Aids: When the doctor, hospital and clear message ‘vanished’

On Sunday, December 1, the world marked the World Aids Day. It is a stark reminder of the devastating effects of one of the most lethal pandemics in human history. Here are some depressing statistics: In Uganda, 1.38 million people are living with HIV/Aids, 1.2 million are on anti-retroviral (ARVs) therapy. There are 53,000 new HIV infections annually while about 23,000 victims die in the same period. About Shs160b is spent by government on ARV drugs to treat people in a year (Sunday Monitor of December 1).
Yet these grim statistics do not tell the whole story. They do not state the number of dependants left behind without food, clothing and shelter. Nor do they tell us the amount lost in terms of investment in manpower and productivity, say if a doctor trained for two decades passes on due to Aids.

Though Uganda has made progress in containing HIV/Aids, there is concern that the scourge is steadily on the rise. Baffling it is, because there is increased awareness, anti-retroviral therapy, auto-disable syringes, availability of condoms, etc.

To understand this, we must note that many things have changed in the last 30 or so years since we first encountered this disease that wasted away the human body and killed its victims in a short time from the incident of infection. Back then, there was nearly no information about the cause of HIV/Aids, how it was transmitted and how to protect oneself against it.

The hospital was the one place of refuge for all for information and medical intervention. There was also one authority whose word was taken as gospel truth and that was the trained doctor in the health centre.

The doctor then, gave a single, simple, but unambiguous clear message and that was “Aids kills once you are infected and there is no cure or treatment.” It was a form of zero sum game. There was no room for manoeuvre. Over the years, the disease has been ‘demystified.’ The information regarding HIV/Aid is now varied. The role of the hitherto authoritative and respectable doctor has been ‘adulterated.’

Now people can get testing and treatment information from anywhere in the name of taking services closer to the people. A good thing it maybe, but it has its own short falls that may be detrimental in containing HIV/Aids. It is possible to procure an sero status of choice without proper supervision and control.

People may also have unprotected intercourse without being counselled on the need for a second test to rule out a change in the status after the three months window period. In place of the hospital and the trained doctor, we now have the herbalist with his untested concoctions. Many times these are quite affordable and, therefore, a viable alternative to the costly Western medicine.

The NGO comes with huge money bags, food and other niceties that are attractive to many and not available in the traditional hospital setting. Many of the messages they disseminate are not in the control of the main stream health sector and may be disastrous in case it is unfavourable.

Yet we cannot do away with them because we need their money and complimentary role in this poorly-funded sector. You also have the rise in the popularity of the church and miracle healing servants of the Lord. Stories of patients dropping their ARVs for fasting and praying abound just like the message that discourages condom use as satanic and ungodly.

For others, the Internet comes in handy with information of cures from all over the world that include herbs, spices, special mystical water, etc. Besides this, many of the messages currently availed even by medical personnel are not clear, concise and helpful for the prevention of the disease. For instance, people now take chances of not using protection because they are being told rather misleadingly that ARVs ‘cure’ the disease.

There is also popular information that once one has sex with a person who is on ARVs the viral load is so low they that they will not catch the virus. Granted, the advancement in human medicine means that these days it is difficult to tell a victim of the virus with the naked eye as it was in the past.

You no longer see shocking images of people with oral thrush, hair falling off their scalp, boils all over the emaciated body, kaposis sarcoma or kisipi’, etc, so people may take the condition lightly.

Then there is the whole story regarding post-exposure prophylaxis (PEP) whereby antiviral drugs are taken immediately after exposure to the virus. A friend who works at a pharmacy says an antiviral drug called Truvada sells like hot cake at the beginning of the week.

This means that many people deliberately have unprotected sex over the weekend then wake up to the reality of the virus and seek an intervention, which is not total insurance cover. Others advise that if males are circumcised, the chances of catching the virus are ‘minimal.’

So, many basing on such information, try their luck without using condoms which may lead to infection.

We will definitely need to restore the significance of the traditional hospital in order to restore confidence in it as a credible place for prevention and cure of HIV/Aids and other ailments. This means funding and equipping it better. We also have to factor in motivating and training health workers to enable them treat and manage this condition.

Lastly, we have to agree on communicating a standard simple, clear and concise message. Otherwise, the situation we have now is one of too many cooks and recipes spoiling the broth.

Mr Sengoba is a commentator on political and social issues.
[email protected].
Twitter:@nsengoba