I still remember in 2015 when I first learned how effective anti-retroviral medicine (ARVs) is at stopping an HIV infection from developing into AIDS. In fact, even when ARVs are started after AIDS has developed, they have brought many people back from their deathbed.
It is well known that ARVs improve overall health and reduce illnesses, but what I came to realize is just how many lives ARVs saves through what’s known as viral suppression. When the first ARVs were invented, they extended a person’s lifespan by a few months or years, but they were not capable of fully suppressing the virus like modern ARVs do.
The more I learned about viral suppression, the more eager I was to enroll on ARV therapy (also called ART). In 2015, I went to the Ministry of Health and Wellness to find out if I was eligible to enroll on ART. Since my CD4 count was above 350, I was told I couldn’t start treatment yet. Then something wonderful happened – the government launched the Treat All program in 2016, enabling all of us who are living with HIV to start treatment immediately, regardless of our CD4 count. I enrolled and collected my first prescription in February 2017, full of excitement for how my life would change.
My doctor told me that most people become fully virally suppressed within the first six months of starting treatment. Naturally, all I could think during the first couple of months was becoming virally suppressed. The day that I got my first viral load test results, I was overjoyed to find that I already had an undetectable viral load. With that result in hand, I knew that I was fully protected. I also knew that I must strictly adhere to my medication, continue using condoms and live a healthy lifestyle in order to maintain my undetectable viral load.
One thing I realized about some people out there is that they don’t understand the meaning of “undetectable viral load.” An undetectable viral load means that so few copies of the virus are present in a blood sample that some laboratory tests are not sensitive enough to detect them. Despite the limitations of the viral load test, having an undetectable viral load does not mean a person is cured. HIV is classified as a persistent infection, meaning the person will always have at least some HIV in their body.
Sadly, the rate of new HIV infections is rising amongst young people in Botswana, despite the availability of ART and the high proportion of people on treatment who are virally suppressed. In fact, it is estimated Botswana will record 14,000 new infections this year- that is 38 every day! There is a dangerous belief that having an undetectable viral load means you can get away with stopping or not adhering to your medication. Others falsely believe that their undetectable status means they no longer need to use condoms. It is important that people realize that viral load can and does fluctuate between times when you are not using condoms, or if a sexually transmitted infection like chlamydia or gonorrhea is present, or when ARV doses are missed. During these times, the chances of transmitting the virus become higher.
Remember that even if you have an undetectable viral load, HIV is still present in your body. Even a small number of skipped doses can allow your viral load to increase, putting your long-term health at risk and allowing your HIV to be transmitted.
The good news is that while your viral load is undetectable, under correct treatment and monitoring pattern, you don’t have to worry about passing HIV to your sexual partner. The international community calls this U=U, which means undetectable equals untransmittable. Being undetectable means that your body is in good health and that your immune system is working well at defending itself from daily germs. Maintaining your treatment and monitoring routine is key to remaining undetectable and ensuring that you stay healthy.
Let’s Fight GBV
On a cool Sunday in March some years ago, I decided to take a walk and I found myself at one very popular place in town.
As the place was known for delicious braai and I was feeling a bit hungry, I decided to order a plate. Seated at a table in the back, I noticed a couple enter. I knew them very well. They chose a table, ordered food, and began drinking beer. It was one beer after the other for both of them. They did not notice me. So I pretended not see them and just sat at my table, slowly sipping my juice. It began to get dark and several things started happening. When I noticed almost everyone was getting very drunk and dancing. I wanted to get out of the place as fast as I could.
As I walked outside to the parking lot, I spotted a cab. As I headed for the cab, I noticed some people in the car next to it. The lady I had seen in the restaurant with her partner earlier was inside the car, but she was kissing a different man. The man who was with the lady earlier arrived and a big fight started. The cab driver refused to go because he wanted to see what was happening. We both were able to hear their loud exchange of words. According to the man, the lady was HIV positive and on treatment. He said he was doing her a favour by dating her while he was HIV negative.
He said he was only in the relationship because he thought he had nowhere to run, because he could be infected and still in the window period. The woman also started shouting out and saying how the man was abusing her because of her condition and that she was fed up. I knew there was no place for me to intervene in this matter, more so that I was sober and they were drunk.
I left the place when the situation was a bit calm, but deep down I wished I could have done something. I told myself I would go see the woman and talk to her on an agreed date, but because of my busy schedule I did not manage to meet with her. Later I heard that the guy had killed her and committed suicide. No one knew the reason for this tragic outcome. I could not help but wonder if the fight that I had witnessed had been the tipping point or if I could have said something to her that would have made a difference.
I share this sad story to illustrate how HIV continues to influence our relationships and contributes to sexual abuse and violence, particularly against women. No one deserves to be mistreated by a partner because of his or her HIV status. We can learn to recognize the signs of abuse, report abuse to the police, and be aware of where to get help if you or someone you know is in an abusive relationship. For help, you can contact the following organizations:
Botswana Gender Based Violence Prevention and Support Center (formerly Kagisano Society Women’s Shelter) at 390-7659, after hours: 74265081, or SMS “HELP” to 16510, or send private message to Facebook: @botswanagbvpreventionandsupportcenter
WoMen Against Rape (WAR) Tel: 686-0865/71311244, Plot 517 Moeti Road, Maun. Facebook: @WoMen Against Rape Email: firstname.lastname@example.org
Stepping Stones International (contact in cases involving children 18 and younger); Tel: 573-9858, Facebook: @SteppingStonesInternational
“Let’s Break Stigma and Face the World”
Iam convinced that the change we need to end the HIV epidemic can only occur if more people living with HIV begin to participate in the response.
I want to appeal to those who have gone into hiding to come out and face the world. We are not part of the problem, rather we are part of the solution. We need to stand up and show people out there HIV is real, but it can be managed if you live positively by starting treatment early and taking care of yourself.
Recently, I met a group of students from a junior secondary school who surprised me with how much they knew about HIV. I realised how important it is to not wait until it’s too late to talk about HIV issues with our young people.
While we are busy trying to hide things from them, thinking that they are too young to understand, they are actually ahead of us. For instance, they asked me why adolescents (under 16) need consent from parents to test for HIV. They explained that this policy presents a barrier to youth knowing their HIV status. Sometimes youth encounter situations that put them at risk and need to test for HIV, but much of the time they cannot easily discuss this with their parents in order to get their consent for testing.
We still have some forms of stigma that are holding us back as a society from ending this epidemic. I have observed on many occasions the look on people’s faces when I talk openly about my status. This is usually followed by silence or unresponsiveness to what I say.
It is my wish to hear an influential person in my country, whether a pastor or any type of leader, talk openly about their HIV-positive status. It would make a big difference and change the public perception about HIV. Of course, going public with your HIV positive status takes not only bravery, but also commitment to a lifelong journey of living not only for yourself but for the community as well. All eyes begin to watch your every move.
For some of us, facing this challenge moulds us into stronger people, while for others, the challenges of going public become too difficult to overcome. That is why it is very important to find a support system before going public, so that one can be prepared ahead of time to respond to these challenges through proper counselling and support. Botswana Network of People Living with HIV/AIDS (BONEPWA+) provides this counselling and support free of charge through a large number of support groups that are based throughout Botswana.
Many people are not aware there is this kind of support near their homes, so when they are faced with challenges they break down or go into hiding. I have seen recent success in adopting what is called the greater involvement of people living with HIV. For example, this year the Treat All Champions project, which was supported by PEPFAR, provided a group of 30 of us with a platform to spearhead new activities addressing stigma, disclosure, ARV adherence, and other issues pertaining to people living with HIV. I am thankful to have served as one of the Treat All champions and I am continuing to encourage people to test and know their status all over the country.
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