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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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Sun Health

Don’t use garlic for yeast infections

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Public Health Specialist, Dr Orapeleng Phuswane-Katse has warned women against using garlic for yeast infections, citing risk for further infections.She explained that while there are a few studies to support the claim that garlic has anti-fungal properties, it is never safe to put anything that is not regulated in the vaginal area.

On Monday, a woman took to social media to seek a remedy describing her symptoms as itchiness and a white discharge from her private area. Out of the 375 comments that she got, almost half advised her to insert garlic into her genital area. The comments indicated that the symptoms would disappear within three days.

“I remember I had the same problem back in 2017, I could not stand the itchiness, a friend of mine advised me to insert garlic, and within two days it was gone,” wrote one commentator. Another one wrote: “Take a clove of fresh garlic and peel off the natural white shell that covers it, leaving the clove intact. At bedtime, put the clove in the private area. “In the morning, remove the garlic clove and throw it in the toilet. I did this one time, if the itchiness goes on, continue for one or two days until all the itchiness is gone.”

However, Dr Phuswane-Katse advised that the only alternative is to see a doctor when one has the symptoms.“The vagina is a fragile moist area that has bacteria that regulates the PH in there. Any foreign objects can cause laceration and even introduce unwanted bacteria that can cause more harm than good”. Furthermore, she added, “There is no regulated size of the garlic to insert and this may pose danger.

Questions like, ‘how many hours do you remove it, in what state should you insert it, crushed or whole’? Since its not regulated medicine, there can be no clear answer”. Dr Tebogo Oleseng, a gynaecologist and obstetrician said women need to be more careful, saying that the birth canal is the ‘perfect’ environment for the botulism bacteria to grow, which can be life-threatening.
Botulism, a condition caused by Clostridium botulinum bacteria, can be offset when someone eats food containing toxins because it has not been properly canned, preserved or cooked.

He advised women not to take medical advice from anyone recommending vaginal garlic for yeast or anything else because there are antifungal drugs specifically for yeast infection. He explained that garlic contains allicin, which in the lab has shown to have antifungal properties. “Bacteria from the soil can be pathogenic for the body. That is why we clean wounds. If you actually happen to have an inflamed yeasty vagina, soil bacteria would be more likely to infect it,” he said.

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Know Your Specialist

Caroline Gartland speaks on Children and Mental Health

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Tell us about yourself and your background
I’m originally from the UK but have been in Botswana for eight years so this is now home! I have a Combined Honours degree in Psychology an MSc in Mental Health and have had a pretty varied career.
I started off working with offenders doing rehabilitation programmes; went on to support the victims of domestic violence then ended up working in Child and Adolescent Mental Health Services for the National Health Service.
I’ve done a lot of work, mainly voluntary, in different fields since being in Botswana but my passion is now Early Childhood Mental Health.

What does your work entail?
Early childhood mental health is mainly working with parents, caregivers and teachers to help them understand how children develop and the best ways to support their mental health and brain development as they grow. It’s about providing training and opportunities for families to bond with their children and introducing new ways of playing and interacting.

What sparked your interest in early childhood mental health?
Quite simply, having my own children! My daughter was born five years ago and I was fascinated watching her develop and grow. It occurred to me that the younger you begin to consider mental health and provide tools for resilience against life’s adversities, the better outcomes you are likely to have.
I began reading everything I could get my hands on, and completed a diploma in Infant Mental Health. I’ve worked down the lifespan but I feel I’m now where I belong, working with babies and young children.

What mental health issues have you observed in children in Botswana?
Mental Health is still stigmatised around the world and Botswana is no exception. Most people immediately think of mental illness, but mental health is about so much more; we all have mental health and some days we are fine and able to deal with life’s challenges and some days we need more support and tools under our belt to help us cope.

Young children can experience mental health problems. Anxiety is a common one, but we are more likely to focus on the behaviour we see rather than how the child is feeling. An anxious child who refuses to go to school may be labelled as ‘difficult’ or ‘naughty’ but what they are expressing is a painful emotion that they need help dealing with.

Describe one thing you find fulfilling and challenging about working in this industry.
Working with children and families is a pleasure and a privilege. To make life a little bit easier for someone is all that matters, you don’t have to be out there saving the world to make a difference.
My major challenge is time. I would love to do more, I’d love to do an MSc in play therapy and a couple of other therapeutic techniques I’ve come across in Europe but that gets put on hold as I focus on my own family and business.

Can you share an anecdote about how mental health consultation works?
I think that education, understanding and connection are the three keys to giving a child the best start in life. Led by that, SensoBaby provides classes in the community for parents and caregivers to connect with their infants.

We offer workshops on parenting and play to foster understanding of child development and wellbeing and we are available to troubleshoot specific problems an individual or agency has with the young children in their care or the systems they have in place. When it comes to individual parents, mostly what they need is to feel heard, supported and guided in their parenting choices.
You can read all the baby books in the world but they won’t give you the answers you need for your child, through responsive parenting and connection, you’ll find you have the solutions you need.

What advice do you have for child-care providers or early childhood teachers who are at their wits’ end over a child’s challenging behaviour but don’t have access to a consultant?
Empathy is an important and undervalued skill – the ability to consider another’s viewpoint. What is that child feeling? Their behaviour might be challenging and hard to deal with but often the root cause is an unmet need. There’s a famous quote from an American Clinical Psychologist, “The children who need love the most, will ask for it in the most unloving ways.”

Does a mother’s mental health affect her foetus? How important would you say is paying attention to women’s well being during pregnancy as with their physical well being?
100% yes. It is so important to support a woman’s wellbeing during pregnancy. As an example, if the mother experiences significant stress and rising levels of cortisol (the stress hormone) during pregnancy, the foetus will be affected and in some cases will be more sensitive to stress in childhood or later in life.

Pregnant women and new families (Dads as well!) deserve nurturing care themselves and shouldn’t be afraid to ask for support. SensoBaby run FREE monthly coffee mornings to support pregnant and new mothers because we understand the importance of maternal wellbeing.

Do smart phones and television make our children mentally ill as is often purported?
I don’t think technology is always the villain it’s made out to be. The key is in the relationship with that technology. Moderate use of TV’s and smart phones are fine, as long as they aren’t a substitute for outdoor play, imaginative play and meaningful interactions. If a child is crying or upset and we hand them a device to keep them quiet then we have missed an important opportunity for connection, helping them process what is going on and supporting them to calm down and settle themselves.

Now, I know you are involved in an exciting programme that helps caregivers and children to bond and get the children off to the best start in life through play. Can you say a little bit about that work and just how you are seeing it play out?
SensoBaby is our baby; a project born from passion and a desire to support families in Botswana. We offer play-based classes for children and their caregivers that are underpinned by the principles of child wellness as well as early foundations for learning.

When you provide developmentally appropriate opportunities to play, you learn so much about your child. That understanding and observation builds strong connections, which will form the basis of that child’s future relationships and self esteem. Play is so much more than ‘a fun activity.’

We offer a number of trainings and workshops for parents, nannies and community stakeholders and hope to increase our offerings this year. Our community partnerships and voluntary programmes have been successful so far and we hope to see more impact in 2018.

We currently serve the Gaborone community but would like to expand throughout Botswana as opportunities arise. The response to SensoBaby has been fantastic so far and we can’t wait to see how far we can go with the concept!

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