No Place Left to Bury the Dead (A Review)

The story of HIV/AIDS can be found in every corner of the globe. Despite this, it is difficult to forget the association with Africa. The novel No Place Left to Bury the Dead: A Tale of Denial, Despair, and Hope in the African AIDS Pandemic by Nicole Itano, provides an in-depth look at the continent where HIV/AIDS is affecting millions of lives.

What strikes me most strongly about the tale is not the location, but the commonality that people share. No Place Left to Bury the Dead is a novel of three stories, three lives. Itano lives with and observes three people who have been affected by HIV/AIDS. She travels to three different countries in Africa and explores the differences in people, cultures, and the role politics has played in the available treatment of the disease.

I find this novel different from so many other novels is the way in which those living with HIV/AIDS are treated by the author. They are not martyred victims, held up as the pinnacle of suffering and bad fortune for us to pity and save. They are real people; individuals with faults, drinking problems, families who care and some who don’t, dreams and goals and strength. They are just like everyone else.

These people are reluctant to learn their status because they are afraid. Their fear, hope, denial, and despair are universal emotions. These people are not defined by their disease; HIV is a part of their lives, but not the entirety of it.

Itano does an excellent job telling stories while integrating her own perceptions into those stories. The author freely discloses her own bias and struggle to maintain journalistic objectivity while staying among people whose standard of living is so much lower than her own. Itano’s emotional entanglement in the stories and lives of her subjects brings a refreshingly honest perspective to the book.

I would highly recommend this book for those just beginning the study of HIV/AIDS. In addition to the personal narratives, the book covers basic scientific and political information about the epidemic.

No Place Left to Bury the Dead may not be considered an uplifting read, but few books discussing the impact of HIV/AIDS are. What this book does provide is a sense of hope, a hope that HIV is not the end to life and that it is possible to continue living even under the shadow of the virus, even in poverty-stricken Africa.

Itano gives HIV/AIDS a face which everyone, regardless of which continent you live in, can relate to and understand.


This guest post was submitted by Amber Dujay. Amber is a certified political nerd with a deep interest in social justice and community health. She writes in hope that others will read it. She is also a Leo and a dog-lover.

HIV virus and gene therapy

Gene therapy had a success this week due to the HIV virus. Two young boys have been treated for ALD, a brain disease, with a modified HIV virus.


From the New York Times article, After Setbacks, Small Successes for Gene Therapy:

The new approach involved using HIV, the virus that causes AIDS, to insert genes, modifying the virus first so it could not cause disease.

“We were scared, of course,” said Dr. Naldini, who was working on the virus in the laboratory of Dr. Inder M. Verma at the Salk Institute. But he reasoned that if he could remove enough H.I.V. genes to make it safe, the modified virus could work.

It solved the efficiency problem — the modified AIDS virus added genes to 15 percent of cells. And researchers believe it solved the cancer problem. The virus had less chance of turning on genes that could lead to cancer.

Ms. Salzman’s son had a bone marrow transplant. Her sister’s older boy died of ALD, and her younger son underwent a bone marrow transplant but had complications from the procedure and now, successfully treated for ALD, is in a wheelchair from side effects of the transplant.

Dr. Aubourg has also treated a third boy with ALD, and he is doing well, but it is too soon to know if his disease has been arrested.

“We have to be cautious — very, very cautious,” Dr. Aubourg said. “But this is the first time that a very serious disease of the brain, a lethal disease of the brain, has been treated with success by gene therapy.”

Here is the complete New York Times article and ScienceNow article.

Calgary Youth, Health and the Street

The Calgary Youth, Health and the Street study had two main purposes. First, the study aimed to describe the spectrum of street-involved youth in Calgary – from those youth who connect with street culture during occasional episodes to those youth who are firmly entrenched in street life – and explore variations among these different sub-populations in terms of HIV and health risks, coping mechanisms, and service needs. Second, the study aimed to develop and enhance existing services for street-involved youth by providing information that is useful to HIV and youth-service organizations in services planning.

From this study a series of fact sheets were developed around critical issues for street involved youth such as: education, housing needs, service needs, sexual health and more. The fact sheets and complete report can be found here. This is just a glimpse of a few findings:

1. 71% of youth surveyed had experienced some neglect or abuse and 92% of those had been abused on more than one occasion.
2. Condom use was inconsistent with only 26% reporting that they always used a condom. Injection drug use was reported among 21% of respondents with 29% of those reporting sharing of needles or equipment. Over 79% of respondents believed they were at low or no risk of contracting HIV.
3. There were two sets of perceptions about how youth became involved in street life as some youth indicated they chose to be on the street and some indicated they did not. The majority of youth who did not perceive they were on the street by choice associated their street involvement with family breakdown, dysfunction, and negative experiences in care. For those who perceived a more active role in becoming street involved, several youth described how decisions led them to be “kicked out” of home. Street peers and access to drugs and alcohol played a role for some in first becoming involved in street life, as well as maintaining street involvement.
4. The majority of the youth who participated in interviews could readily identify personal goals and changes they wanted to make for themselves. In particular, none of the interview respondents wanted to be on the street in the future. Many youth spoke of relationship goals, including being in a healthy relationship, getting married and having children. Many also indicated that these things could not be achieved under their current circumstances.

The full results of this study provide a snapshot of the lives of street youth within the Calgary community, and point to areas where there are differences among youth with different levels of street involvement. The street youth who participated in the study openly shared their experiences and the hope is that these data will contribute to a better understanding of the complexity of their lives, their strengths and challenges, and ways in which services could serve them better. Ongoing community discussion, research and planning are vital in order to better meet the needs of street-involved youth in Calgary.

To read the full study or fact sheets developed from the study, please visit the Resources section of our website.

H1N1 and HIV

H1N1 has been front and centre this week with media coverage focused on the roll out of the H1N1 vaccine in our community. Unlike other provinces, Alberta opened up vaccination clinics to the public at large rather than first focusing on high-risk populations.

Some people have asked us whether people living with HIV are, in fact, more vulnerable to contracting and then suffering from complications related to H1N1.

H1N1 is still a new virus so we can’t answer those questions definitively. In addition, like other flu viruses, H1N1 can have different effects on each person who contracts it.

What we can confidently say is that people with weakened immune systems (including people living with HIV) are considered to be at higher risk for contracting seasonal flu. People living with HIV are also at increased risk for complications arising from seasonal flu, such as bacterial chest infections. (1) We also know that H1N1 is a new strain of flu so people have little to no natural immunity to this virus. This is why there is concern that H1N1 could cause serious and widespread illness. (2)

It is better to be safe than sorry when dealing with the regular variety of seasonal flu or a new flu virus, particularly for people with weakened immune systems. The Public Health Agency of Canada reports that influenza can result in between 2,000 and 8,000 deaths each year.

The good news is that there are steps you can take to reduce your risk of contracting the flu. They may seem simple, and you have likely heard them before, but they are effective measures for protecting your own health.

1. Wash your hands. Sanitation is one of the easiest and most effective ways to protect yourself. Wash your hands regularly throughout the day, particularly before eating, or use a hand sanitizer.
2. Consider getting the H1N1 vaccine. The Public Health Agency of Canada has created this useful page of information about the H1N1 vaccine.
3. Keep your immune system as healthy as possible. Eat well, exercise and be sure to get plenty of sleep.
4. As much as possible, avoid contact with other people who are exhibiting flu-like symptoms.

For more information, including tips on what to do if you are caring for someone infected with H1N1, please check the Public Health Agency of Canada and this CATIE News Bulletin on H1N1 and HIV.


1. Canadian AIDS Treatment Information Exchange. September 2009. CATIE-News: Bite sized HIV/AIDS bulletins. H1N1 and HIV: tips to keep you safe and healthy. Retrieved October 2009. http://www.catie.ca/catienews.nsf/00a48c8905294f0b8525717f00661eb8/ae9e3643001fa87a8525763800553837!OpenDocument
2. Public Health Agency of Canada. Your H1N1 Preparedness Guide. Retrieved October 2009. http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/index-eng.php

Travelling with HIV

The time to migrate south to warmer climates is already upon us and many people are eagerly anticipating winter getaways.

But if you are HIV positive and planning to leave our chilly nation and travel somewhere a bit warmer, you might have to do some research before you pack your bags, even for a short trip to the good old USA.

Currently in the US, if you are HIV positive and not a resident, you would have a very difficult time visiting, applying for residence or even entering the country. Generally, the US refuses entry to foreign nationals known to be HIV positive. This ban has been in effect for over two decades.

In very exceptional cases, a stay of 30 days may be granted (for family visits, medical treatment, business travel or participation in a scientific, health-related conference). Currently, immigrants with HIV are not granted legal permanent residency except under extremely limited circumstances.

The US is working on changing their travel restrictions for people living with HIV. Congress passed a policy change last summer which President George W. Bush signed into law; however, the Bush administration was unable to implement the policy before leaving office.

Earlier this summer, progress was made when the Department of Health and Human Services (HHS) published proposed regulations that would remove HIV as a “communicable disease of public health significance” and eliminate the HIV travel and immigration ban once and for all.

Canada does allow people living with HIV to enter the country for short-term tourist stays, however the majority of foreigners testing positive for HIV won't be granted a residence permit for Canada. There are exceptions for the following groups of people:

• HIV-positive refugees
• HIV-positive sponsored spouses or common law partners of Canadian citizens or permanent residents
• HIV-positive children of Canadian citizens or permanent residents

For a little perspective, these 8 countries have a complete ban on the entry of all HIV positive people: Brunei Darussalam, China, Oman, Qatar, Sudan, United Arab Emirates, United States of America and Yemen.

In these 5 countries, territories and areas, proof of HIV-negative status is required when the period of stay surpasses a particular duration (stays beginning as short as 10 days up to 90 days) : Egypt, Iraq, Singapore, Tunisia, Turks and Caicos Islands

And these 29 countries deport foreigners once they are discovered to be HIV positive: Armenia, Bahrain, Bangladesh, Brunei Darussalam, Bulgaria, China, Egypt, Hungary, Iraq, Jordan, Democratic People’s Republic of Korea (North Korea), Republic of Korea (South Korea), Kuwait, Malaysia, Republic of Moldova, Mongolia, Oman, Qatar, Russian Federation, Saudi Arabia, Singapore, Sudan, Syrian Arabic Republic, Tajikistan, Taiwan, United Arab Emirates, United States of America, Uzbekistan, Yemen.

Many people are unaware that such restrictions exist and that our neighbors to the south still have a system in place with some of the strictest regulations in the world.

If you are living with HIV and plan on traveling or moving to another country it is best to check what regulations are in place for people living with HIV. A good place to start your search is The Global Database on HIV Related Travel Restrictions.

What do you think about Canada's restrictions for people living with HIV? Should we be more in line with European countries who have no restrictions? Why do you think it has taken so long for the United States to start the process of making changes to their policies?