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U=U strides in HIV prevention

Rachel Raditsebe

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HIV positive Gumisayi Bonzo (47) knows first-hand the fear and worry that accompanies every sexual encounter for a serodiscordant couple. This is a situation whereby two people are in a relationship and sexually active but one of them is HIV-positive while the other is HIV-negative.

“Our sex life was a big challenge, with me wanting to use about two condoms at a time, putting barriers during sexual intercourse like no kissing because I was afraid of passing on the virus to my her,” Bonzo shared in an interview with SunHealth on the side-lines of a regional capacity strengthening meeting for African National Human Rights Institutions (NHRIs) in Johannesburg recently.
“My partner is negative and a transgender woman and right from the get go we were dealing with a lot of backlash from both of our families of why we shouldn’t be together. But we perceived and went through a lot of counselling.

“It was in one of those sessions that a doctor explained to them about the growing body of evidence that if Bonzo took her antiretroviral medication religiously and on time, and her viral load was low she would not pass on the virus to her partner.“You don’t know what a load off my shoulders that was. I have been on ARVs for the past 20 years and never defaulted. So we decided that I would go get a viral load test and it was undetectable.

“It doesn’t mean I don’t have the virus in me anymore, it’s just not detectable in my blood and so my partner and I wanted to know what it meant for us and our sex life.“We conducted further research on our own and decided it was worth trying not just for us but others especially adolescents born with the virus who have been led to believe they can’t have full lives like other ‘normal’people. “We started having unprotected sex and went for an HIV test six months later and she was still HIV negative. We have been doing that since 2015 and her status has not changed in that time,” Bonzo stated. For people living with HIV like Bonzo, the knowledge that undetectable virus equals un-transmittable is huge, “not only because it prevents us transmitting the virus to our loved ones but it removes fear,” she said.

“It removes the cloud that because you’re positive, you can’t do certain things. It’s the message that we give which for a long time has been negative and fearful. If we put fear in someone that just because they are HIV positive they can’t do this or that, you are taking away their self- esteem”.

In sharing her experience, Bonzo hopes to remove this cloud of fear and stigma from the community. But admittedly, it’s a difficult message for even the medical fraternity to spread.For a long time HIV/AIDS prevention messaging has been the long standing abstinence, be faithful and condomise. But now ARVs are being counted as a weapon to prevent the spread of HIV as well as to treat the virus, what the experts are now calling treatment-as-prevention. “Getting people to wrap their minds around that is really hard. But currently, no other intervention beyond abstinence shows such a level of protection against HIV. It’s probably even safer than condoms because things often go wrong with condoms,” said Deputy Executive Director of Wits University’s Reproductive Health and HIV Institute, Professor Francois Venter

“I can’t stress enough how strong the evidence that people who are on successful ARV treatment are 100 percent safe and will not transmit the virus,” said Prof Venter.While HIV new infection rates remain high in Southern Africa, there has been a slight decrease with South Africa at 44 percent, Botswana at 30 per cent and it’s similar in other countries in Southern Africa like eSwatini. And Prof Venter gives credit to the roll out of the Treat All campaign, a programme aimed at providing anti-retroviral treatment to all HIV positive people regardless of their CD4 count. Hundreds of health organisations worldwide including the Centre for Disease Control (CDC), now support the Undetectable = Untransmittable message.

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Mental Health Series

The effects of dagga on mental health

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Recently the South African Supreme Court legalised the private use of dagga. Individuals are allowed to consume dagga in private and also grow for private use. The judgement brought mixed reactions on the issue and further fuelled the debate on dagga.

There are those who have used this judgement to the detriment of their own health. The crux of the matter though is that adverse effects of dagga cannot be underemphasised as far as mental health is concerned. Dagga use is quite popular amongst the youth which ostensibly explains the prevalence of dagga related disorders amongst them.

Effects of dagga are instant upon use. When dagga is smoked, it gets into the blood stream and then blood –brain barrier. This results in depressed brain activity, the end result being production of a dreamy state manifesting as delusions or hallucinations.

Delusions are altered thoughts whereby one may think he is a president when the reality is he is not. Hallucinations on the other hand is when an individual has distorted perceptions of reality like seeing a lion when it’s not there!

Others effects include:
paranoia,
panic attacks
anxiety
Impaired coordination and balance
Impairment in learning and memory

Various research studies have shown that heavy use of dagga facilitates the development of schizophrenia and substance use disorders. The amount of the drug used and the age at first use often place an increased vulnerability to develop these disorders. This explicitly explains why there are many youth who are having substance use disorders in our country.

Those using dagga may develop amotivational syndrome which basically means they have lost the willpower to do meaningful activities in life! This is basically the stroke that breaks the camel’s back, as other mental health problems may manifest from this.

Those whom are already diagnosed with mental health disorders can have symptoms of their conditions worsening when they use dagga. Depression and anxiety are often made worse by use of dagga. The false perception that taking dagga has a calming effect often predisposes those having mental health problems to take it in order to deal with their illness burden.

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Sun Health

Lymphedema Management Part II Post Breast Cancer

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Lymphedema can occur to individuals who have had breast cancer treatment with radiation and/or surgical intervention with or without lymph nodes removal usually in the arm pit.

Lymphedema is a special type of swelling that occurs when there is excessive build of fluid that is rich in protein that is to become lymph due to an impairment in the transport of this fluid anywhere enroute to its final drainage site in the neck.

Lymphedema management is divided into two phases: Phase I Congestive/acute phase whose goal is to achieve the greatest decrease in volume of lymphedema and Phase II Maintenance phase, whose purpose is long term maintenance to ensure sustenance of goals achieved in Phase I.

Components of Phase I are, a) patient education about the condition, self management strategies. The patient will be advised to avoid certain medical procedures to be done on the affected side, e.g. blood pressure readings, pricking to withdraw blood.

These procedures especially the pricking will result in minor injury which in a normal functioning system is insignificant. The normal bodily response is that the body will respond as there is injury with insignificant swelling.

In the case of someone with risk to lymphedema this can be a trigger to full blown swelling, b) Meticulous skin and nail care to keep fungal infections and cellulitis at bay, c)Manual Lymphatic Drainage (MLD).

This is specialised manual (hands-on) technique whose purpose is to improve fluid removal from congested (swollen) areas where there is impediment of flow to using alternative routes to de-congest the areas.

For example, if there is lymphedema in the right arm from right partial mastectomy (breast tissue removal) with eight lymph nodes removal in the right arm pit. The alternative routes to drain) the right swollen hand/arm is to re-direct fluid to drain into the left armpit, right groin and maybe right breast bone areas.

Following this during a treatment session, d)multi-layered Compression Bandaging is used. Here special bandages are used which come in different sizes. Which technique to use when bandaging is influenced by the degree of swelling and staging of lymphedema.

The bandage system is tighter at the wrist and progressively becomes looser towards the arm. This creates graduated compression which facilitates fluid to flow from the wrist towards the armpit.
Initially the bandages are worn 24hrs/day at a time.

If there are wounds which is not as common when compared to the leg(s) preference is to co-treat with nursing care for them to manage the wounds while I manage the swelling concurrently. Immediately the patient does, e) therapeutic exercises to further drainage of fluid from the wrist to the armpit.

This phase I duration can be anywhere from three weeks to eight weeks and more if needs be. During this time the patient is taught to self bandage, gentle self manual lymphatic drainage, prepared for wearing and taking off of compression garments.

Phase II: Maintenance phase, this is initiated when there has been maximal limb (arm size) reduction in Phase I. The patient is fitted into a compression garment. This can either be custom made or off the shelf. Compression garment may be arm sleeve, glove with or without fingers.

The compression garments come in a variety of compression (Class I to IV). The therapist advicss on the compression garment class. Most patients use compression Class II and III. Ideally the patient is encouraged to wear the compression garment all the time.

From time to time there will be a relapse, that is, swelling starts and Phase I will need to be initiated. There are a number of treatment approaches that can be taken. Factors influencing choice include cancer disease stage, type of cancer, location of lymphedema, patient mental status.

It is not just lymphedema that needs to be treated. Other things to treat include scarring, pain and decreased function. If you suspect you have lymphedema bring it to the attention of your oncologist who will refer you to someone trained to manage this condition.

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