Doctor's Column: I am HIV positive, what is the best contraceptive to use?

Dear doctor, Iam a person living with HIV but married. Which is the best contraceptive can I use?
Mwajuma

Dear Mwajuma, I wonder why you are asking when you are supposed to be using condoms. They are recommended for every sexual encounter between an HIV infected person and others whether they have or do not have the virus.

Consult your doctor who will counsel you and your partner in choosing the best contraceptive method for yourselves. Please talk to your doctor who will advise you on the best contraceptive for you since what is good for one person with HIV may not be the best for another.

If you are a living with HIV but not taking antiretrovirals (ARVs), you can use most types of contraception. But whether you are using ARVs or not, generally, condoms rank high.

Apart from protecting against pregnancy, they are also effective in preventing spread of HIV and other sexually transmitted infections. Sexually transmitted diseases increase the likelihood of worsening HIV infection.

That said, diaphragms which are not commonly used in Uganda but usually used with the spermicide (nonoxynol 9) are not recommended because the spermicide is more likely to increase HIV transmission though originally it was thought to protect women. Note also that one may get a more dangerous strain of HIV, which may resist drugs.

Antiretroviral drugs affect most hormonal contraceptives, meaning that women who are taking HIV treatment will not get the same level of protection against pregnancy from the contraceptive pill, implant, and emergency contraception (the ‘morning after’ pill).

However, the Intrauterine Device , also known as the coil, just like the condom is unaffected by antiretroviral drugs and ranks second best provided you or your sexual partner have no other sexual partner(s).

Dear doctor, I have a baby who keeps gnashing his teeth. I have done all the rituals to cleanse what they told me could be the cause, that my wife cheated on me, but to no avail. What drug can make him stop doing this?
James Bond Balaaga, Kamuli

Dear James, bruxism (grinding of teeth) in children often occurs during sleep and is usually from unknown causes though it may be blamed on poor alignment of the top and bottom teeth,or as a way to ease the pain from teething and nervous tension or anger.

Some children with other medical conditions (such as cerebral palsy) or pinworm infestation may also grind their teeth. A child is, however, more likely to grind his teeth if the parent did or does the same and then it is also more likely to talk in its sleep. Though even adults grind their teeth, the problem usually starts around three years and by six years it has stopped.

Usually though, the sound may be bothersome to other family members, grinding is usually harmless save for some headaches, earaches and sore jaws it may cause. In some cases, this may wear down teeth making them sensitive especially if grinding is serious or chronic.

Most children outgrow bruxism by the time they reach adolescence. But in case it is serious, a dentist may prescribe a special night toothguard as one grows permanent teeth at around six years of age.

Relaxing a baby before bedtime may help relieve stress and give a child better sleep without grinding the teeth. If this does not help, you may need to see a doctor (paediatrician) for further evaluation.

So, it is unlikely that your wife’s cheating is the cause of bruxism. You need a doctor to evaluate related problems like stress and a dentist to check out for complications instead of seeking drugs for your baby, which are not likely to help.

Dear doctor, I need to get circumcised but I am worried that circumcision may make one’s penis tiny.
Engineer Kyaligonza

Dear Kyaligonza, some methods of circumcision remove too much skin up to the base inevitably making the penis look smaller. Other methods make the penis bend down or even shorter.You need to see a professional to circumcise you so that enough skin is left so that your penis neither grows shorter nor smaller.

Dear doctor, I bought a Vitamin E supplement at Shs150,000. Are such supplements useful or I have just thrown my money in a pit?
Jessica Kirumira

Dear Jessica, Tocopherols are compounds, which have Vitamin E activity. The best sources of the vitamins are natural, these include vegetable and seed or nut oils. Also, the vitamin is available in animal sources like, butter, egg yolk, milk fat, and liver.

The primary function of Vitamin E is to act as an antioxidant. Antioxidants are nutrients (vitamins and minerals) as well as enzymes that counteract the damaging effects of the so-called free radicals (charged molecules) on the body tissues.

The antioxidant activity is said to help prevent the development of such chronic diseases as cancer, heart disease, stroke, and arthritis. Further to that, without much evidence, the vitamin has been used as anti-aging method, apart from the claim to improve fertility and sexual prowess.

I am sorry that you used your Shs150,000 for a vitamin rumoured to carry lots of unconfirmed effects which you could have easily got cheaply in the said foods.

In Uganda, these foods are readily obtainable. Today, instead of Ugandans buying and consuming fresh fruits and foods that carry lots of value, they are copying the western world ways of taking daily food supplements whose consequences are long term and may be grave.

Dear doctor, I am a hypertensive person who is on and off drugs. What I have observed is that whenever I reach the time of my menstrual periods I feel the pressure rises. Why is this?
Julian Ssitenda

Dear Julian, more than 80 per cent of hypertension is from unknown causes hence the name, essential hypertension. Where the cause of hypertension is known, removal of the cause may lead to complete cure.

In essential hypertension, one will not remove a cause since it is unknown apart from involving lifestyle changes in treatment. This includes minimising salt and alcohol intake, exercising regularly and avoiding smoking. In many cases where lifestyle changes do not suffice to normalise the pressure, drugs have to be taken. Being on and off drugs then may lead to failure to control the pressure.

Many Ugandans will take drugs when they “feel pressure” and yet the pressure may rise without a person feeling the symptoms. What you feel as pressure may actually be the usual symptoms that may precede periods in what is known as pre-menstrual syndrome (PMS).

Though there are many symptoms associated with PMS, the most common are either emotional or behavioural (anxiety, mood swings, irritability) and physical (headaches, dizziness and feeling bloated).These can make anyone feel her pressure is up especially if she has only recently started suffering from the condition.

The fact that PMS is associated with some weight gain due to water retention related to the period hormones, it is envisaged that the same water retention may worsen pre-existing hypertension. Also feeling unwell and related stress alone can push pressure upwards.

Dear doctor, explain to me why children get malaria in the evening and yet they may play during the day. Do the parasites know it is night when our medical personnel are away?
Eddy Byankabya

Dear Eddy, malaria is a disease caused by plasmodium parasites acquired from bites of infected female Anopheles mosquitoes seeking blood to help mature their eggs.

The parasites attack our red blood cells and feast on blood cell pigments only for the cells to burst releasing the parasite and debris, which results in substances that lead to fever.

Fortunately, the body clears the mess and with this the fever wanes only for other attacked cells to burst causing yet another bout of fever the time taken to cause fever again generally depending on the type of malaria parasites.

Malaria is caused by parasites called plasmodia, which may be falciparum, ovale, malariae, or vivax. It may be named according to how long it takes for the fever to come back. So the commonest malaria is called Quartan malaria caused by Plasmodium falciparum. So, it is not true that the parasites time when the medics are away to attack the children or even other people.

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