In 2004, the UCSF Positive Health Program (PHP) at San Francisco General Hospital created an international training arm called ASPIRE: AIDS Services, Prevention, Intervention, Research, and Education.

With a staff of ten nurses, nurse practitioners, and physicians, the ASPIRE team works to build capacity at AIDS-focused organizations in Tanzania, Zimbabwe, Côte d'Ivoire, Uganda, Kenya, and South Africa. They partner with the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to boost the provision of antiretroviral therapy (ART) for children and adults in the region.

Dr. Diane Havlir, UCSF Professor of Medicine, is the director of ASPIRE and of PHP overall. "Training and education are central to our mission," Havlir says. "Training African providers in HIV care is an activity that will have immediate and life-saving effects for many persons living with HIV."

The following stories come from members of the ASPIRE and EGPAF teams. With enduring optimism, they cross the world from rural African villages to the streets of San Francisco and back, to share and to learn.

Be Brave Too
Guy Vandenberg, MSW, RN, ASPIRE, Hlabisa District, South Africa, March 2005

At first glance, you won't see Guy Vandenberg's heart pinned on his sleeve. But if you can keep up with this tall, lanky native of the Netherlands and catch the stories he leaves in his wake, you will witness the heart embedded in his work. Vandenberg spends about half of his time in Africa, training healthcare providers. On his first assignment with ASPIRE, he was sent to Mtubatuba, in northernmost South Africa, to train nurses to care for patients who had started ART, recognize side effects, and encourage adherence to therapy. He had years of practical experience to share in his mentoring role. But first, Guy had to get through day one.

The very first day I worked in South Africa, I couldn't speak any Zulu, and they were too busy at the hospital to orient me. I was wondering how to make myself useful when I noticed there was one nurse drawing blood all day long. All these patients had HIV and needed their blood drawn for CD4 counts. I said, "I could do that. I just need to say a few words, so teach me a few words and I can do it." They were very happy because it freed them up. But I hadn't realized that most of the HIV patients that day were children. I never take blood from children in San Francisco, especially not sick children. It was terrifying for me. These kids were very different from American children. They would just stand there with arms out and with big, scared eyes, but they would be motionless. And I would stick them [to draw blood] again and again. And when I asked for their other arm, they would hold it out. It made it even harder. At least if they had kicked me or screamed or something... There was one girl who was probably seven years old or so. She had no veins because she was really sick. I had to stick her three times before I got blood. I said to the counselor who was helping to interpret and direct traffic, "Please say to her that I appreciate how brave she is. Tell her I'm sorry that I had to stick her three times." I was emotional, and the little girl noticed. She said in Zulu to the counselor, "Tell him that he must be brave too." And then I lost it. I had to step out of the clinic and cry for five minutes before I could go back to drawing blood.

Hope Walks In with a Smile
Steve Williams, Volunteer Peer Educator, ASPIRE, Matubatuba, South Africa, June 2005

"My name is Steve and I have HIV," states Steve Williams from a stage on wheels in a village market. When those words reverberate around the crowd in this region of South Africa where one in four are infected with HIV, for a few minutes, stigma's grip of silence and denial is loosened. With the help of a Zulu translator, Williams tells his personal story, then yields the stage to educators who sprinkle the crowd with facts about how to avoid transmitting the virus.

Soon after Williams began ART in 1999, his newly revived immune system overreacted to a latent tuberculosis infection in a case of what is called "immune reconstitution syndrome." He spent three months unconscious and near death at San Francisco General Hospital (SFGH). After a lengthy but successful recovery, it is clear that Steve's glowing good health isn't just skin-deep; it's embedded with an optimistic attitude and a resilient spirit that run deep and strong.

He never expected to find himself a world away from San Francisco, but Vandenberg invited Williams to accompany him to South Africa as a volunteer peer educator. "I had no idea what I was going to do," admits Williams with his big smile. But he soon found plenty to do and attracted a following wherever he went.

His healthful presence alone inspires tremendous hope in patients who are scared about their diagnoses and have yet to see the power of ART. "Patients love to see someone who is HIV positive and who was very, very sick now doing better," says Williams. With his unassuming manner and African American background, Williams connects with them in a unique way, often inspiring individuals to reveal their positive HIV status and seek help. "I don't really feel like I train people," he says. "I'm just talking to get them to open up."



We Want Our Story Told
Guy Vandenberg, Steve Williams, Nzega District Hospital Tanzania, 2007


Three men—grandfather, father, and son—approached Williams and Vandenberg at the end of their presentation to an HIV/AIDS patient support group in Nzega, Tanzania. All three were HIV positive and on antiretroviral therapy. When they heard Williams was a photographer, they insisted he take their picture and tell their story to others. In Tanzania, stigma around HIV/AIDS is strongly rooted, yet these men were not afraid to have their picture taken and their story told. They wanted others with HIV/AIDS to know how ART could improve the quality of their lives.

What had emboldened them? First, the effectiveness of the treatment. The grandfather had been unable to walk when he was initially brought to the clinic, yet, as the recipient of antiretroviral therapy through a program driven by EGPAF with training support by ASPIRE, he made a dramatic recovery. And then there was Williams's inspiration. If he could come all the way from America to share his story of hope, they wanted to add their own story, too.

Find more stories and pictures on the ASPIRE program website.