The Art of Medicine: Women in Sub-Saharan Africa are so Afraid of the Stigma Associated with an HIV/AIDS Diagnosis That They Will Forgo Potentially Life-Saving HIV Testing and Treatment

The Fear Factor: Before a pregnant woman in sub-Saharan Africa will submit herself to testing and treatment for HIV she will often have to be convinced that an HIV-positive diagnosis will not drive her husband or her community away from her.

In 2009, the World Health Organization called for the “virtual elimination” of mother-to-child transmission (MTCT) of HIV by 2015. MTCT of HIV is how 90% of infants contract the disease, i.e. from their HIV-positive mother during pregnancy, childbirth or breastfeeding.

The WHO, emboldened by the promise of prenatal HIV testing and MTCT intervention programs, thus made the claim that in a mere 6 years, MTCT of HIV would be eliminated.

But that has not even come close to happening. In 2011, the last year for which figures are available, the WHO reports that “most” of the more than 3 million children living with HIV in sub-Saharan Africa acquired it from their HIV-infected mothers.

One reason MTCT of HIV continues is that medical care for these pregnant women hasn’t turned out to be as accessible as once thought. But researchers from the University of California discovered something else: that even when HIV testing and other prenatal care programs are available, pregnant women simply won’t avail themselves of those services.

Why? Because of the awful stigma that’s still associated with HIV in sub-Saharan Africa. Specifically, women fear being shunned, or worse, by their community, friends, family, their husbands, and even by health workers.

The woman’s biggest fear, according to the study, is of their male partner. She fears that she will be blamed for bringing the virus into the family, or worse, that her HIV/AIDS infection means that she has been promiscuous: a charge of promiscuity means being abandoned, beaten, or both.

A principal solution offered by the researchers was couple counseling that supports the woman and debunks the myths associated with the disease. However, both the problem of stigma and the offer of counseling reminds us that the practice of medicine is about more than just testing, treatment, and technology; that understanding the patient as a person, that their concerns in their immediate environment often need to come first before science can do its job.

Nelson Mandela and AIDS: A Profile in Courage

Today, in honor of the passing off a great man, the United Nations issued a statement reminding the world that “Nelson Mandela was a central figure in the AIDS movement. He was instrumental in laying the foundations of the modern AIDS response. His actions helped save millions of lives and transformed health in Africa. He broke the conspiracy of silence and gave hope that all people should live with dignity.”

The conspiracy of silence referred to by the UN was a major stumbling block in fighting AIDS and it was locked in place at the very top by people like Thabo Mbeki, Mr Mandela’s successor as president in 1999. Mbeki openly questioned whether AIDS was caused by HIV, telling a US journalist that “personally, I don’t know anybody who has died of Aids” and that he did not know if he had ever met anyone infected with HIV. As a result, the South African government was reluctant to fund anti-retroviral drugs for those with HIV; and in public most South Africans were too afraid to mention the disease.

So it wasn’t  just HIV/AIDS itself that had be dealt with, it was also the veil of secrecy and fear that surrounded it – a challenge that Mr. Mandela chose to face.

Shortly after leaving office, on World Aids Day in 2000, he sent out a hard-hitting message: “Our country is facing a disaster of immeasurable proportions from HIV/Aids. We are facing a silent and invisible enemy that is threatening the very fabric of our society.”

Before the opening of Parliament in 2002 he spoke up again, this time about the importance of preventing mother-to-child transmission of HIV. This was at the very time that the Mbeki government was being dragged to court because it was refusing to treat pregnant mothers with HIV.

Mr. Mandela was personally stuck by the tragedy of AIDS in 2005 when his own son Matata Mandela died from it. “I announce that my son has died of AIDS,” the frail looking 86-year-old Nobel Peace laureate told a news conference, urging a redoubled fight against the disease. “Let us give publicity to HIV/AIDS and not hide it, because the only way to make it appear like a normal illness like tuberculosis, like cancer, is always to come out and to say somebody has died because of HIV/AIDS.

The following year Mr Mandela – and his Nelson Mandela Foundation – stepped up the campaign, launching an HIV/Aids fundraising campaign called 46664, after his prison number on Robben Island. He compared the urgency and drama of his country’s struggle against HIV/Aids to the fight against apartheid.

In one of his notable public statements about AIDS, Mr Mandela called on the world to be brave, “The more we lack the courage and the will to act, the more we condemn to death our brothers and sisters, our children and our grand-children.

According to the UN, South Africa is still  home to more people with the virus than any other country – 6.1 million of its citizens were infected with HIV in 2012, including 410,000 children (aged 0-14), out of a population of just over 51 million.

Of Mr. Mandela we know this: he had the courage to act.

What remains to be seen is whether we do too.

What Will I Tell the Child?

Considerable progress has been made in the battle against HIV/AIDS since it first appeared on the world stage in the early 1980s. It is no longer stigmatized as a “gay” disease, funding for medical research is way up, and modern treatment essentially allows people with HIV to live manageable lives – as we see, for example, in the well-known case of the former NBA player Irvin “Magic” Johnson.

However, there remains one tragic aspect of HIV/AIDS that is still not fully appreciated: the impact on a mother who gives birth to an HIV-positive child. In other words, the giver of life, during pregnancy or childbirth, delivers a lifelong sentence of disease to her child that often results in the child’s death – in front of the mother’s eyes.

This is especially the case in developing countries. While it is generally known that HIV is transmitted through sexual contact and blood-to-blood transfer, less known is the fact that  mother-to-child transmission (MTCT) is how 90% of children get HIV and the 3d most common way globally that HIV is transmitted.

Understandably, the first one to be told that the child has HIV is the mother. As a study conducted by  the Harvard Medical School and colleagues points out, this places a tremendous burden on her to disclose: first to her spouse and then, eventually, to the child. Disclosing their status was often very difficult for women, who feared that their partners would blame and/or abandon them upon hearing the news.

Explaining antiretroviral use to children was cited as a challenge to long-term care of HIV-positive children. Parents generally did not tell their child why they were giving them medicine, but some children started to inquire. As an HIV-positive mother put it:

The thing that disturbs me is that I always think what will I tell my child when he grows to a level of understanding and he asks me why he is taking drugs. Because even now he asks me, ‘Mummy I no longer cough but why am I still taking drugs every day?’ What will I tell the child?

As the Harvard et al. study tells us, motherhood places particular stress on HIV-infected women due to higher levels of depression, poorer family cohesion, less ability to perform daily functions, and the need to care for HIV-infected children.  One serious effect of depression and anxiety is on patient adherence to (lifesaving) medication regimes: i.e. depressed patients had three times the odds of noncompliance compared to non-depressed patients.

But there is a way to avoid these problems: treatment of the mother before she gives birth. Pathogens that are passed on during labor are usually found colonizing the birth canal. Vitalwave treatment targets these pathogens, destroying them safely and effectively and thus prevents the transmission of HIV to the child in the first place.

So in answer to the mother’s question, What will I tell the child? what do we say to her, knowing that if she were properly treated before she gave birth, the question wouldn’t have arisen in the first place?

HIV/AIDS: Using Technology to Mitigate the Global Pandemic

It is difficult to describe the scale of tragedy which HIV and AIDS have brought to the world. What is particularly heart wrenching is that 72% of AID’s related deaths are in Africa, while this continent has 14.5% of the world’s population. Such dominating incidence and precedence in third world instead of first world countries means that there are technological measures which would mitigate, but not fully eliminate, the disease and its effects. Vertical Transmission of HIV (mother to child) is almost non-existent in developed countries, but is a consistent problem in Nigeria, for example.

A technology addressing the issue of Vertical Transmission is Vitalwave™, a technology that shows significant promise by decolonizing the birth canal and reducing the incidence of transmission of HIV and other pathogens (STI). The new technology will be explained along with descriptions of the biological mechanisms of HIV.

Essentially, HIV/AIDS refers to a two fold disorder involving a virus (human immunodeficiency virus infection, HIV) and the manifestation and clinical symptoms in the body. The process in it’s entirety is subdivided into three general stages; Acute infection, clinical latency, and acquired immunodeficiency syndrome.

Prevalence of HIV/AIDs in Africa

The first stage, usually occurring one to two weeks after acquiring HIV, consists of various influenza-like symptoms, but may also include the development of opportunistic infections. Opportunistic infections take place in humans with compromised immune systems and would not normally affect healthy individuals. These early symptoms are general and are not directly indicative of HIV or AIDS.

The second stage of development is known as Clinical Latency, which, as the name implies, denotes an asymptomatic phase of progression. Here, the patient carries the virus but its symptoms are not expressed outright. Instead, near the end of this stage people may experience fever, weight loss, gastrointestinal problems, and muscle pains.

In the absence of specific treatment, roughly half of those with HIV will develop into the third stage, AIDS. There are many symptoms that indicate the presence of AIDS, but the most common are pneumonia, cachexia (loss of weight and muscle atrophy) and recurring respiratory tract infections. Opportunistic infections may develop from bacteria, viruses, fungi, and parasites that would normally be prevented by a more functional immune system. People with AIDS are highly susceptible to cancers, fevers, swollen lymph nodes, and various other diseases. Diseases acquired are dependent greatly on environmental factors such as which bacteria and pathogens are prevalent.

Proportional Development of HIV/AIDs in Africa

A difficult problem to address with HIV/AIDS is how to treat individuals in third world countries. The spread of this disease can certainly be mitigated with the use of several practices and protocols. One such practice is consistent condom use, which could reduce the risk of sexual HIV transmission by approximately 80% over the long term. Programs to prevent the vertical transmission of HIV (from mothers to children) can reduce rates of transmission by 92-99%. This is conventionally done with antiviral medications that target specific viruses (similar to how antibiotics target bacteria) during pregnancy and after birth. There is another method of treating vertical transmission of HIV called Vitalwave™, which has been developed to the prototype stage and shows significant promise. It works on the principle of photodisinfection, and has no systemic effects to the mother or drug interactions with prescribed antiretroviral therapy. It may also block the transmission of other pathogens, such as Group B Streptococcus, HSV, HCV, and other STI’s.

The Global Fund (an international financing organization that targets AIDS, tuberculosis, and malaria) recently released 25 million dollars to 12 states and the Federal Capital Territory to develop treatments of mother to child transmission of HIV. This kind of support shows that Mother to Child Transmission is a vital area to address in the global initiative of fighting AIDS. Vitalwave is part of this initiative, and as the world starts implementing these technologies and continues financial and technological aid, the global pandemic will see life saving and world changing improvements.

The long and winding road: A step-by-step trek towards an HIV cure

The news just keeps rolling in!

After the recent revelation that a Mississippi baby seems to have been functionally cured of AIDS, it seems that the same treatment may work in adults.

Results from a recent study conducted by the Pasteur Institute in Paris showed that early treatment appears to have put HIV in what seems to be permanent remission in 14 adults.

The 14 people were part of a cohort of 70 examined by Asier Saez-Cirion of the Pasteur Institute’s unit for regulation of retroviral infections. Examining the effect of early treatment, Sáez-Cirión treated the group with antiretroviral drugs (ARVs) between 35 days and 10 weeks after infection. This is much sooner than people are normally treated, reinforcing the idea that early treatment may be a vital part of an HIV cure.

According to NewScientist, all the participant’s drug regimens had been interrupted at some point, some willingly, some because of participation in other studies.

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Baby Steps: New leads towards an HIV cure

It’s a good month to be an AIDS activist!

After the publication of results pointing to the success of aggressive antiretroviral therapy campaigns in South Africa last week, the light at the end of the tunnel just got a little bit brighter.

Scientists announced on Sunday that a baby born with HIV might have been cured. The child, born in rural Mississippi, is now 2 and a half, and has been off medication for a year with no further sign of infection, AP reported.

Speaking at a press conference at the start of the 20th Conference on Retroviruses and Opportunistic Infection in Atlanta, pediatrician Deborah Persaud called this “the first well-documented case” of its kind, ScienceNOW reported.

Though Persaud did not treat the child herself, she and her colleagues at the Johns Hopkins Bloomberg School of Public Health conducted studies of blood samples, leading her to conclude that early treatment may be the real hero in this case, ScienceNow added.

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“Do the math!”: Big results for anti-HIV drug proponents

At last, some hope at the end of the AIDS campaign tunnel.

Two studies published in the journal Science last Thursday showed that an aggressive campaign to provide anti-retroviral drugs in Africa improved life expectancy by more than 11 years and reduced the risk of infection for healthy individuals.

But at what price?

Well, that’s the catch. According to the Los Angeles Times, these fantastic results come with a price tag between $500-$900 per patient, pretty hefty for a country with a per capita GDP of only $11,000. Proponents of less costly measures advocate that efforts should be concentrated towards the distribution of condoms, or male circumcision, rather than spending astronomical sums on drugs.

So what is antiretroviral therapy? According to the World Health Organization, it’s “the combination of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease.” (For more on ARV, click here).

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The “Ew” factor : The status of HIV stigma

On March 21, 1994 (back when Stephen Spielberg rocked the mullet), a fresh-faced Tom Hanks double-timed it up the steps of the Dorothy Chandler Pavilion in L.A. to accept his Academy Award for Best Actor in a Leading role.

Pitted against Sir Anthony Hopkins for The Remains of the Day, Daniel Day- Lewis for In the Name of the Father, Lawrence Fishburne in What’s Love Got to Do with It, and Liam Neeson for Schindler’s List, Hanks won his golden statue for his role as a gay man dying of AIDS who combats stigma and discrimination in Philadelphia.

Voice choked with emotion, Hanks ended his speech with a moving cry to action and tolerance:

“I know that my work, in this case, is magnified by the fact that the streets of heaven are too crowded with angels. We know their names. They number a thousand for each one of the red ribbons that we wear here tonight. They finally rest in the warm embrace of the gracious creator of us all – a healing embrace, that cools their fevers, that clears their skin and allows their eyes to see the simple, evident, common-sense truth that is made manifest by the benevolent creator of us all and was written down on paper by wise men, tolerant men in the city of Philadelphia 200 years ago.”

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Turning HIV On Itself: Fighting Fire With Fire

It looks as though HIV may be going down in the storybooks as yet another antagonist that has spelt out its own demise. Dr. David Harrich, of the Queensland Institute of Medical Research in Brisbane, began what was to become a lifelong struggle against HIV, the virus that causes AIDS – a struggle of which now he has the upper hand. Since the appearance of the first cases of AIDS in the 1980s, he has been fighting its spread and worldwide detrimental effects. Now with a laboratory breakthrough in hand, this story’s ending is within reach.

They call it fighting fire with fire. HIV – human immunodeficiency virus – , normally causing AIDS, has been modified to prevent it – turning HIV against itself. A protein, under normal circumstances, helps the virus grow. Mutated, as Harrich has done, it prevents the virus from replicating or spreading. “Patients would still be infected with HIV, but it would not develop into AIDS,” tells Harrich. It’s not the HIV that causes AIDS, but that your immune system becomes run down. “This mutated protein would help to maintain a healthy immune system so patients would be able to handle normal infections.” Without an inside man opening the door, AIDS will have no way to get in. Read More

The Dangers of Bacterial Resistance and AIDS

It seems like only yesterday that the AIDS pandemic first hit— arriving in a storm of panicked media exclusives and misinformation.  As with any communicable, life-threatening disease, the public’s first questions were inevitably ‘have I been exposed?’ or, even, ‘could I already have AIDS without knowing?’  In the beginning, there was little clear information on where the disease came from, or how it was spread—only the grim knowledge that people were dying.  The absurd—and often mocked—notion the illness could be contracted through a toilet seat or drinking fountain seemed very valid and real—and would only later be dispelled through many years of public education and AIDS literacy campaigns.

25 years later, World AIDS Day celebrated the anniversary of its founding in 1987—marking an important global milestone for AIDS research, awareness and fundraising.  The little red ribbon can be seen everywhere— from Vancouver to Helsinki— and AIDS is now a treatable disease with a vastly improved prognosis.  With modern retroviral therapy, many patients are living past the 20-year mark.  Of course, there’s still much to be done, especially in developing nations where these drugs are often not available—mostly due to financial or political concerns. Read More

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