Tag Archives: Health

There’s currently an outbreak of Hepatitis A affecting gay and bisexual men.

Hepatitis A outbreak in England under investigation

Public Health England is investigating a hepatitis A outbreak predominantly affecting men who have sex with men. Between July 2016 and 2 April 2017, 266 cases associated with the outbreak had been identified in England. At least 74% of these were among MSM, and 63% of cases were in London. There is evidence that there have been some cases in the wider population linked to the outbreak.

A high proportion of cases likely acquired the infection abroad at the beginning of the outbreak, but transmission now mainly occurs in England. The outbreak comprises three concurrently-circulating genotype Ia strains, previously not seen in England. Hepatitis A outbreaks caused by the same strains are concurrently occurring in 12 European countries and elsewhere in the UK outside of England [1,2].

As part of the outbreak response, PHE together with the British Association for Sexual health and HIV have recommended that MSM with one or more new or casual partner in the last three months are opportunistically vaccinated in GUM clinics at their next appointment. In addition, pop-up vaccination clinics have been set up around gay venues in London. PHE is considering wider vaccination strategies to respond this outbreak, which is occurring in the context of a global shortage of hepatitis A vaccine.

See the PDF version of this report for the epidemiological curve depicting the outbreak.

References:

  1. ECDC (December 2016). Rapid risk assessment: hepatitis A outbreaks in the EU/EEA mostly affecting men who have sex with men.
  2. Beebeejaun K, Degala S, Balogun K, Simms I, Woodhall SC, Heinsbroek E, et al (2017). Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017. Euro. Surveill. 22(5), 2 February.

Thanks for reading, let us know what you think in the comments below, or you can find us on FacebookTwitter or Instagram!

bfb01    btw01    bin01

                  (Or subscribe to our newsletter)

Advertisements

The Survivors

When they were diagnosed, HIV/AIDS was seen as a death sentence: the Grim Reaper. But medical science eventually found ways to hold AIDS back. Long-term survivors, some now feeling a survivor’s guilt, recall preparing to die – and remember the many who did.

Jay Whitehall was just 18 and mourning the death of a friend in The Peel, a gay pub in Melbourne, on a cold winter’s day in 1991. He had been HIV positive for about two years. He was distraught and thought he was going to die.

AIDS had been ripping through gay communities worldwide since the first reports in 1981 of young, gay American men dying of causes usually associated with the elderly or bone marrow transplant patients – rare cancers, pneumonia, catastrophic bodily failure. Treatments were toxic as hell, and no one was expected to last more than five years after diagnosis.

Whitehall’s head was dipped to the ground in despair when a drag queen he didn’t recognise – and he thought he knew all of them – appeared before him. She was tall – really tall, he says – with blonde hair, draped in a light blue dress which sparkled in the pale light.

The drag queen grabbed Whitehall by his shoulders, forcing him to look at her. She said, “HIV is the best thing that ever happened to me – I’ve lost three inches off my hips, four inches off my waist and I feel f****** fabulous!” She performed a high kick and leaned in to tell the mesmerised teenager: “Don’t ever take HIV seriously or it’ll f****** kill you.”

“It helps keeping a positive outlook and not letting the Grim Reaper get into your head.”
“It was a really good thing for me to hear,” says Whitehall, now 44, who muses if the mysterious drag queen who disappeared so quickly was an angel. He took her advice to heart and his health has been good since – swollen glands occasionally, which he attributes to stress. “It sounds tacky, but it helps keeping a really positive outlook and not letting the Grim Reaper get into your head.”

The outlook for people with HIV improved dramatically in 1996 with new drugs called protease inhibitors, following 15 years of devastation. The treatment helped raise T-cell count – a measure of immune system strength – clear of the range where death was a matter of when, not if. People with HIV began living longer.

“You could see – he was really skinny, he looked really unwell.”
Australian health experts even announced an end to the AIDS epidemic in July. “AIDS as a public health threat is over,” Professor Andrew Grulich, of the UNSW Kirby Institute, told Fairfax Media, adding, “Our treatments are so good that most people recover. You get tested early, you get good treatment and people can live a pretty normal life.”

But a generation of long-term survivors from the pre-1996 days – who never expected to live more than a few years – is now approaching retirement, and they face not just the challenges of ageing, but of ageing with HIV. Many will tackle physical and mental health issues, from decades of drug therapies, which are only just being acknowledged

IN THE DARKEST days of the epidemic when hope was absent, people would just drop out of sight. David Crawford, who thinks he became HIV positive in 1984, managed the AIDS ward at Sydney’s St Vincent’s hospital in the 1990s. He says you didn’t see them become sick. One close friend he knew in the 1980s was studying to be an ambulance officer. Crawford figured that was the reason for months without any contact. Then they met by chance at Redleaf pool at Sydney’s Double Bay.

ore than 30 years of living with HIV: David Crawford.

“He didn’t have to tell me what happened,” says Crawford, now 61, talking in a meeting room at Positive Life NSW, the support group for people with HIV, where he works as treatments officer. A box of tissues sits on a chair from the last counselling session he held here. “You could see – he was really skinny, he looked really unwell. I guess that was obvious in my response, the shock.”

“You werent expected to live. You might as well make the most of the life you had.”
He took his own diagnosis calmly. His mother catastrophised everything, leaving him level-headed. He could have blown his inheritance on a bucket-list holiday – plenty did – but instead studied to be a nurse. A fellow student died of AIDS 12 months into the course.

Crawford still ponders why he knuckled down to a career. “I think it came from my dad,” he says. “He said, ‘Don’t follow the sheep. Do your own thing. Make your decisions and follow them through. Don’t be swayed by anybody else.’”

Jane Costello was given three years to live, 22 years ago.

Jane Costello, the 55-year-old president of Positive Life NSW, knows at least 20 long-term survivors eking out a living on social security after blowing their savings and pensions shortly after diagnosis. “You weren’t expected to live,” says Costello, who tested HIV positive in 1994. “You might as well make the most of the life you had.” She was given three years; her husband, who is still alive, less than a year.

One hospital was nicknamed The Morgue: “Once you went in, you didnt come out.”
Crawford would party at Mardi Gras, have a fantastic time, then return to the ward to discover five patients had died that weekend. He cared for Tim Conigrave, who finished his acclaimed memoir Holding the Man there, and his lover John Caleo before their deaths. “There was a roller-coaster of emotions,” he says.

“People were dropping dead like flies,” recalls Whitehall. One Melbourne hospital was nicknamed “The Morgue”, he says: “Once you went in, you didn’t come out.”

Fear and discrimination of people with HIV were widespread, even in the gay community. “Some people would say ‘we don’t really want you here’,” says David Menadue, a Melbourne writer and activist, who was diagnosed aged 32 in 1984. “That was in a gay bar! They got over that, they worked out you couldn’t catch it casually and oppress your own like that. It was a hairy time.”

Californian Tez Anderson set up grassroots group Let’s Kick ASS, to highlight the plight of long-term survivors, which held its third annual awareness day in June. Chapters are springing up across America, and he tells SBS that he’s received an enquiry from Australia.

He remembers his own diagnosis in 1986. He left the clinic and walked up the street and everything was so electric, the sky bluer than it had ever been, the birds louder and the flowers on the hill such a vivid yellow – a hyper-awareness he now recognises as shock.

“It took a lot longer to get my head around the idea that I might well be an old man with HIV.”
Anderson was given two years to live and he began living, he says, like a dying man. “I was going to be the best dying man in the world.” He bought books on dying and went to classes and tried to accept that as a 26-year-old he would not celebrate his 30th birthday. “It took a lot longer to get my head around the idea that I might well be an old man with HIV,” he says. “A long time. I thought I might have maybe five years. We didn’t know. We were the first ones to have this shit.”

He remembers being at a bus stop one day watching people leaving public transport. “They looked like wounded warriors,” he says. “People were in a daze. So many people you’d see on the street, healthy one day, a little bit more decrepit and sicker and sicker and then you stop seeing them, and then their obituary in the local gay paper. It was page after page after page after page of obituaries.”

It’s hard now to comprehend what a difference the 1996 medications made – Anderson refers to the “Lazarus syndrome – returning from the dead to walk again”. Some were even resistant to the very idea of a future, refusing to take drugs which could keep them alive. “It’s almost like ‘I’ve decided what’s going to happen to me’,” says Menadue. One man told him, “I was planning for an early death.” “That was going to be his release. He thought he’d have nice drugs and float off into the ether and everything would be fine.”

Anderson speaks of being “perplexed by survival” and of “AIDS Survivors Syndrome”, a condition he coined after years of anxiety, depression and suicidal ideation. He was watching a show on Iraq War veterans and post-traumatic stress disorder when he realised that explained how he felt; that living through unrelenting decades of being swamped by death was similar.

“‘We went through a holocaust. And we’re meant to put it behind us and pretend it doesn’t exist.’”
Melbourne man Daniel Cardone recognised the same pathology when shooting a documentary, about long-term survivors who moved to the Californian desert city of Palm Springs to recuperate, which screened at this year’s Melbourne Queer Film Festival. Desert Migration features voice-overs of loss and trauma over tranquil images of mundane beauty: the purpling mountains on the near horizon, a stop sign at the corner of Sunny Dunes and Dunes, a hummingbird’s delicate sip of nectar. Each testament adds to a tapestry of a generation’s obliteration.

“The most immediate thing I learnt from making this was how much unresolved grief people still carried with them, literally post-traumatic stress disorder,” says Cardone, diagnosed in 1995, who moved to Palm Springs in 2010. “And it was really not being acknowledged. The mental health fallout from the epidemic is unparalleled and untreated. As Doc, one of the men in the film, says, ‘We went through a holocaust. And we’re meant to put it behind us and pretend it doesn’t exist.’”

Anderson spoke this July about AIDS Survivor Syndrome at an international AIDS conference in South Africa and launched a social media campaign under the hashtag #WhatAIDSSurvivorsNeed. Someone contacted him via Facebook saying he had no idea there was a name for what he was going through, that he wasn’t alone. “He said you just saved my life,” says Anderson, via Skype, blinking back tears. “It was so lovely.”

“A lot of people sold everything and then suddenly they survived.”
He wants an ongoing conversation moving from survival to one of healthy ageing and recognition of survivors. A 2016 study in New York City suggests 26 per cent of people with HIV are long-term survivors, he says. 

JANE COSTELLO SAYS many long-term survivors are suffering and living in poverty. “We’ve got that whole ‘End HIV by 2020’ thing,” she says, referring to a national health campaign aimed at producing no new cases by the end of the decade, “and you go, okay, but it’s not saying much about the people living with HIV. That’s about ending transmission… A lot of people sold everything and then suddenly they survived.”

Survivors can face physical and mental challenges. Menadue has had to change medication 14 times since he began treatment in 1989 as the virus became resistant to them. “They were toxic,” he says, “affected my kidneys and liver. They stripped so much fat off my arms and legs – I never managed to get it back.”

“No one dies of HIV anymore, but HIV plays a role in their deaths.”
Even 1996’s game-changer of triple combination therapy introduced fresh risks, raising rates of heart disease and osteoporosis. (Those who began treatment after 1996 may not develop such chronic conditions as long-term survivors, though Crawford believes there will be some negative impact on long-term health.)

Menadue has four major co-morbidities – medical complications – with his HIV, including diabetes and osteoarthritis. In the last few years he’s had cancer, a knee replacement, a shoulder replacement and an ankle fusion.

“No one dies of HIV any more,” he says, “but HIV plays a role in their deaths.” He adds, “If you have a decent T-cell count, you’re probably not going to die soon unless you get run over by a bus.” But people “are experiencing lots of frailty from 55 up, even a bit earlier in some cases. People really have a body of a person 15 years older.”

“I’m faced with premature ageing now.”
One drug led to Crawford developing peripheral neuropathy, destroying nerves in his feet so he couldn’t walk. They also caused diarrhoea within half an hour of ingestion and pancreatitis. There was a months-long spell of reactive arthritis earlier this year. He has short-term memory problems caused by the virus replicating in his brain.

“Even though the drugs [now] are really effective, we still live with these really low levels of inflammation,” he says. “When you’re dealing with long-term inflammation, the risk for heart disease is higher.” There could be problems with other organs, such as the kidneys and lungs. “I’m faced with premature ageing now, I’m possibly experiencing some things I’d be experiencing at 70 or 75 now because I’ve been diagnosed so long.”

David Crawford says Positive Life’s research shows 45 per cent of all those with HIV are coping well. Another 40 per cent have a few problems – he puts himself in that bracket – and another 15 per cent are “doing it tough”.

David Crawford, David Menadue and medications taken by another person living with HIV.

Associated mental health issues are depression, suicidal ideation, anxiety and substance abuse – the latter an area swamped by the recent explosion in crystal meth use, but which includes alcohol and tobacco. Costello says some people stop taking their medication, an act known as “passive suicide”.

One of the biggest issues for those newly infected with HIV is how – and whether – to disclose their status to friends, family and lovers. Long-term survivors have different challenges, says Menadue: “How are you living with the various chronic conditions that you’ve got? What kind of support do you need? People are concerned about being frail in the future. What aged-care options are there?”

Women face extra challenges, says Costello. Drug trials have mostly been conducted on men, who represent about 90 per cent of those with HIV in the West.

“Women with HIV generally experience menopause earlier.”
“This means they’ve no idea on how [current treatments] affects women’s bodies,” she notes. That doesn’t mean the drugs aren’t achieving – hopefully – their purpose, of diminishing the viral load and increasing the CD4 count, but the long-term effects are unknown.

The unknowns multiply with age. “With menopause they have no idea,” she says. “Women with HIV generally experience menopause earlier. We don’t know how hormone replacement therapy interacts with the drugs.” Women are also more susceptible to problems with bone density as they age.

Costello feels blessed to have lived longer than her initial three-year prognosis. Instead of wondering whether feelings of ill-health might lead to her body’s immune system being overwhelmed – she’s stayed in relatively good health – she now wonders if joint pains in her knees might be the first sign of decline.

There is care for people who prematurely age, though it’s not thought any planning is under way for old people with HIV – An estimated 73,660 people nationwide were living with the condition in 2002, of which, 12%, or 3,640, were over 50 years old.  By 2011, however, this figure had increased to 22%, or 16,550, even rising to as high as 35% in Brighton.

“Young people don’t understand it. They’ve never seen someone die of AIDS.”

Menadue, and others, think the stories of long-term survivors aren’t being told. He says more could be done to encourage the 50-plus cohort to monitor their health. He praises HIV organisations for their support, but adds, “I do get the message sometimes that we don’t want to give too many negative messages about the awful bits of living with HIV because it’ll freak out the young.”

Whitehall has had unsettling encounters with younger gay men over his status. He was told to “shut up you stupid old c*** and die a slow AIDS death” by a 19-year-old he argued with online. “Young people don’t understand it,” he says. “They’ve never seen someone die of AIDS.”

He also recalls a university student in his 20s – “really good looking, a really smart young man” – wanting sex without a condom, so he could become HIV positive. (He told Whitehall, “It’s like having my man living inside me.”) “They have no grasp of what HIV and AIDS is and what it did to people. So many people died.”

Desert Migration closes with an inky night falling over the city. Backlit clouds race across the moon. Day breaks with a great yellow rind over the horizon, and life goes on. “I don’t even think about my survival any more,” says Whitehall. “I’ll probably die around 70 like my dad did.”

Thanks for reading, let us know what you think in the comments below, or you can find us on FacebookTwitter or Instagram!

bfb01    btw01    bin01

                  (Or subscribe to our newsletter)

President Trump’s next target: People living with HIV

trump-ribbon

A month into Donald Trump’s presidency, and the ways in which Trumpism is a threat to lesbian, gay, bisexual and transgender existence are almost too many to count. However, those most vulnerable to HIV will be hit the hardest.

The threat of actually losing health insurance due to the president’s promise to repeal the Affordable Care Act is making millions of Americans so terrified, even his own voters are increasingly warming up to Obamacare.

But the ACA’s death is still a real possibility, and it would take a particular toll on queer Americans. According to a Yahoo investigation: “Before the ACA was passed, only about 13% of people with HIV had private health insurance and 24% had no coverage at all.” Indeed, the ACA has been a lifesaver for many people living with HIV: its subsidies for private insurance and its robust expansion of Medicaid in many states have greatly increased their access to medical treatment. If you doubt the scale of the continuing epidemiological emergency, consider that only about half of African Americans with HIV have access to continuous medical treatment, according to the Centers for Disease Control.

One way the ACA has addressed the crises is by funding the prevention efforts of Aids service organizations. Beyond people living with HIV, this work is helping to keep the transmission of the virus from further harming the most vulnerable communities, such as transgender women of color, or the one in two black gay men the CDC predicts may become HIV-positive in his lifetime unless radical action is taken.

But if “silence equals death”, as the Act Up slogan says, then loud protest is needed to keep people living with HIV from losing access to medication.

Creating swaths of uninsured people living with HIV who will likely lose access to viral suppressing medication (which makes HIV almost impossible to transmit) will also increase the likelihood of transmission to others. We know that when people in prison who are HIV-positive are released with little medication, they often stop taking it altogether when they run out; their viral load then becomes very high and, research has shown, their sex partners are more susceptible to becoming HIV-positive. (And if Republicans failed to keep the Obamacare provisions which allow people with pre-existing conditions to buy insurance without discrimination, it would be even worse.)

Remember: when then Indiana governor Mike Pence presided over one of the worst HIV outbreaks in the history of the country in 2015, he first turned to prayer before then turning to Obamacare to ameliorate the outbreak (the latter worked).

But as vice-president, Politico reported this week: “Pence is helping to lead the Republican effort to dismantle the program that helped him halt the deadly outbreak in an impoverished swathe of Indiana.” Pence wants to end what he knows worked. His horrific HIV record, steeped in heterosexism, racism and Christian supremacy, is going to hurt people living with HIV, queer people, ethnic minorities and the poor the most.

Advocates of science were alarmed when the Environmental Protection Agency was told it could no longer talk to the public because, among other reasons, the EPA protects the public from environmental harm by giving information and guidance. Similarly, LGBT Americans should be very worried that the Trump administration seems to be dialing back on providing information on HIV/Aids and LGBT health to the public. The website for the White House office of Aids policy is now blank, and the office’s future is unclear. A CDC summit in the works to address LGBT youth health (meant to address pressing issues a CDC report exposed such as how “young gay and bisexual males have disproportionately high rates of HIV, syphilis, and other sexually transmitted diseases”) was infinitely postponed after Trump was elected.

In funding prevention programs, the ACA still remains an important channel of government information about HIV/Aids. But if it disappears, the loss may beespecially harmful in states which only teach “abstinence only” sex education.

As an LGBT community (and this applies to our supporters too), we cannot be focused simply on the Trump administration’s conservative stance on our civil rights. We must be vigilant about how HIV/Aids stands to harm the most vulnerable among us first, do all we can to protect the 1.2 million people in the US already living with HIV, and insist that the government keep the epidemic from getting even worse.

Article via US Politics @ The Guardian

Thanks for reading, let us know what you think in the comments below, or you can find us on FacebookTwitter or Instagram!

bfb01    btw01    bin01

                  (Or subscribe to our newsletter)

‘Tis The Season For Overindulgence ♫

Boxing Day Buffet Lunch Christmas Tree and Log Fir

Many people overdo it at Christmas, celebrating with friends and family, non-stop eating, drinking and late nights can leave us feeling tired, sluggish and quite often, a little poorly if we’ve eaten or drunk too much.  A lot of people with HIV generally have a healthy diet and lifestyle, and may only overindulge once or twice a year, if that’s you, then you’ll have no problems going back to eating sensibly after the holiday season, festive excesses aren’t likely to have a long-term, damaging effect on your health or your weight.  However, the short term strain that too much rich food and alcohol puts on your body can still leave you feeling bloated and out of sorts, when all you need is your body to get back to normal.

An average person can consume as much as 7,000 calories on Christmas Day, (that’s three and a half times the recommended daily intake for a woman.)  As well as dehydrating us and putting a strain on our liver, excessive consumption of alcohol can also make us feel unwell, and ill-equipped to handle a detox correctly.

When the festivities are finally over, there are a few sensible, gimmick-free steps that you can take to help you and your body get back on the road to feeling better.

Get Moving

It’s a cliché, but exercise really is the best way to make your body and metabolism work together so it can make use of the nutrition it’s received over the past few days.  A 30 minute walk is good for your heart, lungs, muscles and bones, as well as improving your mood and giving you a sense of wellbeing.  So instead of watching reruns of Christmas TV, get yourself off the sofa and go out for a stroll!

Be kind to your body

If you’ve over-indulged in rich, fatty, sugary foods with alcohol, if your inclined, your body needs time to recuperate.  You should try to avoid red meats, dairy products and processed foods and opt for lots of fruit and vegetables and wholegrain foods instead.  And one of the best things to drink is water (no surprise there), but did you know that the additional salt and alcohol we consume dehydrates the body, so it’s best to re-hydrate.  If you can’t manage full glasses, frequently just try a glass of water with your cup of tea, coffee or soft drink.  Combined with exercise, you’ll start to feel the benefits almost immediately!

Don’t Forget Protein!

Proteins are extremely important for your diet as they are the building blocks of your cells, muscles, organs, and more importantly, your immune system!  If your body doesn’t get the protein it needs from food, it will start using the protein it has stored up which can result in a weakening of your immune system.  A good rule of thumb for a HIV positive person is 100 to 150 grams of protein per day for men, and 80 to 100 grams of protein per day for women.

Energy & Fat (yes, fat)!

You can rebuild your energy by eating complex carbohydrates, that’s food items such as grains and beans, rice and pasta.  While eating complex carbohydrates, try to focus on foods such as white bread, pasta and potatoes.  These carbohydrates are richer in nutrients and the body absorbs them slower, helping to sustain you while you are between meals.

While carbohydrates help you get energy, fat is what helps the body store energy for later use.  For HIV positive people, doctors recommend a fat intake of less than 30 percent of your daily caloric intake.  Also make sure you are getting the appropriate amounts of fat, sometimes, people with HIV experience an increase in cholesterol because of interactions with medications so it’s important to watch your fat consumption. It is recommended that of that 30 percent, 7 percent be saturated fat from foods like whole milk, butter and fatty meats. The rest of the fat should come from nuts, fish, seeds, canola oil and soy.

If you’d like to know more about HIV and Nutrition, visit Avert, who have comprehensive information and advice on diet, supplements and nutrition.

You can also visit Web MD, National AIDS Trust or Positive Nation for some helpful nutrition information or learn about about eating a balanced diet on the NHS Choices website at: www.nhs.uk/Livewell/Goodfood/Pages/the-eatwell-guide.aspx.

Thanks for reading, let us know what you think in the comments below, or you can find us on FacebookTwitter or Instagram!

Facebook          Twitter         Insta

(Or subscribe to our newsletter)

Left out in the cold: Living with HIV in Russia

‘Talk to Al Jazeera’ traveled Russia to find out what’s behind the fast-growing HIV epidemic there.

Al-Jazeera-banner

Russia, the largest country on earth, which emerged from the post-Soviet economic and political chaos to reassert itself, is facing a HIV epidemic.

The current rate of HIV is less than one percent of Russia’s population of 143 million. It’s far lower than many other countries, such as South Africa which stands at 12.2 percent, that have been battling HIV epidemics.

Russia has one of the fastest-growing rates of HIV/Aids in the world. At the beginning of this year, the number of registered HIV-positive people surpassed one million. The number of Russians living with HIV has almost doubled in the last five years.

The 2016 UNAIDS Prevention Gap Report pointed to Eastern Europe and Central Asia as “the only region in the world where the HIV epidemic continued to rise rapidly”.

Russian activists say the government’s reluctance to introduce internationally-accepted prevention methods is behind this epidemic. Potential solutions such as sex education, the distribution of condoms to sex workers, methadone therapy and the availability of clean needles to drug addicts are strongly opposed by religious leaders and other conservatives.

It is estimated that over 50 percent of HIV cases in Russia are the result of intravenous drug use. Methadone therapy, however, was made illegal by President Vladimir Putin’s government, despite being classified as “the most promising method of reducing drug dependency” by the World Health Organization.

Talk to Al Jazeera travels to St Petersburg and Moscow to meet people living with HIV and the activists doing all they can to help.

In St Petersburg, we meet Aleksandr Romanov, 47, who discovered that he was HIV-positive six years ago. He grew up in Kazakhstan, then part of the Soviet Union. He says his infection can be traced back to the post-Soviet effects on society – dramatic changes, which included widespread drug use.

Maria Yakovleva, also known as Masha, is part of Svecha, or Candle Foundation, an organisation which provides support, guidance, education, and hope to those living with HIV. She herself is HIV-positive. Changes need to come from the top, she says. 

“There are plenty of things [people need to know], but there is no information [from the government],” Yakovleva says.

Maksim Malyshev works as a social worker with a local NGO in Moscow, which promotes humane drug policies. He worries about the negative impact that the government’s approach has on Russians living with HIV. He can’t understand whether Russia’s leadership simply doesn’t care or is just incompetent.

“In my view, the problem of HIV infection in Russia exists because the people whose job it is to find ways of preventing HIV in Russia are doing a crap job. They are living in some kind of fantasy world of their own, and they have no desire to listen about science-based methods and to the specialists who are working on this problem,” he says.

“Either these people are hypocrites who don’t care about the thousands of people who get infected with HIV and die, or they are simply too stupid to research the HIV prevention information in order to ascertain what is and isn’t working and to resolve this problem.”

The government needs to wake up to a problem that has long been urgent, he believes.

“I think we are already long past the point when something should have been done.”

Pregnant and diagnosed with HIV: the group providing support for mothers

6016

Thirteen years ago, when Babalwa Mbono was eight months pregnant with her second child, she went to her clinic in Cape Town, South Africa, to have a routine HIV test.

Article via The Guardian
guardianlogo

“I went with confidence because my first child was negative and I was negative then,” she says. When the test came back positive, Mbono couldn’t believe it. “When the counsellor who tested me showed me the results I thought, ‘you’re joking!’ I even asked her if she was sure.”

Mbono left the clinic in a daze and went home to reflect on the news, still in denial. She looked healthy and well, unlike her sister who had died three years previously from Aids-related tuberculosis. “For me, [the result] was something that was not real,” Mbono adds.

Nowadays many people in South Africa know about HIV. The country has the biggest and most high-profile epidemic in the world, with an estimated 7 million people living with the condition, according to UNAids figures. But in 2003 it was not a big topic, and discussions usually revolved around death, says Mbono. The fear of what having HIV might mean for her unborn child started to creep in, and she worried that she would not live long enough to care for a baby who might be infected.

When Mbono found out that she had HIV, South Africa’s government was still deciding whether to make antiretroviral treatment (ARVs) available to all, despite a third of pregnant women testing positive. Today, 48% of infected South African adults are on ARVs.

Back at the clinic, Mbono was linked up to a mentor mother through Johnson & Johnson’s mothers2mothers (M2M) programme. The scheme started in 2001 and has helped 1.4 million HIV-positive mothers in nine sub-Saharan African countries. It currently operates in Kenya, South Africa, Malawi, Lesotho, Uganda, Swaziland and Zambia – seven countries where it has virtually eliminated mother-to-child transmission (MTCT) among its patients, with a 2.1% transmission rate (the UN classifies virtual elimination as less than 5%).

Mbono’s HIV-positive mentor allayed her fears about death and her anger towards her husband, whom she blamed for giving her HIV after he tested positive with a much higher viral load. Through M2M, Mbono learned about taking ARVs to reduce the risk of MTCT in the womb and during breastfeeding, and about how to change her lifestyle to live a long and happy life with her children.

Last year, South Africa was one of six priority countries (all in sub-Saharan Africa) to meet a Global Plan target of reducing MTCT by 90%, with 95% of pregnant women with HIV on ARVs and an 84% reduction in new HIV infections among children.

Over the past year, Cuba, Belarus, Armenia and Thailand – non-priority countries – managed to eliminate MTCT altogether. In South Africa, mother-to-child transmission of HIV has fallen to 3.5%, putting the country within reach of eliminating paediatric infections, although maternal mortality remains high.

The M2M programme “makes the person feel supported”, Mbono says. “It’s a sisterhood, and it makes you feel like you have a family to cry on.” Through counselling, which helps to breaks down the stigma still attached to HIV/Aids in South Africa despite its high prevalence, Mbono also found the courage to confide in her parents and siblings.

And six months ago, she decided to disclose her HIV status to her daughter Anathi, who had just turned 13. “It really felt shocking,” says Anathi, who feared that there would be no one to look after her seven-year-old brother, who was born HIV negative. “I was afraid that she would leave us.”

Mbono reassured her daughter that she had tested negative when she was 18 months old, but Anathi decided to go alone to the clinic and be tested anyway, where she also accessed free counselling from health workers.

“I was so, so scared, but eventually they just sat with me and told me to not freak out and to not think negative things about my mum,” Anathi says. Over the two days she waited for her results, she spent time with her mother and learned more about M2M, even reading her mentoring books.

Mbono’s experience with M2M made her give up unhealthy habits, such as not eating properly and drinking alcohol, and inspired her to become a mentor mother in 2003. “The [programme] gave me the strength to go out there and tell people about HIV and correct the mistakes that people are making and [that] I also made when I didn’t have any information.”

She has gone from counselling others on HIV/Aids and family planning, to training other mentors and seeing them become nurses, social workers and students.

“What makes me most happy [is] when I see a woman who had broken up in pieces when she was told about HIV … and when you see her on the next visit she is much better than the day she left.”

Some 95% of babies in M2M’s South Africa programme test negative for HIV at 18 months, and that also makes Mbono proud. “That makes me feel that I’ve done my job, because 18 months is a long time for the mother to be supported and to be educated. There are so many challenges that they come across, and we are there [for them].”

Anathi set up a counselling group at school to discuss HIV and sex with 18 girls and five teachers, as well as a drama group to perform plays to parents and pupils that discuss staying HIV negative and breaking down stigma.

“Most people don’t talk about it … Young people are not getting enough information about HIV,” she says. Anathi has a friend who she says became a recluse after she found out she is positive, and she knows two girls who have gone off the rails since their mothers recently died of Aids.

But for Anathi, dealing with her mother’s HIV has made them stronger and brought them closer together.

She still worries about how well her mother has slept or eaten when they are apart, even though learning about ARVs has lessened her fears of her mother falling ill and not recovering. “I just worry too much and I call,” she says. “She is like my daughter.”

Thanks for reading, let us know what you think in the comments below, or you can find us on FacebookTwitter or Instagram!

Facebook          Twitter         Insta

(Or subscribe to our newsletter)

How to combat the threat of HIV drug resistance

 A mother holds her antiretroviral drugs, Triomune, at a HIV testing and treatment clinic in Lagos, Nigeria. Photograph: David Levene for the Guardian

A mother holds her antiretroviral drugs, Triomune, at a HIV testing and treatment clinic in Lagos, Nigeria. Photograph: David Levene for the Guardian

As we strive for an Aids-free generation, we must help people adhere to antiretroviral treatment to stop them developing resistance.

For people living with HIV, antiretroviral treatment (ART) has been a life-saver. ART stops HIV from making copies of itself and prevents HIV from attacking the body’s immune system.

At the end of 2015, 17 million people were taking ART around the world and Aids-related deaths had fallen by 45% since the peak in 2005.

Story via The Guardian
guardianlogo

But those who don’t stick to the ART regimen set out by their doctor or health worker might become resistant to the drugs. Resistance occurs when ART regimens are not taken as prescribed, which allows HIV to make copies of itself and increases the risk that the virus will mutate and produce drug-resistant HIV. A person who is on a drug such as Efavirenz can develop resistance after as little as a two-day interruption of treatment.

Globally, HIV drug resistance is on the rise. The World Health Organisation (WHO) reported that up to 2010, HIV drug resistance levels remained at 7% in developing countries. However, recently, some countries have reported levels at or above 10% among those starting ART, and up to 40% among people restarting ART.

At the beginning of the epidemic in sub-Saharan Africa, there was fear among the international community that people living with HIV in resource-limited settings would not be able to adhere to their treatment due to a lack of education and resources. Would they be able to keep time well enough to take their ART at the same time every day?

However, studies have demonstrated that people in sub-Saharan Africa may be better than people in the west at taking their ART as prescribed. The issue in developing countries is that people lack the resources to get to a clinic and pick up their pills. I’ve worked in Namibia since 2009, and whenever I visit ART clinics, there are long queues stretching out the door. People often have to wait all day and many can’t afford to take this time off work every month.

The stigma associated with being seen waiting in a queue to pick up medication is also a factor in people not adhering to their treatment plans. To avoid this, some people on ARTs travel to a clinic many kilometres away from their town, so they can receive treatment without anyone recognising them. And if you took a whole day off work, borrowed money for the transport and stood in a queue all day, only to learn that the clinic had run out of your pills, what would you do?

ARTs & HIV drug resistance

As the use of ART increases, so does the risk of HIV drug resistance. It’s no surprise, then, that global HIV drug resistance is on the rise, both among those already on ART and those just starting on it.

What could happen if levels of drug resistance reached critical levels? Their ART regimens would no longer be able to stop the HIV in their bodies from making copies of itself and they would then have to be switched to second-line regimens, if available.

But second-line regimens are more expensive. For countries already struggling to provide ART to those who need it, this would is likely to mean that fewer people could be started on ART.

Drug resistance has been a problem since the beginning of the HIV epidemic. In the west the problem was usually limited to individual patients. But in resource-limited settings, if a high percentage of the population develops drug resistance we could see large increases in Aids-related deaths and higher healthcare costs.

We must act now to help people adhere to their treatment plans, before it’s too late. Globally, there has been a huge focus on getting more people on treatment, but the quality of how it’s delivered has fallen by the wayside.

Drug resistance will rise when ART is not delivered in a well thought-out way. That requires strong drug supply systems with zero tolerance for an interruption of ART drug supply, strong and locally appropriate counselling to promote adherence, support for patients who don’t have the resources to access care, re-engagement of patients who have stopped going to the clinics, alternative ways to deliver care such as community-based ART groups, and strong medical record systems.

As we strive to end Aids as a public health threat by 2030, greater attention must be focused on identifying and correcting gaps in the quality of ART service delivery. Many lives depend on it and the time to act is now. If we don’t, we may find ourselves with a new global pandemic of drug-resistant HIV and be faced with a deadlier enemy than we started with.

Thanks for reading, let us know what you think in the comments below, or you can find us on FacebookTwitter or Instagram!

Facebook          Twitter         Insta

(Or subscribe to our newsletter)