vcu professor makes a difference overseas
Educating and medicating to stop the spread of HIV
By Doug Childers

Currently, South Africa has the highest number of persons living with HIV of any country in the world (5.3 million in 2003). By the end of 2004, a total of 5.7 million to 6.2 million South Africans were estimated to be living with HIV infection.

Martha W. Moon has racked up serious frequent flyer miles for good causes. She lived in Zimbabwe for a year, conducting HIV prevention studies. And she spent a summer in Guatemala , teaching a course for Virginia Commonwealth University students on community health nursing in developing countries.

"In Zimbabwe , I was working with the University of California , San Francisco and the University of Zimbabwe to study the potential for introducing new barrier methods to prevent HIV transmission," said Dr. Moon, an associate professor of nursing at VCU.  

Barriers include physical barriers like condoms, as well as chemical barriers called microbicides.  

"Our job was to find out whether Zimbabweans were willing to use these methods, and then to test the methods to see if they are acceptable in actual use," she said.  "These studies showed that people were very interested in using the new methods, under certain circum-stances.  Subsequent studies established the safety of the microbicides, and studies currently underway will determine how effective they are at preventing HIV transmission."

Motherwall. Settlement on the outskirts of Port Elizabeth, South Africa.

In Guatemala , Dr. Moon and a group of students visited health care sites in Antigua and the surrounding rural areas.  

"They met midwives, doctors, nurses, health educators and others working to improve public health," Dr. Moon said.  "The students lived with local families and studied community health in the mornings and Spanish in the afternoons."

Now Dr. Moon is working in the Eastern Cape Province of South Africa, where HIV statistics are particularly grim.

"Although it has only about 10 percent of the world's population, Sub-Saharan Africa has two-thirds of the world's people with HIV, and over three-quarters of the world's HIV-infected women," Dr. Moon said.  " South Africa has the greatest number of persons living with AIDS of any country in the world, and the Eastern Cape Province , where I work, has been particularly hard hit.  Nearly one in three women from 20 to 34 years old is infected."

Dr. Moon is working with researchers in South Africa to study changes in behavior, attitudes and knowledge in response to the introduction of HIV medications among South Africans who live in the Eastern Cape Province.

"We are looking for lessons we might learn that will help make the introduction of new medicines more successful there and in other regions," she said. "We have found through our research that stigma is a tremendous issue there for those infected with HIV.  I have just submitted another proposal to conduct an intervention among clinic workers to decrease HIV-related stigma in order to increase the use of HIV testing and services."

Dr. Moon has been working in South Africa for about two years, and she has been to the Eastern Cape twice in that time.  Now that the projects are picking up speed, though, she will need to travel there more often.  In fact, she has three trips planned for the rest of this calendar year.

The cultural differences she has experienced abroad have proved to be interesting at times, she says. "When we were preparing to hire interviewers for one of the studies in Zimbabwe, we learned that we needed to hire 'ambuyas,' the Shona word for grandmothers.  Older women are respected and would be able to ask difficult questions without putting people off."

In the United States, Dr. Moon would probably hire graduate students to conduct interviews, but that would not have worked in Zimbabwe.  "It would have been very offensive for a young person to ask questions about sexual behavior and attitudes, especially if the interviewer and interviewee were of different genders," she said.  "We learned many times over the importance of not making assumptions when in a different culture."

The options for nurses who are interested in working abroad are wide-ranging. In addition to offering direct nursing care, they can help "build schools and clinics, or write grant proposals to get money for a project," Dr. Moon said. "Governmental agencies, non-governmental agencies, private foundations, churches and universities all offer avenues for nurses who want to travel to learn and to help in other countries."

Dr. Moon suggests that nurses interested in working abroad should select a destination based on a number of factors:

• What languages do you speak, and what languages are spoken in the host country?
• What are your comfort levels in cultures different from your own?
• How remote is the location, and what is its infrastructure like? (Does it have clean running water and electricity, for example?)
• Is the country politically stable?
• How developed is the health care system? (Are there hospitals, and are they well-staffed? Are medical and surgical supplies available?)

Ultimately, she says, success should be measured by whether one makes a lasting contribution.  

"Providing care and improving even one person's life is a wonderful thing, but it is so much greater to pass along skills and resources so that improvements may continue long after a volunteer or visiting professional returns to his or her home country," Dr. Moon says. "Working collaboratively with colleagues from the other country, offering educational exchanges, supporting self-sufficiency projects and finding ways to share knowledge and resources with local colleagues are excellent ways to make a lasting contribution."