He was a proud and energetic guy, very popular and ambitious with a deadly sense of fun. Most of all he hates the fact that he leaks and drips, smells badly and often cannot control his bowel movements or urination. He gets really angry at himself. Headaches are constant and he is weak and gets very dizzy . . .
He is now six stone. After another few weeks, the boy will be much drained; his mouth will be full of oral thrush, a white fungus over his tongue and gums. His mouth has many ulcers and he has difficulty swallowing. Breathing is increasingly difficult and laboured. By now, pneumonia is taking over his ruined body.
All movement is acutely painful and distressing. Intestinal worms are back again . . . Atria's limbs are stiffening and his back is covered in large sores. These are ulcers that leak and bleed but do not heal, they are very distressing and impossible to manage in a small hut . . .
The issues are controlling pain, managing distress, reducing humiliation, creating dignity in extreme distress, reducing multiple infections, reducing cross infection to children . . .
However, the biggest thing of all is loneliness. To die of AIDS in Africa for many thousands of people is an intensely humiliating ordeal, slow . . . obscene.
Atria is now in the last days of his life. His tear ducts have dried up, his hair has fallen out, and his bones are brittle. He has no muscle or fat and his heart is 70 per cent weaker than pre-HIV.
He has been eaten alive by repeated assaults on his body and has no resistance. All Atria's senses are shutting down. His skin is blistered and scaly, scabs cannot form.
His finger- and toenails have fallen out. The bedsores and ulcers have spread, becoming sources of deep infection. Breathing is almost impossible and the slightest movement is slow and full of dreadful anxiety. I give him water drop-by-drop through a straw . . . I hold his frail stiffened hand, he is cold, and he has no tears. I look into his eyes . . . I whisper to him, and kiss him . . . He slowly inhales, half closes his eyes . . . He breathes out, very slowly . . .
Atria's face relaxes, the tormented body loosens . . . He has gone.
I held him in my arms and wept.
This an edited version of article by Dr Michael Meegan, appeared in the Journal of the American Medical Association