Faithful home-based care, the informal, friendly climate permeating the modest building among the banana trees that serves as the centre (until a more functional building is constructed), the very recent birth of the Mimi DREAM (I DREAM) Movement: all are factors that have strengthened the trust nurtured among patients for the DREAM programme and its employees.

As a consequence, people living with HIV have put more and more questions to the centre staff: questions about their health, about nutrition, about routes of transmission of the HIV virus, about how to help those living in their same conditions.

At the same time, DREAM workers have become more sharply aware about the impact of stigma on those living with AIDS in this region along a transit area in northern Tanzania, no longer a wholly rural area, but certainly not urbanised either.

It is neither easy nor cheap to get along the big road linking Moshi to Arusha, and education is one of the foremost victims of the precarious economic situation and the increase in gas prices. The lack of adequate education and scarcity of knowledge relating to medical, hygienic and nutritional matters are elements contributing to the growing isolation of people with HIV, who face a heavy climate of exclusion in school and other places, even at hospital sometimes. The entire AIDS discourse is shrouded by a heavy oppressive cloud, and fear chases away solidarity and erodes human rights.

It is in such a climate – of greater confidence in DREAM and of more awareness of the potentially immense value of health education to defeat ignorance, stigma and fear – that health and nutrition education activities have intensified at the centre of Usa River.

Members of the DREAM staff – health workers and others – are putting health education more and more at the heart of their activities, using the book How is your health? in its bilingual edition of English and Swahili.

The basic education delivered to people with HIV as they sit at the centre waiting to be examined or to pick up their medicines, is proving to be an important and appreciated time. The means of prevention of transmission of the HIV virus and of malaria, but especially basic notions of hygiene and nutritional culture, are at the centre of expressive lessons with patients, who respond with interest, asking questions and trying to understand how they may better help themselves and those dear to them.