a higher hill in this region. We eat rice and boiled beef for lunch in Bulongwa at a village councilor's home. Kabuyu tells us the story of the elephant, lion and leopard who each vie to be named king. The little animals, fearing of oppression, elect a hyena instead. Although pleased at his luck, the hyena cannot avoid his old habit of continuously plundering garbage piles for bones to lick and chew. The hyena is quickly removed from office because he is never around to perform his duties. Kabuyu says that HIV positive patients are the lucky hyena who has a chance at a better life. The old habits are patients' proclivities for alcohol and unprotected sex. Kabuyu declares that he himself plunders for these bones no more.

Kabuyu, like almost all other PIUMA members, is a Wakinga and his tribal language is Kikinga. Other marchers are from a neighbouring tribe, the Wabena. Kabuyu is 53 years old and a practicing Christian. His face is chiseled and handsome. He is fit and lean like the rest of the marchers. Until his public announcement of being infected, he was a security guard at the Bulongwa Lutheran Hospital. After his declaration, he was dismissed and could not find a job for over 18 months.

We recommence the march after lunch and make it to Iniho by five. No village officials are present to receive us due to the death of the village wazee (elder) that day. The office where the HIV testing was to take place is locked. Even the hip hop music is delayed as the generator is out of diesel and cannot seem to operate both the music and lighting at the same time. Finally, it is up and running and over a hundred village children and youth are dancing in the dark to 50 Cent.

We sleep at Pastor Sanga's house and are served tea and bread in the morning in their mud hut. The children cling to their mother as we eat, the chickens run about and smoke gather overhead.

Kabuyu leads us out of Iniho towards Ipelele, a 20 Kilometer journey. As we approach the town in mid afternoon, dozens of green sweatered Ipelele students run to join us as we arrive in the town centre. A warm welcome clearly awaits us. The village Mayor and the HIV regional coordinator are present and give very supportive talks. The PIUMA nurse, Mary Musoma, has been given access to an office and tests 30 villagers that day. And the generator works. The clouds roll in but the dancing doesn't abate until late.

A short night in a local guest house and tea and potatoes for breakfast precede the longest and hardest day, but the last leg of the March. A solidarity song is sung to the tune of Glory, Glory Halleluiah and we're off by 6h45. Kabuyu is nowhere to be seen.

By 10h00, our canteen truck, which had left Ipelele the previous evening to fetch provisions, catches up with us. Kabuyu gets out. He had returned to Bulongwa with the canteen truck so that he could make his shift as a security guard with his new employer. After a short sleep, he's back with us, beaming. He'll return again to work tonight.

Today, we have a 35 kilometer walk through the beautiful but stark Kitulo Natural Reserve, reminiscent of the moors in The Hound of the Baskervilles. We are now at 3000 meters above sea level. It is a cool walk but, even leaving early, we won't make it to Ujuni in time for the official reception. Part of our group jam into the canteen truck and the rest of us hop in the back of a passing 24 foot transport in order to make it by the designated hour.

The march, the first of its kind in East Africa, ends with speeches ("PIUMA Safi", meaning "good", starts every presentation), choirs and more hip hop. 21 people in Ujuni are tested by Mary. The village leaders have informed the BBC reporter (Swahili service) that they would like PIUMA to set up an HIV counseling and testing centre in their little town. PIUMA, which is entirely funded by membership fees and foreign donations, has no capacity to agree to the request. Ujuni residents, like most of the rural Southern Highlands, will have to continue to travel great distances, to Bulongwa or Mbeya, for testing. It is not just ignorance and the fear of testing positive that fuels the pandemic but the great difficulty in accessing any health services at all.

As a result, Kabuyu wants to take his organization mobile. PIUMA plans on buying and equipping a mobile HIV counseling, testing and treatment vehicle in order to bring quality HIV services to the whole district. The problem is scratching together the funds and permits to do so.

There is another problem. The day of President Kikwete's announcement, the PIUMA nurse tells me the Southern Highlands has run out of the reagents necessary to use the equipment that tests the progress of a person's HIV infection. Although Kabuyu's PIUMA is on the march, Tanzania has a long road ahead to defeat HIV.

James Hughes
July 23rd, 2007