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Health24.com | How South Africa can build a child-centred health care system

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It is more than 20 years since the South African constitution first guaranteed children’s “right to basic health care services”. This is part of a broader commitment to ensure children’s rights to optimal survival, health and development. The question is how close South Africa is to realising these rights in practice.

We address this issue in a chapter of the South African Child Gauge 2019 report.

Unlike adults’ right to health, children’s right to basic health care services is not subject to progressive realisation. Children should therefore be prioritised within the health care system. Yet the state has still not defined an essential package of health care services for children. This makes it difficult to determine what they are entitled to and what the state should be held accountable for.

Without a defined package, there’s a danger that the drive for efficiencies and cost saving may result in a limited basket of care that doesn’t address the complex needs of children. This is particularly true for those with chronic (long term) health conditions.

This essential package of care needs to be supported by a set of norms and standards. These need to specify the infrastructure, equipment, medicines and staff needed to meet the unique needs of children and adolescents. A clear package will also make explicit how health care establishments need to be equipped. These would include neonatal and paediatric wards as well as emergency medical services and primary health care services, where children currently have to compete for attention with sick and injured adults.

In other facets of the health system, too, budgets, building of infrastructure and medicine supplies need to consider children’s unique needs.

A child rights approach to health requires health professionals to treat children and their caregivers with respect and communicate effectively. Health care providers also need to build children’s and adolescents’ capacity to take responsibility for their own health and include them in decision making.

These fundamental shifts in the balance of power between adult and child, doctor and patient have been found to relieve pain and suffering. They also improve diagnosis, compliance with treatment, patient satisfaction and health outcomes.

Training health workers

The United Nations Committee on the Rights of Child has called for children’s rights to be integrated in the curriculum and performance criteria of all professionals working with children. These include health and allied professionals, teachers and social workers. The aim is to ensure that they are better attuned to children’s needs and rights.

For example, the LinCARE programme, where a team of health workers provides mother and child health care in Limpopo province, aims to reduce neonatal mortality. It does this by improving the quality of care during pregnancy and labour. The programme is aimed at ensuring that all women have a positive pregnancy and birth experience. It includes antenatal classes and ensures that women have practical and emotional support from a birth companion and kind, respectful and technically competent clinical staff.

As part of current preparation for a national health insurance system, which is aimed at extending universal health care to all South Africans, bolstering the primary health care system offers three opportunities to strengthen the child health workforce and improve the quality of care:

  • Community health workers play a central role in bringing health care services close to home, particularly for children living in poor or remote households. It’s therefore encouraging to see the national department of health’s commitment to employing them and paying them the minimum wage. This should improve supervision and support and ensure greater continuity of care between community-based services and health care facilities.

  • School health teams are another essential ingredient of the child system, helping to screen older children and address barriers to learning. Yet coverage reaches only one third of pupils in their first year of schooling and 20% of grade 8 learners. Its effectiveness is compromised by the shortage of health and other social service professionals, such as social workers, oral hygienists and dentists, psychologists, physiotherapists, speech and language therapists and occupational therapists.

  • Finally, district clinical specialist teams provide essential leadership for child and adolescent health at district level. For example, neonatal mortality has dropped by 30% in districts where there are paediatricians and paediatric nurses, yet less than half of specialist teams have a full paediatric team.

What needs to be done

The progress for child health has been uneven in South Africa with significant variation between provinces and districts. For example, immunisation varied from 90% in Mpumalanga to 69% in the Eastern Cape – signalling persistent inequities in access and coverage of care.

Given these challenges, greater investment is needed to strengthen systems and build a workforce for child and adolescent health. National health insurance provides an important opportunity to ensure universal health coverage and financial risk protection for the poor, as well as to improve the quality of care.

This requires leadership for child health at every level of the health care system – from individual encounters with children and their families, to ensuring that child health is adequately represented on key decision-making structures that will decide how resources are allocated.

Very importantly, it requires that the health sector works with and alongside other sectors. Interventions such as sufficient good quality food, good quality education, safe water and sanitation, good housing, safe roads and safe communities can significantly promote the health and well-being of children.

The South African Child Gauge 2019 report is published by the Children’s Institute at the University of Cape Town. The theme of the 2019 issue – “Child and adolescent health: leave no one behind” – is a call to prioritise child and adolescent health and put children at the heart of the health care system.

Lori Lake, a co-editor of the Child Gauge report, also contributed to this article.The Conversation

Maylene Shung-King, Professor, Health Policy, University of Cape Town

This article is republished from The Conversationunder a Creative Commons license. Read the original article.

Image credit: Duncan Alfreds, News24

Maylene Shung-King, University of Cape Town

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Health24.com | Telling the complex story of ‘medical xenophobia’ in South Africa

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The phrase “medical xenophobia” is often used to describe the negative attitudes and practices of South African health care professionals towards refugees and migrants. It is used whenever foreign nationals are denied access to any medical treatment or care.

Research on migration and health in South Africa has documented public health care providers as indiscriminately practising “medical xenophobia”. But this dominant, single narrative around migrants and health care is misleading.

My recent research showed that there was more complexity, ambivalence and a range of possible experiences of non-nationals in South Africa’s public health care system. I conducted the research in a public health clinic in Musina, a small town on the border of South Africa and Zimbabwe.

I found that frontline health care workers provided services, including HIV treatment, to black African migrants who are often at the receiving end of xenophobic sentiment and violence. This was in spite of several institutional and policy-related challenges.

Discretion and innovation played a crucial role in inclusive health care delivery to migrants in a country marred by high xenophobic sentiment. This was because health care providers subscribed to an ethos of what was right for the patient.

Public health and individual discretion

There are a few issues with the current framing of “medical xenophobia”. First, the focus on attitudes – and not health care delivery – reflects a particular generalisation of how health providers are perceived to treat African migrants in South Africa.

This framing does not consider challenges facing the health system. These include shortages of medical personnel. Many migrants seeking care in South Africa’s public health system do face challenges arising from being “foreigners”. But there are other grounds beyond citizenship or legal status on which medical care might be denied. Not all cases of poor treatment are “medical xenophobia”.

South Africans also face challenges with the public health care system. These are related to the general shortages of nurses and doctors. Other challenges include high bed occupancy, high workload, low morale among nurses in public health facilities and the burden of the HIV pandemic.

Second, existing policy responses to communicable diseases in South Africa and the southern African region do not adequately cater for migrants. For example, treatment guidelines in South Africa have been found to be incomplete or inapplicable to migrant patients. Policies and programmes in the Southern African Development Community on communicable diseases such as HIV do not extend to migrant patients.

Health care providers often have to operate within these institutional, bureaucratic and policy constraints.

This scenario makes frontline discretion unavoidable. Health care providers have to rely on their own judgement to determine what “best practices” to invoke with relatively little input or interference from other institutions.

In spite of these challenges, frontline health care providers were doing their best to provide health services to black African migrants. They bypassed institutional and policy-related barriers to registering and treating undocumented migrants, non-native speaking migrants and migrants without referral letters.

This suggests that the experiences of non-nationals in South Africa’s public health care system were more complex and varied than implied by the dominant discourse on “medical xenophobia”.

It is true that some health care providers stereotyped migrant patients and blamed them for their destitution. But my research showed that these stereotypes didn’t directly translate to the exclusion of migrant patients from health care services. This was because of the health workers’ strong professional conduct and an awareness of the public health implications of not providing migrant patients with HIV treatment.

Working around the system

Health care providers in the clinic I visited came up with a system of using the date of birth to identify and keep a record of undocumented migrant patients. This replaced the 13-digit South African identity number, which is normally used to open patient files. Several of them used notions of morality, ethics and public service to frame their decision making. They understood health care to be a right for everyone, in line with Section 27 of the country’s constitution.

Others provided HIV treatment to migrant patients without referral letters. This decision was also mediated by how patients professed their “belonging” through “alternative” forms of knowledge and expertise. For example, one nurse claimed that she only provided anteretroviral therapy if migrant patients demonstrated knowledge of their medication, or if they brought a medicine container for a refill.

Health care providers reported difficulties interacting with migrant patients who spoke Swahili, French, Portuguese or Chewa. Staff and local patients worked together to ensure that migrant patients accessed health care services, often in extremely demanding circumstances. Health care providers made the effort to connect with migrant patients through informal interpreters by asking co-workers or patients fluent in these non-native languages to translate in English or other native languages.

These health care providers didn’t use language, documentation and referral letters to discriminate against migrant patients. They used innovation, creativity and compromise to provide services to migrant patients living with HIV.

Way forward

Policymakers need to recognise the importance of human relationships, communication networks, leadership and motivation in strengthening the country’s ailing public health system.

More crucially, activists need to identify the informal, inclusive and innovative practices of health care providers in addressing challenges related to documentation, referrals and language.

This should be coupled with calls to strengthen and invest in these grassroots responses to build greater solidarity. This is what can be done while waiting for policymakers to respond to ongoing calls for public health care systems to adequately engage with mobility.The Conversation

Kudakwashe Vanyoro, Research Communications Officer and Doctoral Researcher at the African Centre for Migration & Society, University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Kudakwashe Vanyoro

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Health24.com | Who’s helping smokers quit? Probably not their heart doctor

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Smoking doesn’t just wreck the lungs. It’s a leading cause of heart disease and stroke, and a new study says most cardiologists aren’t doing enough to help patients snuff out their cigarettes.

“We know that smoking is a risk factor for cardiovascular disease and that cessation leads to decreases in cardiovascular disease and the risk of death,” said the study’s lead author, Dr Mayank Sardana, a cardiac electrophysiology fellow at the University of California San Francisco School of Medicine. “But only a minority of smokers are receiving counselling in cardiology clinics and assistance in trying to quit.”

A practical solution

Only one in three, in fact. The study analysed data collected between 2013 and 2016 from 348 cardiology practices associated with the National Cardiovascular Data Registry, which documents treatment provided to patients. Of more than 328 000 patients classified as smokers, only 34% received smoking cessation assistance, according to the study published in the Journal of the American Heart Association.

That assistance, Sardana said, ranges from assessing a smokers’ readiness to stop and counselling them about the health benefits of doing so to recommending cessation programmes and prescribing nicotine patches and drugs to help them quit.

The study did not examine reasons for the low rate, but Sardana suggested two possible factors: lack of time during a doctor visit and the assumption that the primary care provider, not the cardiologist, should take the lead in discouraging smoking.

“We need to work with cardiologists and primary care providers to understand the problem and come up with a practical solution,” Sardana said.

The JAHA study follows a ground-breaking report last December by the American College of Cardiology urging health care providers to take a bigger role in promoting smoking cessation and setting out a detailled pathway for cardiologists to address the issue with patients.

The forgotten risk factor

Dr Nancy Rigotti, a professor of medicine and internist at Harvard Medical School and Massachusetts General Hospital who served as vice chair of the group that wrote the ACC report, said every doctor taking care of smokers should do whatever possible to help them quit. She hopes the new study will bring more urgency to the issue and draw attention to the ACC recommendations.

“My experience has been that for cardiologists, tobacco has sort of been the forgotten risk factor,” said Rigotti, who directs the hospital’s Tobacco Research and Treatment Center.

“They’re aggressive about taking care of high cholesterol and high blood pressure, and we have medicines that are very effective for that,” she said. “But with smoking cessation it’s more of a chronic problem that takes a long time to work. It’s not a simple fix.”

The timing of a visit to the cardiologist can make a big difference, Rigotti said. “Someone who has newly diagnosed heart disease or just had a heart attack may be scared and willing to make behavioural changes that maybe they didn’t think they needed to do before.”

Reversing the extra risk

Rigotti said many smokers she has counselled associate smoking more with lung cancer than cardiovascular disease. But according to the Centers for Disease Control and Prevention, smoking wreaks cardiovascular consequences ranging from damaged arteries and lower levels of “good” cholesterol to sticky blood that’s more prone to clotting.

Smokers, the American Heart Association reports, are two to four times more likely to have a stroke than non-smokers or those who quit more than a decade ago. And almost a third of deaths from coronary heart disease are caused by smoking and second-hand smoke, according to the AHA.

The good news for all doctors to emphasise, Rigotti said, is that “if you quit smoking you reverse the extra risk relatively rapidly.

“It’s never too early to quit,” she said. “But it’s never too late to quit.”

Image credit: iStock

Health24.com | Could MS have links to the herpes virus?

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A variant of a common herpes virus may play a role in the development of multiple sclerosis (MS), Swedish researchers say.

They analysed the blood of about 8 700 MS patients and a control group of more than 7 200 people without MS. They were looking for antibodies against proteins of two variants (A and B) of human herpes virus 6 (HHV-6), which has been linked with MS.

Cause unclear

MS patients were 55% more likely to have antibodies against the HHV-6A protein than the control group.

The researchers also looked a sub-group of almost 500 people who did not have MS. The risk of developing MS more than doubled for those who’d had a HHV-6A infection. The younger they were when the virus was found in their blood, the greater their future MS risk.

The findings suggest that HHV-6A may play a role in the development of MS, according to the authors of the study published in the journal Frontiers in Immunology.

MS is an autoimmune disease that affects the central nervous system, causing weakness, movement problems and tremors. Its cause is unclear, but one theory is that a virus tricks the immune system to attack the body’s own tissue.

Though previous research linked HHV-6 with MS, it couldn’t distinguish between the 6A and 6B variants. Researchers in this new study were able to do that.

Antibodies for the rest of their lives

“This is a big breakthrough for both the MS and herpes virus research,” said study co-senior author Anna Fogdell-Hahn, an associate professor of clinical neuroscience at Karolinska Institute in Stockholm.

“For one, it supports the theory that HHV-6A could be a contributing factor to the development of MS,” Fogdell-Hahn said in an institute news release. “On top of that, we are now able, with this new method, to find out how common these two different types of HHV-6 are, something we haven’t been able to do previously.”

It’s believed that as many as 80% of children are infected with the HHV-6 virus before they’re 2 years old, and many have antibodies against it for the rest of their lives.

“Both HHV-6A and 6B can infect our brain cells, but they do it in slightly different ways. Therefore, it is now interesting to go forward and attempt to map out exactly how the viruses could affect the onset of MS,” Fogdell-Hahn said.

Image credit: iStock

Health24.com | Bad vibes with your fam can lead to chronic illness, says new study

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We all know that having a good relationship with your family is important for a lot of reasons, but what if you were told that one of them was to maintain good physical health as you grow older? Well, this is a suggestion a new study published in the Journal of Family Psychology is making…

According to the study, individuals who have a strained relationship with their extended family (including mom, dad, siblings, aunts, uncles and grandparents) are more likely to develop a chronic illness than those who have a strained relationship with their intimate partner(s)s/spouse(s).

READ MORE: The Truth About Chronic Inflammation And What It Means For Your Health

“Most often, researchers focus on romantic relationships, especially marriage, presuming they likely have more of a powerful effect on health,” said Prof. Sarah Woods, lead author of the study and assistant professor of family and community medicine at University of Texas Southwestern Medical Centre, in a statement.

“Family relationships are long and emotionally intense. These are people you are connected to you forever. If you are sensitive to emotional stress, then being bathed in that stress would over time wear and tear on your body.”

How did they reach that conclusion?

To get to this conclusion, researchers looked at data from just under 3 000 individuals collected between 1995 and 2014. On three occasions over these years (between 1995 and 1996, 2004 and 2006, 2013 and 2014), the participants each rated the state of their interactions with their families and spouses.

On family, the respondents were asked questions like: “How often do members of your family criticise you?” and “How much can you rely on your family if you have a serious problem?”

On spouses, the respondents were asked questions like: “How often does your spouse or partner argue with you?” and “How much does your spouse or partner appreciate you?”

The participants’ health was measured looking at the total number of chronic conditions suffered 12 months before each of the three times their data was collected.

Through this analysis, the researchers found that there was a strong association with strained family interactions and a greater number of chronic illnesses.

READ MORE: “Fitness Helped Me Deal With Family Drama, Failing Friendships And Depression”

“We found that family and emotional climate had a big effect on overall health, including the development or worsening of chronic conditions such as stroke and headaches over the 20-year span of midlife,” Prof. Woods said.

Interestingly, they found no significant link with intimate partner relationships and later health. This was something that “stunned” the researchers.

As alluded to earlier in the article, the researchers believe that this is the case because family relationships go on forever, versus intimate relationships which can simply end.

“The vast majority of the people in the study had living parents or siblings, thus their relationship with a spouse or intimate partner was less likely to be as long as that of their family members,” Prof. Patricia Robertson, co-author of the study, said in a statement. “Therefore, the emotional intensity of these relationships may be greater, so much so that people experience more of an effect on their health and wellbeing.”

READ MORE: “I Have Crohn’s Disease – But Some People Think It’s All In My Head”

Why does this matter?

The researchers believe that these findings are critical particularly for healthcare practitioners because they highlight the importance of considering family relationships when assessing and treating patients.

“For adults who already have a chronic condition, a negative family emotional climate may increase their poor health and, conversely, supportive family members may help improve their health outcomes,” Prof. Woods concluded.

This article was originally published on www.womenshealthsa.co.za

Image credit: iStock

Yamkela Mdaka

Health24.com | THE REAL POLLEN COUNT: Much lower levels countrywide

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Amid the highest recorded pollen counts in history, Health24 will be bringing you exclusive pollen count updates courtesy of the UCT Lung Institute’s Allergy and Immunology Unit.

Here are the major city updates for 21 November:

Cape Town (Western Cape)

The Cape Town spore trap is running again. Fungal spores increased in response to some overnight rain. Ascospores increased and a small spike was seen for Rust spores.  Grasses were low, trees were similarly low (eucalyptus, cypress and white stinkwood) and a few weed pollen grains were detected. These were: English Plantain and Euphorbia.

Count: 5 (low) [Last week: 16 (moderate)]

Johannesburg  (Gauteng)

Fungal spores were low but spikes were seen for Cladosporium indicating an increase in humidity. Trees levels were low and included: birch, bush willow, ash, mulberry, eucalyptus, pine, yellowwood and plane. Grasses were very low. Weed levels were low and included: English Plantain, daisy, Apiaceae (shrubs of the carrot and celery family), Parietaria and the indigenous shrub Stoebe.

Count: 6 (moderate) [Last week: 6 (moderate)]

Pretoria (Gauteng)

Fungal spore loads were low but are increasing, especially Cladosporium levels. Pollen levels were low. Grass levels were low. Weeds were low and included, daisy, English Plantain, Prunus and ferns. Tree pollen was also low and included: birch, bush willow, jacaranda, oak, cypress, ash, mulberry, eucalyptus, yellowwood and Rhus/Searsia.

Count: 5 (low) [Last week: 26 (high)]

Bloemfontein (Orange Free State)

The fungal spore levels were very low. Pollen levels were similarly low and included low levels of grasses and trees including: olive, eucalyptus, white stinkwood, buddleja and oak. Weed pollen included goosefoot.

Count: 12 (moderate) [Last week: 9 (moderate)]

Kimberly (Northern Cape)

All pollen and fungal spore levels were low, yet there is clearly more moisture in the atmosphere as Cladosporium is beginning to appear in clumps. Pollen levels were low, with a constant low presence of grasses. Acacia pollen was detected in the category of trees; and Euphorbia pollen appeared regularly for the category: weeds and shrubs, along with English Plantain.

Count: 2 very low [Last week: 2 (very low)]

Durban (KZN)

Part of the strip was lost during this sampling week so the counts have been extrapolated from previous weeks and this week’s weather parameters. Fungal spore levels are lower than previous weeks but are still at moderate levels. Pollen levels are low and include low grass counts, birch and mulberry tree and the weed pollen: Daisy and English Plantain.

Count: 2 (very low) [Last week: 3 (very low)]

Port Elizabeth (Eastern Cape)

The fungal spore levels were low. Pollen levels were also low, but  new species were identified. In the category: Trees, only olive pollen was detected. In the weed/shrub category, Iridaceae, rarely seen at other sites was detected and Hermannia, a fynbos shrub that has not previously been identified from other sites was seen.

Count: 16 (moderate) [Last week: 4 (low)

See the full report HERE.

Reference ranges:

Overall, Trees, Grasses and Weeds all use the same values (grains per cubic metres of air)

Overall count is the daily average of pollen grains per cubic metres of air (trees plus grasses plus weeds)

In partnership with the the UCT Lung Institute’s Allergy and Immunology Unit.

As the pollen problem worsens, precise and expanded monitoring becomes even more essential. And here’s how you can help.

Image credit: Valentin Hermann, Unsplash

Health24.com | Sex isn’t always what drives ‘sexting’

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“Sexting” may sound salacious, but it isn’t always about sex, a new study shows.

In fact, two-thirds of adults who send these sexually oriented text messages don’t have sex in mind at all, the Texas Tech University researchers report.

Nonsexual purposes

Some sexting is about foreplay for sex later on. Sexting is also used for reassurance about the relationship. And sometimes it’s done to score points for something like a dinner date down the road, said report assistant professor Joseph Currin and doctoral student Kassidy Cox.

The duo are from the department of psychological sciences at Texas Tech. They used data gathered online from 160 people aged 18 to 69 for the study.

They looked specifically at the sexting motivations, relationship attachments and sexual behaviours.

“It was intriguing that two-thirds of the individuals who engaged in sexting did so for nonsexual purposes,” Cox said in a school news release. “This may actually be demonstrating some individuals engage in sexting, but would prefer not to, but do so as a means to either gain affirmation about their relationship, relieve anxiety or get something tangible – nonsexual – in return.”

Necessary to have consent

These three motivations for sexting were consistent regardless of sexual orientation, gender or age, Cox and Currin found.

“This tells us that sexting among adults is an evolution of how we have communicated our sexual desires to our partners in the past. People used to write love poems and steamy letters, then when photography became more commonplace, couples used to take boudoir photos for each other,” Currin said.

The researchers note that their study involved only consensual sexting.

“As with any sexual behaviour, it is important and necessary to have consent to engage in sexting,” Currin said. “Individuals who send unsolicited sext messages – such as images of their genitalia – are not actually engaging in sexting; they are sexually harassing the recipient.”

Image credit: iStock

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Health24.com | Tainted faecal transplant killed one patient – more vigilance needed

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Faecal transplants can bring the promise of an improved microbiome in ill patients, but a new report suggests they are not risk-free.

In a faecal transplant, donated faecal matter is processed and put into capsules for patients to swallow. Once in the gut, the capsules dissolve, releasing new, healthy bacteria into the gut.

A variety of harmful bacteria

But doctors from Massachusetts General Hospital in Boston reported that two patients who received faecal transplants suffered infections from drug-resistant E. coli, and one of them died from their infection.

Although donors and donated matter are typically tested for a variety of harmful bacteria, at the time of these transplants, drug-resistant extended spectrum beta-lactamase E. coli wasn’t one of those germs tested. Now it is. Continually adding germs to screen is one way to reduce future risk, the researchers noted.

“I think screening is important, but it’s a work in progress,” explained lead researcher Dr Elizabeth Hohmann, an investigator in the division of infectious diseases at Mass General.

“It’s not a panacea, because we can’t screen for everything,” she said. “There could still be things there that we’re transmitting which might cause medical consequences down the road.”

Hohmann believes that patients need to weigh the benefits of a faecal transplant against the possible risks.

“I have patients tell me they don’t want to have a faecal transplant because of the risk of infection, because of the ‘yuck’ factor, because intestinal microbiome are linked to weight and they’re worried about becoming overweight,” she said. “It’s a personal decision that people need to talk through with their physician.”

Used for other conditions

Faecal transplants were first developed to treat infection with Clostridioides difficile (C. diff), a common bacterial infection seen in hospitals and nursing homes.

Antibiotics are the usual treatment for C. diff, but the treatment often destroys the good bacteria along with the bad, and C. diff can return. That’s where faecal transplants can help.

The two patients in this report were enrolled in studies to see if fecal transplants could be used for other conditions.

The first patient, a 69-year-old man with liver damage from hepatitis C, was in a study to see if faecal transplants could improve brain function in patients with liver disease. When this patient came down with drug-resistant E. coli, he was treated with antibiotics and recovered.

The second patient, a 73-year-old man with leukaemia, was in a study to improve the microbiome at the time he was receiving a stem-cell transplant.

This patient developed E. coli infection shortly after the faecal transplant, and died of complications from the infection.

Once the US Food and Drug Administration was notified of these outcomes, they stopped both studies and issued a warning. Both studies are underway again with added precautions, Hohmann said.

Balance benefit and risk

She also said that new methods of faecal transplants are being developed, including one that would not rely on donors but on bacteria grown in the lab, which would all but eliminate the odds of transplanting harmful germs.

The report was published online in the New England Journal of Medicine.

Dr Martin Blaser is chair of the human microbiome at Rutgers University, in Piscataway, New Jersey. He said, “Any time we give people biological products from people, there is the risk of transmitting infectious agents.”

The more this is done, the more agents will be discovered, said Blaser, who wrote an accompanying editorial.

“On the other hand, there are important diseases for which treatment is not good enough, and we need to find new treatments. Scientists and doctors need to balance benefit and risk,” he said.

Image credit: iStock

Health24.com | World Aids Day: 7 things you should know about HIV, but probably don’t

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For the past few decades, myths and misinformation about HIV/Aids have put people at increased risk of infection, causing the condition to assume pandemic proportions, especially in South Africa.

Ahead of World Aids Day, South African physician Dr Sindi van Zyl, a specialist in the HIV and Aids field, spoke at the Cipla HIV/Aids press workshop about what everyone – regardless of whether you’re HIV-positive – should know.

If you have HIV, it can take up to 20 years for symptoms to show

HIV attacks the CD4 cells, a type of white blood cell, and uses them to make copies of the virus (called the viral load) and eventually destroy them. 

This process can go on for many years without any symptoms, which is known as the asymptomatic phase. During this time, you have no idea the virus is in your system, although your immune system is being weakened in the process. “South Africa has a problem of what I call the ‘blind spot’,” says van Zyl. “There are groups of society in our country who believe they’re ‘immune’ to HIV, who think it happens to ‘them’ but never to ‘me’. But there’s no them or me with HIV. 

“If you’re sexually active, then you’re at risk of HIV, because this is how HIV is primarily transmitted. This is why it’s crucial for everyone to test for HIV every 6–12 months, regardless of where you come from.”

There are HIV self-test kits on the market, but most people are unaware of it

There are now several approved home-testing HIV kits on the shelves. If you’re pressed for time, van Zyl says these at-home tests are a really convenient option.   

Professor Ian Sanne, Founding Director and CEO of Right to Care, also told Health24 that self-testing is recommended, but one shouldn’t panic should the results indicate you’re HIV positive. “We recommend that if the result shows you’re HIV positive, you don’t get distressed and rather have a second, complementary test done at a health clinic or by a general practitioner.

“The kit works very well and the studies that we’ve done on these kits show very good results, but the prevention method still needs to be linked to the self-test kit,” Sanne explains.

U=U: Undetectable = Untransmittable

The International Aids Society endorsed the U=U consensus statement of the Prevention Access Campaign. This statement makes the critical point that not every HIV-positive person is infectious. A person living with HIV who has an ‘undetectable viral load’ will not transmit the virus to their partner. And as long as your viral load remains undetectable, your chance of passing on HIV to a sexual partner is zero.

“And this is important because not only does this prevent transmission, but it also changes the way people feel about themselves,” says van Zyl.

“When an HIV-positive person’s viral load becomes undetectable, it changes the way they live their life: they can have condomless sex, they can have babies, mothers can breastfeed, for example. If you’re ‘undetectable’, you can essentially live the life of a normal, healthy person.”

It is important to remember that having an undetectable viral load does not mean you are cured of HIV. If you quit taking treatment, your viral load will increase and become detectable.

Proxy testing is not encouraged

“Proxy testing is when you assume you’ve HIV negative because your partner tested negative, and we don’t encourage that,” says van Zyl. “Each person has to know their own status.”

You need 3 or more ARV drugs to treat HIV

Antiretroviral therapy (ART) will always include a combination of three or more ARVs which is taken to suppress the virus’s ability to make copies of itself. However, van Zyl says that the majority of people believe that two ARVs are sufficient.

“We always give more than two drugs to block the life cycle of HIV, because different drugs work at different phases of the life cycle to stop the virus from multiplying. And this is why taking medication every day is absolutely crucial.”

Side effects of current ART not that bad compared to past ART

The treatment for HIV that we have today is much superior to what we had years ago, says van Zyl.

“People’s bodies used to get deformed because of the treatment in the past. And that put people off medication. And there were a few drugs that caused lipodystrophy [abnormal distribution of fat], but we’ve moved away from those drugs and only use them if we’re absolutely desperate.

“The newer drugs, however, don’t cause that. And if the treatment you’re on brings about side effects that are unbearable, I encourage you to tell your doctor so that the medication can be changed. Don’t tell yourself to ‘just hang in there’.”

HIV prevention is really a ‘basket of things’, says van Zyl

Condoms: When used correctly and consistently, condoms are highly effective in preventing HIV.

Abstinence: It’s the only 100% effective way to prevent HIV, although it can be challenging. “We’re sexual animals, and asking us to go against something that is essentially part of our nature is really difficult.

“We’ve been preaching it, but it doesn’t always work,” said Dr Michelle Moorhouse, co-principal investigator of ADVANCE and Head of treatment strategies at Ezintsha.

This is why experts recommend that everyone is aware of all forms of prevention strategies.

Post-exposure Prophylaxis (PEP): PEP is treatment that is used for preventing HIV after exposure. However, it should only be used in emergency situations and started within 72 hours after a possible exposure to HIV. The treatment is taken for 28 days, and can only be taken if you’re HIV negative.

For this reason, your healthcare practitioner will test you for HIV before prescribing PEP, and you may be required to test for the virus for up to 6 months after you begin taking PEP to ensure you stay HIV-negative.

Pre-exposure prophylaxis (PrEP): People who are at very high risk for HIV must take PrEP daily to prevent HIV. Trials for this have shown more than a 90% success rate. Van Zyl explains that with this treatment you have to commit to three-four monthly check-ups.

“There are different regimens, but the pills work if you take them. And there are actually medical aids in South Africa that cover this. It won’t cost you more than R250 per month, considering the generic forms out there.

“South Africa is lagging behind a lot when it comes to PrEP, and we shouldn’t. It’s one pill, once a day, and it works,” says Van Zyl.

PrEP isn’t available at every clinic in South Africa. However, by March 2020, it’s expected to be rolled out at 1 000 facilities across the country.

World Aids Day has been taking place on 1 December every year since 1988, and is dedicated to raising awareness of the Aids pandemic, caused by the spread of HIV infection, and mourning those who have died of the disease.

Image: Getty

Zakiyah Ebrahim