Living positively with HIV

Health promotion practitioners Chillestine Hackley, from Portland, and Carol Kompe-Balintulo, from Khayelitsha, at Mitchell's Plain Community Health Centre.

Having started with 600 patients on ARV medication, Mitchell’s Plain Community Health Centre (CHC), now has 3 500, patients half of whom successfully manage their own treatment.

The clinic was opened to children, aged from infancy to adolescents, in 2006 and it currently has 261 children on ARVs.

Last Thursday December 1 marked the annual World Aids Day commemoration.

To confirm an HIV positive status one can wait up to a week. Initial test results take about a few minutes.

If the test is positive then another test is done. A second test is done, and if it proves negative, a third test is done.

Bloods are then taken and sent off to the labs to do an ELISA test to confirm status which takes 7 days.

This wait can be terrifying but it can also save lives.

Since September 1 the national Department of Health adopted a “test and treat” approach to HIV and Aids, in line with World Health Organisation (WHO) guidelines.

Prior to September, people being tested had to confirm a CD4 level of less than 500.

The new guidelines for the treatment of people with HIV were announced by WHO in December last year.

The guidelines were based on new research that found that getting people diagnosed with HIV on treatment as soon as possible, regardless of CD4 levels (the number of CD4 T lymphocytes (CD4cells) in a sample of blood), is beneficial.

In people with HIV, it is the most important laboratory indicator of how well one’s immune system is working and the strongest predictor of HIV progression.

There is an infectious disease clinic at Mitchell’s Plain Community Health Centre, where people who are at risk and want to know their status can be counselled, be tested for HIV and tuberculosis (TB); and receive ARV (antiretroviral) medication.

“We have, on the basis of research evidence, already removed CD4 count as an eligibility criterion for HIV positive pregnant women, children under five years of age as well as HIV and TB co-infected patients over the past few years.

“This new policy extends this to all people living with HIV,” said the Health Department.

The department said the implementation of what is now known as “test and treat” for HIV will contribute to the National Development Plan goal of increasing life expectancy to at least 70 years by 2030.

People diagnosed with HIV can also live long and healthy lives once they are on ARV medication.

Sister Frances Fielies, acting operational manager of the clinic in Mitchell’s Plain, said they also refer patients, who screen positive for TB to City of Cape Town clinics for treatment.

The clinic was opened in 2005, in room number 5, but recorded 600 adult patients early the following year.

It is also opened its doors to children, aged from infants to adolescents, the same year.

Today the approximately 3 500 adults and 261 children they treat are appointed hourly slots, during four sessions a day with 35 to 40 patients in each slot.

They also accommodate “walk-ins”.

The clinic started off with three doctors, a clinical nurse practitioner, two professional nurses, five adherence counsellors and five administration clerks.

Nowadays they have a doctor,three clinical nurse practitioners, a professional nurse, who can initiate the management of ARV therapy (Nurse Initiated Management of Antiretroviral Therapy) NIMART, hree administration clerks and three adherence counsellors.

Sister Fielies explained that health care today is more nurse-driven and doctor-supported.

Similarly the roll-out of NIMART to primary healthcare facilities increases the access to antiretrovirals, according to the South African Medical Journal.

She said they have continuous training to get more registered NIMART professionals, who are trained and skilled to help patients speedily.

The Mitchell’s Plain Midwife Obstetrics Units (MOU) also have NIMART nurses who treat mothers who are HIV positive but their children are negative to prevent the transference of the disease during pregnancy, birth or breastfeeding.

They advocate that HIV positive mothers solely breastfeed to encourage a strong immune system and prevent the baby from contracting the disease.

With continuous development in HIV treatment and increasing the number of people living with the virus, the clinic has adherence clubs, where patients are empowered to take control of their treatment.

Sister Fielies said medication has been decreased from six tablets a day to two tablets a day.

To be members of the club patients have had to be taking their tablets as prescribed for more than a year; their CD4 levels have to be stable; and their HIV viral load suppressed – ultimately they have to be healthy.

Club members receive their two-month supply of ARV medication and a four-month supply during the festive season.

“With the adherence clubs patients come in less often and it is seen as an incentive to be healthy and be more responsible,” she said.

During meetings members receive further counselling and support to live with the disease.

A counsellor at the clinic who did not want to be named said people want to know their status.”The only thing they fear is stigmatisation,” she said.

She said communities have to work together to understand the person has a disease but can live a long healthy life by living responsibly. “That is taking medication and by making the right decisions,” she said.

BLOB According the government’s HIV and Aids frequently asked questions webpage, HIV is the human immunodeficiency virus.

This virus can lead to acquired immune deficiency syndrome or Aids.

HIV destroys blood cells called CD4+ T cells. These cells help your body fight diseases.

This means that HIV stops your body from fighting diseases.

HIV spreads when body fluids like blood or semen from an HIV positive person come into contact with broken skin from another person.

The most common ways to get HIV is: unprotected (without a condom) sex with an HIV positive person, sharing needles, syringes and other equipment used to inject drugs; and from an infected mother.

You cannot get HIV from casual contact like hugging, shaking hands or sharing dishes, closed mouth or ‘social’ kissing, clear saliva, tears or sweat, insects like mosquitoes and air or water.