– But fear keeps stigma and discrimination alive
There has been a glimmer of hope that a cure for the Human Immunodeficiency Virus (HIV) may be imminent. According to Programme Coordinator of the National AIDS Programme Secretariat, Dr Shanti Singh, with the announcement made a few years ago based on studies undertaken in Bangkok, China, there is some optimism.
“There is the microbe side that is out now and we know that it has limited efficiency….It is about 50 percent, but it is a good start, as it is adding to prevention but in terms of a cure, I think we can all hope.”
According to Dr Singh, there has been a lot of investment through the Bill and Melinda Gates Foundation and other international agencies, in addition to individuals around the world that are working together to realise a cure. In the meantime, though, the Programme Coordinator disclosed that the life expectancy of those who are infected and are on medication has increased significantly. According to Dr. Singh, some persons have been known to live healthy lives even in excess of 20 years.
“A lot of patients die now not of their HIV infection but of some other chronic disease. And with the newer antiretroviral drugs that have less side effects, people are living longer.
The older regimen had some side effects which saw some persons suffering from increased cholesterol and such but the new regimen is more effective.”
However, there is no way that the life expectancy of a patient can be calculated, Dr Singh asserted. She revealed that the local treatment programme has a mechanism which monitors patients’ survival rate by 12, 24, 36 and 48 months and even up to about five years.
“When we first started our treatment programme the average survival time was about five months for somebody walking into the then GUM Clinic. Now when we look at our statistics and we report it to the United Nations about 78 percent of our patients are still alive.”
“However when you look at the five years survival rate, that would have been our very old cohort of people; but if you take a cohort now, let’s say 500 people that start now, and you monitor them one year later it is different than if you took 500 people five years ago because they would have come in much later with very low CD4 count and probably with opportunistic infections.”
In addition, Dr Singh revealed that even though the regimen that was used in the past was considered the best then, the one that is being used now is even better, in terms of drug resistance.
With the new regimen currently in place, Dr Singh revealed that it is highly unlikely that a patient on antiretrovirals could develop a resistance if he or she is unable to take the recommended medication over a 24-hour period. In fact, there may be no side effects over a two-week long period.
She disclosed that in matured treatment programmes, one of the strategies that is employed is a feature called structured interruption of treatment. According to her, doctors have been known to introduce a strategy whereby patients who have been on antiretrovirals for a number of years are given a drug holiday, because the body has to do extra work to be able to process the ARV medication.
This process, she said, could be as long as two weeks and still it has been proven that the HIV in patients will not become resistant to the recommended treatment when reintroduced.
And though the local treatment programme is not as matured as some other programmes around the world, Dr Singh is confident that it is on par with what is obtained on an international scale.
Meanwhile, NAPS is still vigorously working towards reducing the stigma and discrimination associated with HIV/AIDS. Dr Singh speculated that a lot that is said about the stigma and discrimination is about people’s own fear. She noted that although there has been improvement in the reduction of stigma and discrimination, fear is still a very prominent factor.
“Lots of families when they learn that a member is HIV positive or if that person discloses his or her status, the initial reaction is that of fear… That fear of being close to someone that has the virus often causes people to question, ‘what if per chance I get it too?’”
However, concerns are usually alleviated, Dr Singh added, once proper explanations are forthcoming. She recounted one incident when NAPS was forced to intervene when an employee was sent home because that employee’s HIV status was made known to the employer.
“That worker was sent home and told that she was no longer employed…somebody had disclosed that person’s status. We went into that agency and we spoke with the proprietor and it became evident that the proprietor just didn’t know the facts about HIV. The next day that employee was back on the job…” Dr Singh disclosed.
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