ARVs: the sooner the better

The earlier a person living with HIV it receiving antiretroviral drugs (ARVs), the better. You do not have to be a rocket scientist for this to make sense. The sicker you are, the harder the body and the meds need to work to get you back on your feet.

According to the current guidelines, a person is best put on antiretrovirals before his or her CD4 count – a measure of immunity strength – drops below 250 cells per millilitre of blood. HIV experts, however, argue that people should be put on medication even before that.

The problem is that most countries with a high HIV prevalence, of which the bulk are situated in developing countries, are not able to meet the current guidelines.

I recently wrote a story on this topic for Inter Press Service, when attending the 5th conference of the International Aids Society on prevention, treatment and pathogenesis.I attended the conference as a Journalist 2 Journalist fellow of the National Press Foundation in the US.

Please click here if you want to read it.

Love in times of HIV

Living together with or being married to someone who is HIV positive, while you are HIV negative. Would you be able to do it? Apart from the fact that your loved one will – at some point – die as a result of this nasty and dreadful virus, you are also confronted with the fact that you are exposed to HIV on a regular basis. Would be able to put your love for someone ahead of your own health?

I am not sure if I could, who knows. Maybe the interviews that I will have with various serodiscordant couples, as well as people who left their partner after finding out they were infected with HIV, will bring some clarity.

* WATCH THIS SPACE!*

HIV nurses tell their tales

Working in a South African can be a tricky and an exhausting affair. Under staffed facilities, being under paid, working long hours, and too little resources are some of the issues nurses in South Africa have to deal with on a day to day basis. And then, there are the risks that come with the HIV and TB epidemic.

Pauline Jooste has been working as a nurse for the 31 years. Five years ago, she left South Africa’s public health care system and accepted the position of health worker supervisor at HOPE Cape Town – a non-profit organisation providing outreach, education and counseling at the community level focused on HIV, AIDS and TB in the Western Cape Province of South Africa.

According to her, one of the biggest challenges is being overworked as a result of a shortage of nurses. “The ration of nurses to patients is 1:45, while 1:25 is ideal. That means that we make sacrifices: we do not have lunch, go home late and are at work early in order to help as many people as possible.”

“We specifically need male nurses, but they are hard to find,” Jooste added. “I call them an endangered species.”

The reason why more male nurses in South Africa are needed, is to attract male patients to clinics in order to get themselves tested for HIV, Tuberculosis (TB) and other diseases. “Men stay away from health facilities because they are seen as men unfriendly. Why? because most health care workers are female,” Jooste explained.

“The massive workload and long hours are quite a risk to us,” Angela Abrahams added, who also works for HOPE Cape Town.

“When you are tired you are less alert to what you are doing. One day, I was taking blood from a female patient, who was a bit afraid. She jumped and I pricked myself through the latex glove. I had to take antiretrovirals for a month. Luckily the patient tested negative for HIV, and so did I!”

Other health risks South Africa’s nurses face are tuberculosis. “Apart from being provided with a mask, we do not have a lot of ways to protect ourselves,” explained HOPE health care worker Dandelene Sylvester. “I usually wear a mask, but some patients feel that by doing this, we stigmatise them as being dangerous. So sometimes, I rather keep the air flowing between me and the patient, and therefore work without a mask but open all the windows to limit exposure. I simply do not want the patient to think that I see them as less.”

The stigma that is attached to HIV/AIDS, poses challenges to clinic and hospital staff, Jooste told me. “I drive around the communities in a van with a big HOPE logo on it. Not everyone is happy with that, because one is afraid what the neighbourhood will say if the van is parked outside their house. So sometimes, I put a sheet of paper over the logo, to keep everyone happy.”

Luckily, there are moments of joy too. “When a baby from a HIV positive mother is tested negative is simply amazing,” Jooste said. “People in the community of that baby will give a party to celebrate that. Things like that keep you going, and prevent you from losing perspective.”

Copyright content: Miriam Mannak / All rights reserved

13% kids RSA HIV orphans

About 1.5 million South Africans older then 15 years, and 106.000 children, will be in need but do not have access to  antiretroviral treatment (ARV) by the end of 2009, new figures by Statistics South Africa (STATSA) show. Compared to the previous year, 1.420.000 adults and 91.000 children were in need of HIV medication.

This could mean that the South African government is losing grip on HIV, which at this pace will infect 413.000 South Africans, including 59.000 children, by the end of 2009.

ARVs are drugs that are used to prolong the lives of people living with HIV.

On the slightly brighter side,  the 2009 mid year population report estimates that 800.000 South Africans aged 15 and older will be on ARV treatment by the time 2009 draws to a close, compared to 655.000 during the previous year. Furthermore, 2009 will see 70.000 children on HIV medication, which is an increase of over 30 percent compared to 2008.

Apart from that, there is not a lot of reason for optimism. While 10.6 percent of the entire population of 48 million is HIV positive, the statistics for people aged 15-49 is much higher. STATSA expects that by the end of 2009, 17 percent of this demographic group will be living with HIV.

All in all, 5.21 million South Africans will be living with the virus this year – compared to 5.06 million in 2008.

One of the most shocking developments however, concerns the number of Aids orphans in South Africa. Up until recently, it was estimated that South Africa had 1.5 million Aids orphans. By the time 2009 makes place for 2010, the number of children (people younger then 15) who have lost their parents due to HIV/AIDS will have risen to a staggering 1.91 million.

South Africa’s children population (people below 15 years of age) is estimated to be 31.8 percent of the total population, which comes down to 15-odd million individuals.

This means that almost 13 percent of South African children have lost one of both parents due to HIV/AIDS.

Copyright content: Miriam Mannak / All rights reserved

TB vaccine in the pipeline

For the first time in eighty years, a new Tuberculosis (TB) vaccine has entered the efficacy stage of a clinical trial in South Africa.

The TB vaccine trial, which has entered phase IIb – was announced during the 5th International Aids Conference on HIV Pathogenesis, Treatment and Prevention – which took place in Cape Town in July 2009.

Clinical trials, during which a potential drug is tested on humans, comprise of three stages or phases. Phase I aims to see whether the drug is safe to use for people, and concerns a small group of volunteers (20-50). Phase II, which aims to determine whether the drug is working, concerns several hundreds of volunteers and is often divided in two sub stages.

While phase IIa assess how well the drug works, phase IIb focuses on how much of the product should be given to a patient. The final stage of the trial or phase III aims at the definitive assessment of the potential new drug. All in all it can take up to twenty years before a drug is given the green light.

The development of a new TB vaccine is crucial, especially in Sub Saharan Africa where so many people living with HIV suffer from TB. The reason for this is that the immune system of someone living with HIV is often not capable of fighting off the TB bacteria. The chance of developing active TB when being HIV negative is about 10 percent in a lifetime. Someone who is living with HIV has a ten percent chance a year to develop TB.

Although the World Health Organisation (WHO) in 2005 declared TB as an emergency in Africa, the region in the world which is hit the hardest by the HIV epidemic, the number of infections as well as the death rates have continued to soar over the past years.  About 70 percent of the 14 million people who are co-infected with HIV and TB live in Africa.

According to the WHO, the TB epidemic in Africa is rising by four per cent a year and is now the most common opportunistic infection of people living with HIV.

Copyright content: Miriam Mannak / All Rights Reserved