back to work

I've been here in Moshi for 5 days and I finally feel settled enough to sit and write a little something about the work I'm doing here.

As you probably already know I've been intersted in the AIDS epidemic in Africa for quite a long time.  It was the subject of my honors thesis in college, and it was my main motivation for going back to grad school.  Last winter I met the director of the Duke Center for Health Policy, and she invited me to work with her on a project here in Moshi.  The project is called CHAT (Coping with HIV/AIDS in Tanzania) - catchy huh?  It started in 2008 when they began interviewing a mix of HIV positive and negative people in the Moshi area.  The study asks them many questions about their families, jobs, attitudes, opinions, health history, trauma history, medication history, and (most important for me) medication adherence.  While AIDS is certainly a huge problem in sub-Saharan Africa, many countries have taken huge steps in combatting the epidemic.  Tanzania, in particular, offers every citizen free anti-retro-viral drugs through the public health system.  We have found, through the first few rounds of data, that many HIV positive people who are on anti-retroviral drugs, do not fully adhere to their recommended treatment regimen, making the drugs far less effective, and in most cases, completely ineffective.

In a nutshell, my research is studying why, if they have access to free drugs, they do not fully adhere.  The subject is common in sociology, psychology, and public health, but not in economics.  I suppose it seems like a weak link to what most people think is economics, but having just finished teaching Economic Principles, I am even more convinced that my work has a place in the field.  After all, economics is the study of how individuals, businesses, and governments make decisions when resources are scarce.  It seems more relevant with this definition in mind.

Ok, I'm getting way off track...Basically, I'm writing a new section of the CHAT survey to be included in the next 2 rounds (November and April) of data collection.  In order to make sure I have good, culturally relevant, and useful questions I came to Moshi to talk with people who are similar to the people in the CHAT survey.  This way I can get a preview of how my questions will be interpreted, what people don't understand, and first-hand information about how people think about the problems that I have written so much about.

On Monday I met with all of the 18 people that will be participating in my focus groups throughout the next week to make sure that they all knew which day they were supposed to come and what time we were starting, etc.  It was really an amazing experience to be in a room full of HIV positive patients who had all come into the office because of my project.  It was really the first time that I felt that I was in control of some aspect of my research and that it would go in the direction that I decided, it's really empowering.  I am obviously very thankful to all of them for agreeing to spend a day talking about HIV and helping me understand how they think about their situation and their future.  What I wasn't expecting at all was how enthusiastic they were about participating and how grateful they were to me for being interested.  Each and every one of them came up to me after the meeting wanting to shake my hand and thank me profusely.

Yesterday, Tuesday, was our first full day focus group.  While I'm still inexperienced, I can now say I have some experience running a focus group.  It was really kind of fun.  The project coordinator here, Berny, was translating from English to Swahili and back again.  He really was doing most of the work.  But it was so great to hear their answers to questions, think to myself, "why on earth would someone choose to loose $10 tomorrow instead of $5 today?" and be able to ask them myself and get an answer.  The most common answer to that question was that you need money today, and you have to deal with tomorrow when it comes.  It's pretty sad if you think about it.  In fact, there were many aspects about the day that were heartbreaking.  The people who came were all HIV positive and all had very depressing stories.  Most of them were widowed, and had overcome tremendous obstacles in their lives.  When asked if she would rather have 10 extra healthy days this year or 100 extra healthy days next year, a common response was that they would rather have the 10 days this year because they don't know if they will be alive to collect the healthy days next year.

I don't know if I'm getting any closer to answering my research question, but I am learning much more about the problem.  I suppose that has to be the first step.