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Module 1: HIV

“First Lesson”

The clouds moving over the West annex today seem as tired as the students in Biology 301; they seem to creep rather than float, shuffling across the blue behind them. Lang watches them, wondering if that blue tint is the same the world over, or whether it’s unique to North Carolina. Such thoughts have been brewing within him for weeks, ever since the class started their correspondence with students from Pierpont Pharmaceutical’s charter school in Malawi.

* * *

It had begun several Thursdays ago, with an odd question.

“Who thinks they’re good at geography?”

Unsure whether it was a rhetorical question to which the answer was understood to be “no one smart,” none of the four had responded to Mrs. K’s question.

“Let’s try an example,” she continued, pulling down a global atlas over the smeared chalkboard. “Where is North Carolina on this map?”

Reluctantly, Fallon ultimately pointed the state out on the eastern seaboard, rather than endure another awkward silence.

“Right,” she said, “and . . . France anyone?”

Fallon had again volunteered, before Mrs. K had finally come to the point of this exercise – which was, as they had guessed, not to test their knowledge of Western geography.

“And where is Malawi?”

As she had expected, blank stares proved the only reply from her students.

“Strange, isn’t it, how we can talk about disease in developing countries and have no idea where they are?”

They would have been more embarrassed if it hadn’t been obvious that this was the point of her demonstration. Nevertheless, Angelica had offered that it “was somewhere in Africa.”

Mrs. K had turned back to the map, looking at the size of the continent and replying, “and North Carolina is somewhere in North America.” Pausing a moment, she continued. “Pierpont has arranged a very unique opportunity for you all to find out where Malawi is – the charter school the company has constructed there has agreed to engage in some cross-cultural exchange.”

“What does that mean?” Maxine had asked.


* * *

Though he had initially been skeptical, in retrospect Lang thought the envelopes he had dropped in the school mailbox were the most enlightening part of the class so far. It was one thing to study how all these horrible illnesses affected the developing world, but another to receive notes from other students looking at the lazy clouds outside.

As the class soon learned, the sliver of eastern African land containing Malawi was not an easy place to live. The students who wrote back to them described an instructor in his mid-fifties as astonishingly old – with malnutrition and AIDS, the nation’s life expectancy had dropped steeply. It became clear, as well, that most of their correspondents knew friends or family members infected with HIV. With a term paper already drawing near, Lang had a thesis in mind: “The first lesson in understanding disease is to know the human face behind the disease.”

Unlike the clouds drifting over the West annex, the political situation in the area around Pierpont’s charter institute was far from placid. Local elections were on the horizon and, as Lang and his classmates had learned, the result could have a major impact on the AIDS crisis in the area. One of the letters had arrived, describing:

. . . the younger brother of our history teacher . . . he finished studying surgery abroad, and has already become a local hero after performing a risky heart surgery on a newborn. He’s promised that if he gets elected he’ll end some of the ridiculous policies that have allowed so many people to get sick . . . he says that knowledge is one of the most powerful medicines.

Maxine had been immediately charmed by the idea of an educated physician moving back to his home to make a difference, leading Fallon to talk noticeably for a week about wanting to do something similar – despite the fact that health crises were few and far between in Fairview.

“I wonder, though,” Lang says, turning from the window, “whether most of this guy’s voters even know how bad things are – I certainly wouldn’t have learned all the material about AIDS on my own. Maybe some of them just think life is hard.”

“I never thought of it that way,” replies Angelica, uncharacteristically affected by his observation. “It’s just become . . . normal.”

“However,” says Lang, “I guess it’s not all that different from what goes on in the US, too – I mean, if everyone our age actually understood everything we know about transmission, do you think there’d be so many infections in the US?”

“It’s almost the opposite problem,” Maxine thinks aloud. “Everyone in Malawi thinks it’s normal; everyone in the US thinks it’s abnormal enough that it couldn’t possibly happen to them.”

“That’s what they thought in the eighties, too,” says Angelica. “It was just a ‘gay’ disease. Then it became everyone’s disease. Now it’s the third world’s disease – just that it’s not really, people just think that way.”

“What could convince them otherwise?” Lang wonders.


1. What are some reasons AIDS might not be discussed in public in other countries?
2. How would you go about describing AIDS to someone who knew nothing about viruses? What are the most important features of the virus and the disease?
3. What hygiene and public health recommendations would be important to impart to that individual? How would your suggestions differ between Africa and the US?
4. What might be some challenges to implementing those recommendations here and abroad?