Face HIV
Jun 06, 2007
<b>How will we survive?</b><br>Dear doctor, <br>I have just lost my job and I’m now unable to pay for ARVs, which my wife and I have been taking for the last three years. When we went to one of the AIDS service organisations to try to access free ARVs, they told us we were not ART naïve and as
How will we survive?
Dear doctor,
I have just lost my job and I’m now unable to pay for ARVs, which my wife and I have been taking for the last three years. When we went to one of the AIDS service organisations to try to access free ARVs, they told us we were not ART naïve and as such could not be helped. What does it mean to be ART naïve and what do we do now because our health had improved so much on ARVs?
Morris K
Dear Morris,
Many people are finding themselves in a similar situation because of certain important issues, which were not discussed during counselling, before being initiated on ARVs. They could not, therefore, plan for future sustainability of the treatment. Some who were started on ARVs based on organisational health polices that offer free medical treatment (including ART) to their workers, often find themselves unable to sustain treatment once they stop working. This is certainly going to have a critical effect on the entire ART programme in this country, unless a corrective action is taken. I recommend that you try organisations like The Mildmay Centre and TASO, which may offer you free ARVs, or any other help. Many AIDS service organisations usually prefer to recruit people who have never been on ARVs (i.e. ART naïve) because donors want them to increase ART coverage which is still quite low.
In my opinion, people who need ARVs should access them, whether ART naïve or not. It is the responsibility of the Government to make sure there is universal access. Whether it requires introduction of an HIV tax, or another strategy, something must be done or else HIV/AIDS will continue to be a serious health hazard, if people in need of treatment are not given any solution.
It is unfortunate that people of high profile and in positions of influence, are not doing enough to remind the Government of its responsibility which is the reason why we have only about 80,000 people accessing ARVs, out of the estimated 200,000, who need them. We should all advocate for universal access to HIV prevention, care and treatment.
Aren’t the ARVS working?
Dear doctor,
I have been doing an HIV test on a regular basis for the last five years and it has always been negative. I am a married woman, but each time I have encouraged my husband to go for a test, he has refused, explaining that since I am negative, he should also be negative. Unfortunately, mid last year, he fell very sick and was diagnosed with cryptococcal meningitis. An HIV test showed he is positive, with a CD4 count of 50 cells only. The meningitis was treated and he was put on ARVs, but when his CD4 was checked after six months, it was found to be only 30 cells! What could be the problem and what should we do?
Debby
Dear Debby,
First, it should be stressed that in the case of married couples, no one should determine his or her HIV status using that of his or her spouse. HIV discordance is fairly common, especially in marriage where consensual sex is practiced.
The second issue is about HIV that is resistant to ARVs. This can be either primary or secondary resistance. Primary HIV resistance to ARVs means the person was infected with a virus from another person who was on ARVs, but possibly because of poor adherence, the virus had developed resistance or capacity to survive, even in the presence of the drugs. In such a case, the patient never responds to treatment right from the start, like in the case of your husband. This is why we stress strict adherence to ARVs, because resistance affects not only the individual on drugs, but the community is at risk of coming into contact with the resistant virus.
Secondary resistance means a patient is put on ARVs and improves with his or her CD4 count going up, but as time goes on, the CD4 count starts to fall and the patient develops opportunistic infections.
If it is confirmed that your husband’s CD4 count is repeatedly found to be lower than when he started taking ARVs, his healthcare provider should put him on a second line regimen of ARVs, to which he must strictly adhere. This, I hope, will improve his situation.
Send your question on HIV to Health Editor, The New Vision. P. O. Box 9815, Kampala or health&beauty@newvision.co.ug
Dear doctor,
I have just lost my job and I’m now unable to pay for ARVs, which my wife and I have been taking for the last three years. When we went to one of the AIDS service organisations to try to access free ARVs, they told us we were not ART naïve and as such could not be helped. What does it mean to be ART naïve and what do we do now because our health had improved so much on ARVs?
Morris K
Dear Morris,
Many people are finding themselves in a similar situation because of certain important issues, which were not discussed during counselling, before being initiated on ARVs. They could not, therefore, plan for future sustainability of the treatment. Some who were started on ARVs based on organisational health polices that offer free medical treatment (including ART) to their workers, often find themselves unable to sustain treatment once they stop working. This is certainly going to have a critical effect on the entire ART programme in this country, unless a corrective action is taken. I recommend that you try organisations like The Mildmay Centre and TASO, which may offer you free ARVs, or any other help. Many AIDS service organisations usually prefer to recruit people who have never been on ARVs (i.e. ART naïve) because donors want them to increase ART coverage which is still quite low.
In my opinion, people who need ARVs should access them, whether ART naïve or not. It is the responsibility of the Government to make sure there is universal access. Whether it requires introduction of an HIV tax, or another strategy, something must be done or else HIV/AIDS will continue to be a serious health hazard, if people in need of treatment are not given any solution.
It is unfortunate that people of high profile and in positions of influence, are not doing enough to remind the Government of its responsibility which is the reason why we have only about 80,000 people accessing ARVs, out of the estimated 200,000, who need them. We should all advocate for universal access to HIV prevention, care and treatment.
Aren’t the ARVS working?
Dear doctor,
I have been doing an HIV test on a regular basis for the last five years and it has always been negative. I am a married woman, but each time I have encouraged my husband to go for a test, he has refused, explaining that since I am negative, he should also be negative. Unfortunately, mid last year, he fell very sick and was diagnosed with cryptococcal meningitis. An HIV test showed he is positive, with a CD4 count of 50 cells only. The meningitis was treated and he was put on ARVs, but when his CD4 was checked after six months, it was found to be only 30 cells! What could be the problem and what should we do?
Debby
Dear Debby,
First, it should be stressed that in the case of married couples, no one should determine his or her HIV status using that of his or her spouse. HIV discordance is fairly common, especially in marriage where consensual sex is practiced.
The second issue is about HIV that is resistant to ARVs. This can be either primary or secondary resistance. Primary HIV resistance to ARVs means the person was infected with a virus from another person who was on ARVs, but possibly because of poor adherence, the virus had developed resistance or capacity to survive, even in the presence of the drugs. In such a case, the patient never responds to treatment right from the start, like in the case of your husband. This is why we stress strict adherence to ARVs, because resistance affects not only the individual on drugs, but the community is at risk of coming into contact with the resistant virus.
Secondary resistance means a patient is put on ARVs and improves with his or her CD4 count going up, but as time goes on, the CD4 count starts to fall and the patient develops opportunistic infections.
If it is confirmed that your husband’s CD4 count is repeatedly found to be lower than when he started taking ARVs, his healthcare provider should put him on a second line regimen of ARVs, to which he must strictly adhere. This, I hope, will improve his situation.
Send your question on HIV to Health Editor, The New Vision. P. O. Box 9815, Kampala or health&beauty@newvision.co.ug