Retracing the evolution of HIV treatment

Sep 27, 2015 News

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– as Guyana eyes mother-to-child elimination status
 
By Sharmain Grainger

Could it have been her imagination? He was so rude, harsh even, when he asked her to surrender the single prized possession she had. She was keeping it for that occasion which she had rehearsed so many times in her mind; it was supposed to be beautiful! She nevertheless gave in to his crude demand. A single encounter and it was no more.
In retrospect she wish she’d taken heed to that silent warning that came from somewhere, perhaps within her sub-conscience, that ‘it wasn’t worth it…this isn’t the way it should be’.
Five years later and Cathy (not her real name) still reflects on “what if” but it really doesn’t matter now, the damage has already been done.
CATHY IS INFECTED
Although the Human Immunodeficiency Virus (HIV) can be transmitted by the sharing of injection needles, the most common of transmission is believed to be through unprotected sexual intercourse.
Cathy knew of HIV and so many other diseases that can be transmitted sexually but yet she is sure that she was among those who contracted the HIV sexually. And she remembers all too well when it occurred. She was just a first year student at the University of Guyana (UG) pursuing studies in Public Management.
Although reluctant, at first, to talk about her experience with a young man whom she described as “the most cutest guy I’d ever met’, she eventually divulged how disturbingly insensitive he was. “Maybe he thought he was too good looking to be nice but for some reason I couldn’t keep away from him,” she recalled.
She remembered him picking her out from a group of her classmates to take out on a date. She wasn’t much of a looker nor was she a party girl but for this ‘cute guy’ she was prepared to even go to Venus.
Cathy convinced her mother that she was studying late with some friends and would be staying over at one of their homes. Her mother hesitated a bit but eventually gave consent.

It was a night of mostly drinking alcohol and dancing but ended with the young man taking her to a ‘short-time’ hotel.  His intention was clear. “Things were moving much too fast for me but I was too chicken to say anything…besides I thought he liked me. I was on cloud nine because he chose me; out of all the girls around he chose me…” she reminisced.
He did not hesitate to let her know that he was there for one thing only and before long they were both undressed. She was however trembling.  ‘What’s wrong with you girl?’ she remembered him asking in a vexed tone. “‘I don’t have time for babies and like you’re a baby…is either we do this or I gonna call one of your friends who can prove they really like me’,” he warned.
She remembered whispering to him that she was a virgin but was taken aback when he retorted “I know.”
That would be the only encounter she would have with him….He hadn’t even taken her number or shared his for that matter.
She saw him a few times after on campus but his actions suggested that he wasn’t really into her. Crushed by the experience, Cathy vowed that she would never become involved with another guy on campus.
The heartbreak was however very difficult to cope with especially after she started hearing rumours that she was just another mission accomplished for the “cute guy”. Months later she still cried over him. Her appetite had considerably diminished and her immune system became weakened; she even seemed susceptible to every flu virus around.
Cathy’s life went on but she was in despair.
She remembers attributing her slender physique to rigorous exercise routines but that was just a theory she conjured up in her mind; after all she wasn’t going to any gym or doing any form of rigorous exercise for that matter. But she had that answer for all who asked. She had a sneaky suspicion that something wasn’t right when her collar bone started protruding.
Her mother was worried and would often remark “‘Girl I proud of you but I don’t want studying be the death of you…you better try eat on time’,” she would scold.
Cathy however suppressed all untoward thoughts.
But there was the day, Cathy recalled that she and two girlfriends casually decided to get tested at a testing site during the Ministry of Health’s spearheaded national week of testing in 2011.

She was the last of her friends to get her results although she was tested before them.
“‘I just need to talk to you before I show you this’,” Cathy recalled being told by the attending Voluntary Counselling and Testing (VCT) worker. “‘You might want to fold this up and put it in your pocket because you’re the only one I’m giving this to’,” Cathy remembered the pale skinned VCT worker telling her before handing over a referral slip and informing her that the test suggested that she was HIV positive.
“How could this be?” Cathy recalled asking through a quiet whimper. “I don’t even have sex!”
But then the memory of that horrible encounter came flooding back in her mind. That single encounter with “the cute guy” was very unprotected. Did she sign her death warrant?
She couldn’t let her friends know…
Fortunately, she had her mother and siblings who didn’t judge when she reluctantly told them. She had to tell someone or risk giving in to that desire that overwhelmed her to just die. “I was constantly thinking – Why me? I wasn’t even wild…Why not some of those other girls who were changing boys like clothes?”
Recognising that this was a reality that wasn’t going to go away no matter how many wishes were made, Cathy’s mother encouraged her to visit a health facility. And she wasn’t going to let her daughter do it alone…Cathy’s mother was, and still is, especially supportive of her daughter.
The VCT worker had referred Cathy to a public health institution in Georgetown where the test was repeated producing an identical result. She was examined and registered at a care and treatment facility where she continues to be monitored.
She has since become a HIV Voluntary Counsellor herself and is hopeful that her story, though unfortunate, would be motivation enough for many young girls, and even boys, to at least practice safe sex if they can’t abstain.
LIVING WITH HIV
At just 25 years of age Cathy is living with HIV which is known to cause the dreaded Acquired Immune Deficiency Syndrome (AIDS). Although the disease has been around for decades there is currently no cure available to people like Cathy. She however takes solace in the fact that she contracted it at a time when treatment is readily available.
With Anti Retroviral Therapy (ART), which in essence is a treatment regimen intended to help suppress the replication of the virus in her body, she is able to lead a normal life.
She attends Clinic every three months where she sees a doctor and a Counsellor before being administered fresh doses of a drug (tablet form) called Atripla which is manufactured in India. Based on its label, the drug she uses consists of Efavirenz, Emtricitabine and Tenofovir, a combination of drugs that together fight the virus.
She is sometimes required to visit a laboratory to have her blood drawn and checked to determine her viral load (the amount of HIV in her blood) and her CD4 count (a test done to determine if her treatment is effective).
According to the World Health Organization, “ART has the potential to both reduce mortality and morbidity rates among HIV infected people and to improve their quality of life.”
Cathy is only required to take one tablet a day. She has an alarm on her smartphone that goes off at noon each day to remind her that it is time to take her life saving tablet.
She has been taking it for the past three years and claims to have never missed a dose.
In fact she is convinced that she feels much healthier than she did before commencing use of the tablet. She has even thrown on a few pounds.
According to her, when most of her friends and family members are subjected to the common flu, her immune system “kicks into high gear” and is rarely infiltrated.  While this may suggest that her medication is working well, her improved immune system might however be also linked to an  ardent exercise routine she now engages four times per week and the strict diet she consumes daily based on the advice of her doctor.
Cathy was especially reflective when she celebrated her 25th birthday last week. Occasions like these, she related, mean a lot to her and her close-knit family.
She mused over the fact that many people who contracted the virus a few decades earlier are just a memory today.
PREPARE TO DIE
This is due to the fact that treatment back in the day was as elusive as a cure is today. While there have been reports of medical breakthroughs such as a bone marrow transplant that has reportedly been done to cure at least one patient, researchers are still seeking out a full-fledged HIV cure that could be less invasive.
But the fact that there is available treatment is as heartening to patients as it is to medical practitioners.
Among those who have a sterling appreciation for the evolution of the delivery of health care to HIV patients is Chronic Diseases Director within the Ministry of Public Health, Dr Morris Edwards.
Dr Edwards intimated to me that he was among the first medical practitioners to be tasked with manning the Georgetown Public Hospital’s Genitourinary Medicine Clinic commonly referred to as the GUM Clinic. The clinic is one that was set up to deal specifically with sexually transmitted diseases and included HIV by the late 1980s.
As a young doctor then, Dr Edwards recalled that he was asked to head the Clinic at a time when even experienced health professionals had an aversion to dealing with patients with sexually transmitted infections. HIV was just becoming a challenge here when he assumed headship of the Clinic.
According Dr Edwards, who was appointed the first National AIDS Programme Director, at first the efforts by the public health sector to tackle HIV simply translated to preparing patients for their impending death due to health complications caused by the development of AIDS.
Many of the patients he attended to were young people with promising futures but there was simply no way of helping them. It was in essence a hopeless situation, he recalled.
“I started managing the GUM Clinic when everything bad you could think about HIV/AIDS was rampant; there was stigma and discrimination and there was fear. Nobody wanted to manage people with HIV. In fact people didn’t even want to come to the Clinic,” he recalled.
He remembers losing patients such as an athletically-inclined young man; a young woman in the midst of her studies at UG, and another who contracted the disease from her first sexual encounter much like Cathy.
“As a physician you are trained to diagnose and treat, but with HIV (in the early days) you had nothing available to treat persons. Seeing young people looking to you for answers and you really don’t have much answers to give them…those things can take a psychological toll on you,” confessed Dr Edwards who oftentimes had to cater to patients alone.
HOPE IS A REALITY
It was moreover Dr Edwards who had to chart a way forward for HIV patients in a health sector in which there was literally no hope. He’d sought to learn as much as he could about the disease and back in the year 2000 he was challenged by then Minister of Health, Dr Henry Jeffrey, to make a way for Guyana’s HIV infected patients to have access to very high-priced ART that had become available in the first world.
The task was indeed tall, as Guyana could ill-afford to pay the annual US$10,000 per patient cost.
It was around this time that the Pan Caribbean Partnership Against HIV and AIDS (PANCAP) had negotiated at a World AIDS Conference for HIV drugs to be lowered to at least US$2,000, an amount that was yet too steep for a Highly Indebted Poor Country like Guyana, Dr Edwards recounted. At the time, he disclosed, there were about 3,000 people of the population living with the virus.
But moves were soon being made for cheaper anti retroviral drugs to be made available to local patients.
“I advised the Minister…I did the concept paper and that is how we started the treatment programme,” Dr Edwards intimated, as he disclosed how the annual cost of treatment per patient eventually dropped to an all time low of US$596 annually.
“This was a Highly Indebted Poor Country starting a treatment programme with Government resources,” Dr Edwards recalled with pride as he informed that simultaneously another laudable pilot programme was being introduced – the Prevention of Mother to Child Transmission (PMTCT).
The programme was one geared to prevent the transmission of HIV from infected mothers to their unborn children.
POSSIBLE ELIMINATION
Cathy like many others who understand the reality of HIV and AIDS is only too elated that Guyana is currently on course to eliminate the transmission of HIV.
Minister of Public Health, Dr George Norton, recently announced that Guyana is currently in the process of preparing a report for the validation of the elimination of mother-to-child transmission of HIV.
He confidently declared that “if Cuba can do it, so should Guyana and with that we have to work.”
In June of this year Cuba was named the first country to eliminate mother-to-child transmission of HIV and syphilis but, according to Minister Norton, achieving this is no small task, even for an island territory.
“We recognise them for what they have done and there are many things that might have gone in their favour or might be in their favour, but we take away no credit and laud Cuba for being the first country in the world to have achieved that,” said the Minister. Guyana is poised for a similar achievement, he said.
Minister Norton has asserted that Guyana has seen a decline in the mother-to-child transmission of HIV from 5.8 percent in 2010 to less than one percent today.
With the achievements made over the years, Cathy can in fact now see herself having a family of her own, a feat she thought would have only been possible in her dreams.
And this might very well be happening in the near future as, according to her, “Mr Right has finally come along and he appreciates everything about me…”
“He wants us to have a family together and has been talking about all the possible advice and help we need to get there,” said a blushing Cathy of her “Mr Right”.

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