We were a group from the United States — Center for Global Health Policy staff and five congressional staffers — on a study tour to see what is happening on the ground in the places hardest hit by HIV and TB epidemics with responses supported by the President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS Tuberculosis and Malaria.
The “us” that Mauly referred to are the residents of Detroit Sober House, a residential substance addiction twelve-step model recovery center that houses 25 men at a time, among whom the rate of HIV hovers near 15 percent. On an island where the HIV epidemic among the general population is about 1 percent, what happens here is important, both to the men who have taken the step of coming to the house, and to public health.
Outside, the men and others we met during three days in Zanzibar tell us, the stigma surrounding addiction, and HIV is huge, each associated with the other, and discouraging both efforts to provide and seek services. Inside, the support and respect the men offer each other encourage them to stay, and, if they relapse, to return.
They named the place themselves, Mauly explains, after it was launched with help from a group in Detroit. “I’m going to Detroit,” became a way of saying one was ready to change.
How do they get people to overcome the pull of addiction and the stigma on the outside, to come inside? “We shine,” Mauly says, “and they want what we have.”
The men introduce themselves, adding how long they have been sober, a few days, a few weeks, years. They can stay four months inside, graduate to after care, and remain linked to the house through volunteer work.
A young man who came to Dar es Salaam with his family and ended up in Zanzibar “after the insanity” of addiction started, calls a fellow resident he has known for a few weeks his “new best friend.” Another man who says he was a football (here, soccer) player, before “brown sugar” took over bemoans his lost physical prowess, but looks younger than his stated age of 47.
Members of the group go out in their former community to actively screen potential TB patients — the number for that disease is higher than that among the general population too, but with resources challenging definitive diagnoses among transient populations and among people living with HIV, it is likely underestimated.
Still for all the volunteers and the government supported rent, keeping the place going — and it is a spartan environment — remains a struggle. The nature of addiction, Mauly notes, alienates families, so they stay away. The men sell art work, both on the premises and from a store in Stone Town, but the flow of funds it brings in is unreliable. So on an island where what needs doing to confront HIV and tuberculosis is given some focus by the contrasting numbers inside and outside the Detroit Sober House, whether opportunity to make a difference will be adequately realized remains a question.