The Wits Pharmacy Student Council (WPSC) and the Sefako Makgatho Health Science University (SMU) explored the pros and cons of PIMART in South Africa.
Pharmacists from both Wits University and SMU debated the issue of HIV treatment relating to the Pharmacist-Initiated Management of Antiretroviral Therapy implementation at the Wits Education Campus on Friday, July 28.
The Wits team argued in favour of the treatment, while SMU argued against it.
PIMART appeared in the Government Gazette for implementation in August 2021. This type of therapy would allow pharmacists to administer HIV medication without a script or medical consultation from a general practitioner.
The Independent Practitioner Association (IPA) has taken PIMART to court claiming that pharmacists are not qualified enough to supply ARVs, which formed the foundation of the debate. The IPA represents all primary healthcare practitioners in independent private practice.
Former South African Medical Association chairperson, Dr. Angelique said the move would allow for “unfair competition”, as pharmacists would “compete with general practitioners whilst not having the necessary qualifications.”
A pharmacy student from the SMU team, Covenant Ngomana, argued that PIMART is needed to address the “high volume of HIV-related deaths in South Africa” due to lack of treatment. Statistics show that 94.2% of South Africans know their HIV status but only 75% seek treatment.
Wits pharmacy student, Maria Phalane, disagreed, she said pharmacists mainly work in the private sector with only “27% of South Africans in private healthcare, leaving 73% [of the majority] uncatered for.”
Dr. Maria Eksteen, a professional in pharmacy education, told Wits Vuvuzela that “PIMART has a valuable place in the South African healthcare context,” and added that pharmacists are the “most accessible healthcare professionals, [changing] the game in terms of accessibility to treatment for employed and uninsured patients.”
Eksteen adds that PIMART is definitely “part of many solutions to Africa’s high HIV infection rates,” with an estimated 13.2% of South Africans living with HIV in 2022.
It is unclear at this point whether PIMART will be fully implemented in South Africa, but the debate was meant to help “raise awareness and promote a discussion around PIMART,” said WPSC member, Lethokuhle Ndaba.
Although the IPA and some practitioners are against PIMART, the debate highlighted how it could help increase the treatment rates of HIV positive patients throughout South Africa.
FEATURED IMAGE: Students watching and discussing the PIMART Debate at Wits’ Education Campus in Parktown. Photo: Georgia Cartwright
Statistics from the past year point to wide gaps in translation between what is being taught in schools about sex and what is really happening to many young girls in South Africa.
The coronavirus pandemic has negatively affected the delivering of primary healthcare services and health-seeking behaviour, according to experts. (more…)
Wits Business School calls for its student to help fight HIV. (more…)
On-campus HIV treatment has become a norm at many institutions across the country, but as the rest of SA takes action Gauteng engages in talks
Health fair: Wits students visit health stations in numbers. Photo: Londell Phumi Ramalepe
Wits health science students hosted a two day health fair on July 20 and 21 at Solomon Mahlangu House Concourse to raise awareness about health issues faced by students.
The students offered a number of healthcare checks including dentistry, dermatology, eye testing and physiotherapy.
The event which was hosted by Jesus Christ To All Languages (JTL) society together with the Wits Campus Health and Wellness Centre (CHWC) also provided services related to specific men’s and women’s health issues along with dietary and chronic conditions.
Participants were also able to donate blood and make use of aerobic and resistance training stalls.
Final year Bachelor of Medicine and Surgery student, and leader of the JTL society, Hennah Mungure, said that convenience plays a major role in people checking up on their well-being. The 24-year-old told Wits Vuvuzela, “Students have many questions about health issues but do not necessarily go to the doctor to find out or get answers.”
The acting head nurse of CHWC, Sister Maggie Moloi, told Wits Vuvuzela that male healthcare was one of the priorities at the fair. The CHWC have partnered with Wise Up, an operation which focuses on Voluntary Male Medical Circumcision (VMMC).
Dr Lubwana J. Kigozi from the VMMC project, who was also present at the fair, said that the aim of his organisation is to ensure that males are given knowledge about their medical healthcare so that they can voluntarily go for circumcision which is shown to reduce the “risks of acquiring HIV by 60%,” in males.
The high cost of health is one of the factors preventing students from getting regular health checks. “The only option left for students is to go to the public sector which can be a tedious process because you cannot wait an entire day when suffering from sinusitis,” said Mungure.
“Some of us do not have enough money to go to campus health, so this fair makes it easier,” said Dimakatso Hlahlu, a Wits second year geology student.
“I wouldn’t necessarily go to the doctor to check up on my health because the medical aid does not pay the full amount and I would have to top up,” said Yenzokuhle Hleta, a second year Wits mechanical engineering student.
Moloi added that ignorance also prevents students from thinking about their health. “Students tell themselves that they are only here to study and don’t have to look after their health. In the long run they end up with high blood pressure with the stress they get from studies,” Moloi said.
Diagnosed as HIV positive in 2007, the now nine year old child, stopped taking ARV’s and has no symptoms of HIV infections.
Is the government prioritising supplying free condoms over free sanitary pads for underprivileged women?
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.
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: 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.”
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.”
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”.