HIV rise: Is it a drugs paradox?

Kampala- After years of making progress in the fight against HIV/Aids, recent statics show Uganda is retrogressing, with some experts suggesting that access to anti-retro viral (ARV) drugs could be the reason for new infections in adults owing to lack of adherence to medication and slowdown in suitable preventive messages.
Although Uganda has succeeded in the elimination of mother-to-child transmission (EMCT) by up to 68 per cent through administering ARVs, HIV experts argue that the drug is also responsible for further spread as people become complacent.
On the other hand, experts argue that some people already on medication fail to adhere to medical prescriptions, a development that leads to secondary problems such as drug resistance and new infections.

There is no vaccine against HIV, but research has led to discoveries of medication that can suppress the amount of virus in the blood (viral load). When the viral load is low, HIV positive persons do not fall sick and act normally, like non- positive persons.

Full adherence to the medication leads to situation where the virus becomes undetectable and a person’s capacity to infect others is reduced.
“That does not mean that you have healed because the virus escapes to the lymphatic system where it hibernates for years and gradually change in form,” says Dr Alex Ario.

“Lymphatic system moves and at one point mixes with blood so when HIV detects that it is not containing drugs, it wakes up and that is why stopping ART it is very dangerous because it now comes out as XYZ when it was ABC. By that time, the earlier medication becomes ineffective and one becomes resistant,” Dr Ario says.

That period, the doctors, explain the person becomes again highly infectious as the virus multiplies very fast. “Adherence is not only taking the drugs every day, but taking it at consistent time,” says Dr Mary Kiconco, a clinical services coordinator.

Close to 2.6 million Ugandans have been infected with HIV, but less than one million are on treatment. While those not on treatment, with high or low CD4 count can be identified easily owing to frequency of disease attack, which is suspicious, those on drugs look unsuspecting, which is tempting to some people.

Uganda’s efforts to bring down prevalence from 30 per cent in the 1980s down to 18 per cent in the 1990s and dropped further to 6.4 per cent in 2006 was commended as the most successful story globally. Today the country’s prevalence is on the rise standing at 7.3 per cent of the population.

The sharp drop was not a result of bias in measurement of natural die-off syndrome, but rather from combination of efforts that include preaching behaviour changes. The question is what has gone wrong today?

“In the past, the anti-HIV messages were strong and vigorously done. Those days it was easy to communicate strategies like abstinence because HIV positive persons looked miserable, but with medication, you cannot tell who is positive and who is not…ARVs is responsible for the spread,” says Florence Awor, senior counsellor at Reach Out Mbuya, even as she admits that it is a paradox.

Experts argue that the current messages are numerous and lack focus which makes them unsuitable to fight persisting stigma, protection of HIV negative persons and prevention of spread of new infection by those already on treatment and those not yet on treatment.

The East African has learnt that couples are even disguising, or hiding away ARVs from their partners in a bid to conceal their status.
Some chose to keep the drugs in places of work or with neighbours or disguising original drug packaging to packing that reveals medicine for curable diseases.

“They change the packing material of the ARV and disguise it as medicine for easy to treat illnesses. I have seen many HIV positive men and women do that upon moving just a few metres away from the health facility,” said a source who until recently was working at Taso[The Aids Support Organisation], an NGO that works with people living with HIV.

“We have high class patients who do not want to be seen picking drugs alongside our usual clients for fear of being identified so we have collaborative arrangement with private non HIV clinics where they pick their drugs from,” says Dr Kiconco.

In any case, the partner on medication continues to look healthy, at the detriment of the partner who does not know the truth. This scenario is one of the reasons why Uganda passed anti-HIV Act 2014 –to stop intentionally infection.

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