WITH INFOGRAPHIC: Health science students in HIV exposure frustrated by ARV treatment protocols

IMG_1261

FOLLOWING PROTOCOL IS IMPORTANT: A Wits student gets her blood tested for HIV at a testing campaign on Wits Education Campus earlier this year. Photo: Tracey Ruff

From lost blood test results to a lack of guidance about antiretroviral treatment (ARVs), the protocol after exposure to a potential HIV (human immunodeficiency virus) threat is both frustrating and time-consuming for some students.

Students at the Wits Faculty of Health Sciences are required to follow a strict protocol when accessing ARVs after an exposure to the virus in the course of their practical work.

“[Students] have to come to Campus Health for reporting purposes,”  explained Sister Yvonne Matimba of Campus Health. While students can access an ARV starter pack immediately after an exposure from the hospital in which they are working, further treatment can only be accessed through Campus Health located in the Matrix building on main campus.

The alternative is to pay for the treatment through a private health care provider.

“She didn’t really know what the protocol was and just gave me the pills and told me I had to make the decision”

However, as Krystle Moodley, a Wits dentistry graduate currently completing her community service year in Mpumulanga, said, “It sucks [going to Campus Health] if you’re at med school because you have to go all the way to [main] campus. How does that make sense?”

Moodley has been on ARVs twice. Her first time was in fourth year after she pricked herself with a needle.

Once she had reported the incident to Campus Health, her bloods were taken immediately and she was put on a 28-day ARV treatment regime. She then had to go back for a six-week, and three-month, blood test.

Missing results

After not receiving her results from her three-month blood test, Moodley phoned Campus Health and was informed her results had been lost. She then decided to go to a private doctor and had to pay about R150 to get her bloods done.

“No one [at Campus Health] bothered to tell me or bring me in to retake [my bloods].”

Counselling is also provided by Campus Health to the affected students.  However, according to Moodley, she feels that what she was told was information she had studied and already knew about.

CLICK TO ENLARGE: The Wits ARV treatment protocol. Graphic Tracy Ruff.

CLICK TO ENLARGE: What does ARV treatment involve? Graphic: Tracy Ruff.

A sixth-year medical student who did not want to be named, who has been on ARVs twice, has also expressed difficulties with the Campus Health process. “In terms of waiting times, [Campus Health] was good, but the sister (who was a new employee at the time) couldn’t give me advice on whether or not to take the ARVs, she said.

She didn’t really know what the protocol was and just gave me the pills and told me I had to make the decision.”

However, according to Matimba, all staff at Campus Health are adequately trained to deal with the protocol.

A Wits postgraduate student, who also did not want to be identified, said dealing with Campus Health after she received a needle-stick injury was “a  pleasure.”

“The nurses are friendly and extremely professional. They help you every step of the way.”

In need of more guidance

Students who fail to follow the protocol strictly are exempt from making any insurance claims according to the Faculty of Health Sciences’ Student Protection and Insurance booklet.

The booklet directs students to contact any of a number of doctors and staff members if an exposure occurs. There are also two additional emergency numbers provided. Wits Vuvuzela tried to reach an adviser via one of the numbers provided but was told that the staff member in question had left a few years ago.

The sixth-year medical student feels that students need to be given a card with the relevant protocol information that they can carry with them at all times. She also believes students should be informed about the ARV protocol properly at the beginning of their studies.

“They (lectures and doctors) should sit you down and tell you what to do.”

Protocol in the working world also frustrating

A Wits occupational therapy graduate, who asked not to be named, has recently completed her ARV treatment for HIV exposure outside of Wits.

“I had problems with the workman compensation procedures … so I went about paying for everything and thought I could claim back but turned out I couldn’t,” explained the graduate.

Moodley, who is now working for a public hospital, has just completed her 28-day ARV treatment. Describing her experience with the ARV protocol in the hospital she said, “it was kind of haphazard and no one knew what to do.”

RELATED ARTICLES:

 

 

Blood donor ban on gay men lifted in South Africa

Blood drive

The South African National Blood Services (SANBS) has lifted a ban on blood donation by gay men. Certain high risk categories of potential donors though, remained banned. Photo: Wits Vuvuzela.

Gay men across South Africa are now permitted to donate blood, according to shift in policy at the South African National Blood Service (SANBS).

A new “non-discriminatory” SANBS policy now considers those in monogamous homosexual relationships as eligible but there is still a restriction on certain high risk categories of potential donors.

Those with a new sexual partner, or multiple partners are not allowed to donate, regardless of their sexuality, as the risk of HIV/AIDS infection is too large.

Those with a new sexual partner, or multiple partners are not allowed to donate, regardless of their sexuality, as the risk of HIV/AIDS infection is too large, according to the SANBS.

Previously, only those who had been in heterosexual monogamous relationships for over six months were allowed to donate blood.

“As an organisation that is consistently improving the way we screen donors, and test the blood collected, SANBS together with the Western Province Blood Transfusion Service (WPBTS) … have been working … to relook at the donor acceptance criteria with regards to the South African community,” read a SANBS press release.

The amendment to the questionnaire someone has to complete when donating blood on the definition of a sexual act has been altered, removing the question on male to male sex. The new policy will “address sexual risk, in that any sexual act or contact with a NEW partner/s during the preceding six months will be deemed a risk to the safety of blood supply, irrespective of the personal sexual orientation or preference”.

The previous policy existed as a result of international trends which sought to address the high rate of HIV-infection in South Africa.

Dawie Nel, a member of OUT, an organisation serving the Lesbian, Gay, Bisexual and Transgender community, is very happy with the SANBS’s announcement. He said, “Our argument was that it’s not about gay identity, but about risky behaviour and I hope it will encourage more gay men to donate blood.”

Medical students face threat of HIV

IMG_1258

DIFFICULT TEST: A Wits student gets tested on Wits Education Campus for HIV. Photo: Tracey Ruff

Dedicating their lives to the health and well-being of their patients comes at a great personal and health risk for students in the Faculty of Health Sciences.

With the prevalence of HIV in South Africa, exposure to HIV-positive patients is an everyday occurrence for students in the medical field.

Wits Vuvuzela recently spoke to a number of health sciences students who have had to go on antiretroviral medication (ARVs) after accidents – such as needle stick injuries – have occurred.

Suffering from side-effects

Krystle Moodley, a Wits dentistry graduate who is currently doing her community service year, has been on ARVs twice. Her first time was in fourth year when she got a needle stick injury.

“I was unscrewing the needle from the syringe and the cap fell off and I got pricked,” explained Moodley. She is currently on ARVs for a recent scare she had while cleaning a dry socket – a condition that develops after a patient’s tooth has been extracted.

The side-effects she is presently experiencing from the ARVs include nausea and vomiting. Moodley adds she has heard of people who stop taking the ARVs because of the side-effects, which can include fatigue, migraines, loss of appetite and diarrhoea.

“I [would] rather suffer a month than my whole life personally (sic),” says Moodley.

A sixth year MBBCh student, who has chosen to remain anonymous, went on ARVs in 2012. Describing her experience, the student said it was “terrible” and “horrible”.

[pullquote]“You think it’s just taking your ARVs, but it’s an emotional thing … It’s just really a heart-wrenching experience.”[/pullquote]

“You think it’s just taking your ARVs, but it’s an emotional thing … It’s just really a heart-wrenching experience. You feel like you’ll be stigmatised. It was literally the worst three weeks [taking ARVs] of my life”.

Stacey Fourie, 6th year MBBCh, has, like Moodley, been on ARVs twice. Both incidents occurred in the early hours of the morning while she was stitching trauma patients.

Fourie describes the second incident where she was stitching a man who had been stabbed all over with a broken bottle. She stitched him for three hours without a break and due to sheer exhaustion; she tried to re-cap a needle and pricked herself. The man was HIV positive.

While on the ARVs, Fourie experienced severe fatigue and struggled to study because of this.

Fourie said anybody would be “very hard-pressed to find an intern (a doctor-in-training) who hasn’t been on ARVs at some stage”.

Muhammed Makda, another sixth-year MBBCh student, describes his 28-day ARV experience as both depressing and emotional. Makda was accidentally pricked by a doctor performing a lumbar puncture on an HIV-positive patient.

Makda was on one of the “older ARV regiments” and, as a result, he suffered from severe fatigue and lethargy for the entire 28 days. He said his body felt quite weak and he experienced severe nausea which was worse in the mornings when he would occasionally experience vomiting.

He says that although “the risk of contracting HIV through this kind of exposure (needle-stick injuries etc.) is [statistically] minimal, one cannot truly rest at ease knowing that it is still possible and may just happen to you”.

A constant threat

Another sixth-year medical student, who hasn’t been on ARVs, said that as a medical doctor living in South Africa, there is a “very real danger that one morning you might wake up HIV free (sic), go to hospital and come back HIV positive”. He says he finds this “really scary” and with being tired, overworked and hungry, the ability to concentrate and work cautiously becomes difficult.

Makda said students who have had an HIV scare need to make the decision to go on ARVs “fast”, as the sooner one takes them, the less the chance of infection.

When asked if the threat of HIV has made them think twice about their choice of their profession, the students interviewed all echoed the same sentiments. They love what they do and as Moodley said, “I love seeing the smile on my patients’ faces, and that is reward enough”.

Media mis-reporting HIV rate among SA schoolgirls. True rate is 12.7 percent

Reproduced with permission of Africacheck.org. See the full article here.

by Julian Rademeyer

The claim that 28 percent of South African schoolgirls are living with HIV started with a remark by Health Minister Aaron Motsoaledi, misreported by The Sowetan.

Unquestioned, it has been repeated by media across the country and the world. The true rate is half that.

The Sowetan headline was shocking: “28% of schoolgirls are HIV positive”.

The article that followed read: “At least 28% of schoolgirls are HIV positive while only 4% of young boys are infected with the virus in the country.

-“Health Minister Aaron Motsoaledi said this was a clear indication that old men were sleeping with young girls – a statistic he said ‘destroyed my soul.’”

The startling claim was picked up by the South African Press Association (Sapa) which ran a piece citing the Sowetan report with the headline: “Nearly a third of schoolgirls have HIV: Motsoaledi”.

Then the story went global

The report was then picked up around the world.

The Independent in the UK: “Over 25% of schoolgirls in South Africa are HIV positive because ‘sugar daddies are taking advantage of them’, says health minister Aaron Motsoaledi.”

Al Jazeera: “HIV rampant among South African schoolgirls. Country’s health minister says more than quarter of schoolgirls HIV positive, because “sugar daddies” exploiting them.”

Xinhua News Agency: “Despite marked progress in curbing the HIV epidemic, a high percentage of schoolgirls are still HIV positive in South Africa, latest figures revealed…Schoolgirls tested HIV positive constitute at least 28 percent of female pupils in schools across the country.”

The figure was also cited in a column in the Sunday Times by influential Talk Radio 702 host Redi Tlhabi. And it continues to gain momentum, carried most recently by the Nigerian Tribune and the Australian website AdelaideNow.

Variations of the story were tweeted and retweeted, posted and reposted hundreds of times on social networking sites Twitter and Facebook.

What the minister actually said

But the story was fatally flawed; an uncritical rehashing of a half-heard statement made by the minister during a “taking Parliament to the people event” in Carolina in Mpumalanga province.

In his address in Carolina, Motsoaledi did indeed refer to a figure of 28%, but only in relation to the findings of an HIV testing and counselling campaign at a small number of hard-hit schools in the Natal Midlands.“The Minister of Health did not say ‘28% of school girls in South Africa are HIV positive,’” his spokesman, Joe Maila, told AfricaCheck.

“The journalist who wrote the story and the agencies that publicised the story got it all wrong.”

Maila said Motsoaledi had referred to a figure of 28% with reference to “a small sample of a few schools in the Natal Midlands”.

The real rate is half what the media said

The most recent statistics, compiled as part of a 2011 HIV and syphilis survey, which was published last year by the Department of Health, indicate that HIV prevalence among young women aged between 15 and 19 was around 12.7% in 2011, a decrease on the previous year’s figure of 14%.

This is less than half the figure in the Sowetan’s headline.

It is even less than the figure (20.5%) for HIV prevalence among pregnant women aged 15-24, a population group who are always likely to have a higher prevalence rate than all schoolgirls, for obvious reasons.

Conclusion – Check before you report a figure

The website JournAIDS.org – which monitors media reporting on HIV and AIDS – has also sharply criticised the Sowetan saying its misinterpretation of Motsoaledi’s comments “points to an urgent need for a culture of fact checking in journalism”.

As we know ourselves, checking these sorts of facts is not always easy. But when a figure is as shocking as the one mistakenly thought to have been given as a national average by the minister, it is important for journalists to check before publishing.

As JournAIDS said, journalists should not simply report what an official says if it contradicts the easily checked facts. We could not say it better ourselves.

Edited by Peter Cunliffe-Jones. Additional research by Ruth Becker

 

Health workers with attitude

A GAY man who went for a routine HIV test in the Johannesburg CBD was told by a doctor to remember “Sodom and Gomorrah” and that “the mouth is meant for eating only”.

Speaking on condition of anonymity, the man shared his story in a group discussion at a health cafe at Wits recently. The health café was held to educate media practitioners on writing correctly about issues surrounding HIV. 

“I don’t know the name of the clinic but it’s in the Johannesburg CBD inside Carlton Centre,” the man said. While waiting for the results, he asked the doctor about the risks of contracting HIV through oral sex.

“He [the doctor] giggled and asked if I was a Christian. I said yes and that I believed in God. And then he said that I would remember then what happened in Sodom and Gomorrah. I was shocked. He told me that people back then were behaving like that. That’s why God burnt the town. He told me that the mouth is meant for eating only. I was totally taken aback by this.”

During the discussions, journalists from different media houses mentioned that they were reluctant to get tested because of the “bad attitude” displayed by nurses and doctors in conducting tests.

Another journalist,  who identified himself only as Thabo, said he had also gone to a clinic for an HIV test and the nurse on duty passed a snide remark, suggesting that he had come for a test because he had been having unprotected sex.

“She then asked me to take out my penis so that she could see if there was evidence of a disease.  She looked at it and told me that I was fine.”

Some women in the group complained they had been subjected to HIV tests without their consent while pregnant.

Dr Sindi Van Zyl, who specialises in HIV with Anova, encouraged patients to know their rights in the face of violation by medical personnel and overcome all barriers by getting tested for HIV. She said “angry nurses” intimidated men from clinics, but they should just go and get tested anyway.

Van Zyl added that foreigners should be able to access anti-retroviral drugs. A memo was passed in 2008 to this effect.

Melissa Meyer, HIV and AIDS media project manager with Anova, said patients should not just accept bad treatment from nurses and doctors.  “The same way you go to a restaurant and say: ‘This is not what I ordered,’ is the same way you should react when you get bad service at clinics.”

The HIV and AIDS Act of 2006 stipulates that “an HIV test on another person shall not be undertaken, except with the informed consent of the other person”.

 

charlotte@witsvuvuzela.com

In it for health, not money

Wits researchers have found that participants in drug trials may be genuinely concerned about their health, rather than taking part just for the promise of payment.

Until now, researchers have raised concerns that participation in clinical trials related to HIV may be mainly motivated by compensation, or that women in these studies would abuse reimbursements, share drugs with other people or dump the drugs.

But according to a study published by researchers at the Wits Reproductive Health and HIV Institute last week, none of these concerns was found to be true after interviewing women who took part in such a trial.

The women were positive for HIV and Herpes Simplex Virus 2, both sexually transmitted infections (STIs). The risk of spreading HIV is three times higher when a person is infected with both viruses. The women had participated in a trial which tested how efficient an anti-herpes drug was at reducing the risk of spreading HIV.

The women were asked how well they kept to the rules of the trial and what motivated them to do so. For a clinical trial to work, participants have to visit the clinic regularly for medication and check-ups. They also have to take the drugs at certain times and change some of their behaviour. For example, they were required to use condoms and avoid vaginal douching.

The women followed these rules about 90% of the time, and they said they were motivated by concerns for their health. Co-author of the paper, Dr Catherine MacPhail, said this was significant because the health system was not perceived as adequate or user-friendly.

“The thing that made me decide to participate in the study was I started to see symptoms that I did not understand, like I had discharge and I was always sick so then I decided to go and find out about my status,” said one participant.

The women also welcomed the free health care that came with the trial, even though they knew some of the drugs were placebos, or sugar pills.

A major factor that encouraged women to visit the clinic regularly was staff support. “I think it [staff attitude] helped me because when I thought about coming to the clinic I knew that I am going to be laughing and talking to people who care about me and I loved to come to the clinic,” said another participant.

Researchers said the study also showed that people in low and middle-income countries, characterised by poverty and social deprivation, could be trusted to take medication as prescribed.

The paper was published in Dove Press, an open access medical journal. It was authored by Dr Catherine MacPhail and Dr Sinead Delany-Moretlwe from Wits, and Prof Philippe Mayaud from the Faculty of Infectious and Tropical Diseases, at the London School of Hygiene and Tropical Medicine.

Predictive test

It is expensive to check whether anti-retroviral drugs are working in an HIV-positive patient, but a new approach could halve the costs.

Doctors monitor the success of anti-HIV drugs using a “CD4 count”. The fewer CD4 cells a patient has, the more HIV has damaged the immune system.

When an HIV positive person starts antiretroviral treatment (ART) against HIV, the number of CD4 cells should increase if the ARTs are working. If the CD4 count is below 200, the person has AIDS, according to the Centre for Disease Control.

But these tests are costly and, in developing countries like South Africa, lab equipment and trained staff are limited. To address this, Wits researcher Prof Ian Sanne and a team of international researchers have suggested a new way to predict which patients are likely to have a low CD4 count.

 Those patients who are predicted to have a low CD4 count can then have the test done to confirm it. Their “Prediction-Based Classification” tool correctly predicted 90% of low CD4 counts.

Their study was published the PLoS Medicine Journal in April 2012. The authors emphasise that their tool should not replace CD4 tests, but could improve the monitoring of treatment by making better use of money, staff and equipment.

“Introducing PBC will diminish the burden on poorly resourced laboratories, releasing funding to reach more patients,” Sanne told Scidev.net, a prominent science news website for developing countries.

The tool, a mathematical algorithm, could also reduce the need to repeat tests that give unexpected results. Their research also provides a basis for future studies to look at the economic and health benefits of the tool.

Sanne is the founder and director of the Clinical HIV Research Unit at Wits.

Published in Wits Vuvuzela, 18 May 2012

Smart Witsies make smart moves

The Counselling and Careers Development Unit (CCDU) is launching the Smart Moves campaign next week to create awareness around health, lifestyle and gender issues. 

The campaign will run on East and West Campus between August 15 and 18 and on Education Campus on the 19th.

The sex and alcohol and Let’s red card HIV campaigns will also be running in the week. These campaigns have proven to be popular with students in previous years.

The campaign is taking a human rights approach to promote diversity and respect for one another. “We need to be responsible about our choices because our decisions can affect others; especially in this kind of small society and open environment and culture.

We can easily cross those boundaries and infringe others (of their rights)”, says the CCDU HIV co-ordinator Vinoba Krishna. She says the campaign is structured to be more “colourful and embracing of other issues”.

To make the Smart Moves campaign more accessible to students and more engaging, it will be run by students who volunteer at the CCDU. “Meaningful” giveaways will be handed out at the stalls Campus Health will be on site to run wellness tests.

They will calculate body mass indices of students and also check glucose levels. Phuza Wize (drink wisely) will also be taking part in this project to help students make wiser decisions when engaging in sexual intercourse under the influence of alcohol and drugs.