HIV/AIDS: A cure remains elusive but we can still effectively combat the pandemic

When it comes to HIV/AIDS which currently infects an estimated 33 million people worldwide – with indirect severe consequences on the lives of many times over the above figure – people are compelled to ask questions, “Is there a cure?”, “When shall we have vaccine against AIDS?”, questions which even legions of scientists trying to unravel the mysteries of HIV are not comfortable enough in providing the answers.

The fact is, no scientific breakthrough can yet help an HIV infected person completely get rid of the virus from his body system, which we term as ‘cure’. And these scientists, whom many consider as ‘magic workers’, are reluctant to disappoint humanity with the second best answer they have: yes the condition is treatable and is quite responsive to treatment at least for a certain period of time.

Challenges the scientists faced are these. HIV is a retrovirus that turns its RNA into DNA which it splices directly to the DNA of the infected CD4 T-helper lymphocyte of the host, giving independent instructions. It targets, infects and cripples the CD4 T-helper lymphocyte, the cell vital in fighting back against infections. It’s difficult to fight against an enemy that hides within our own primary arsenal.

The virus also changes its DNA so often and so rapidly that it’s like the body encountering a new bug every time it does so, making it difficult to develop effective and permanent drugs against it.

Let’s look for another alternative, the AIDS vaccine. AIDS vaccine, in general, is a substance that is introduced into the body, so that the body can defend itself against HIV by creating an immune response by making antibodies and/or killer cells against the HIV. The success of vaccine depends on its effectiveness and safety. Unlike smallpox or hepatitis B vaccines, all the experimental AIDS vaccines fail to fulfil the first requirement. The reason is HIV has a property of extreme genetic variation which occurs as a result of its rapid-fire replication rate once it is inside a human. In a single HIV-infected person, about 10 billion new HIV particles are formed every day. On the way HIV makes several mistakes – like that of a typing error one makes by hitting the wrong key while in a hurry – giving rise to accumulation of new strains of the virus having totally different genetic sequence, a condition called ‘mutation’. This variation pose a significant challenge to AIDS vaccine researchers, because the new strains of the virus can easily evade the existing antibodies induced by the AIDS vaccine in the body. The antibodies produced against the earlier strains do not work against strains that appear later. So, even when effective vaccines against certain strains of HIV can be developed, a greater number of variant strains will still escape unharmed.

Considering all these stumble-blocks, ‘prevention’ appears to be the most desirable method we can adopt to effectively combat the pandemic. Here are my suggested HIV prevention strategies:

Prevention of Sexual Transmission: Sexual networking patterns like commercial sex, polygamy, and multiple relationships minus consistent condom use encourages the spread of HIV. Culturally accepted dry sex, wife inheritance and initiation rites also add to the problem. The global AIDS epidemic is driven by men because men have more opportunity to contract and transmit HIV, hence implementation of male circumcision programme and consistent condom use will contribute significantly to HIV prevention. Either abstinence or fidelity as preventive measures should also be encouraged. The power of openness in the form sex education must also be realized, as evidence shows more talk about sex leads to less sex act. Reformation of the social structure in favour of women empowerment through appropriate government action is the need of the hour.

Prevention of Mother-to-Child Transmission: One of the tragedies of AIDS is that without protection, roughly one-third of babies born to HIV positive mothers will be infected while in uterus or during birth or through breastfeeding. Reduction of mother-to-child transmission rely on voluntary counselling and testing to identify mothers who are HIV positive, and on adopting these intervention options: (a) short-course antiretroviral (ARV) to the mother during pregnancy and labour and also to the baby and mother afterwards, which reduces the transmission to babies from 40% to 70%, (b) Caesarean Section at term before onset of labour, (c) prevention of early rupture of membrane during labour, (d) breast feeding practice, such as total formula feeding from start, or exclusive breast feeding and then weaning at 3-6 months, or heating expressed breast milk.

Prevention of Blood-borne Transmission: Transfusion of HIV contaminated blood is the most efficient mode of HIV transmission. This can be prevented by through screening of blood and by avoiding unnecessary transfusion. HIV transmission among injecting drugs users and hospital patients can be reduced by adopting needle exchange programme. Health workers can lessen their chance of acquiring the virus or of infecting their patients by taking universal precaution through use of masks, goggles and gloves during operation, injections and handling a patient’s blood or secretions. Chances of acquiring HIV after needle-stick injury and other occupational exposures can be lowered by a four weeks ARV course of post-exposure prophylaxis (PEP) starting within 72 hours of exposure. Best is to avoid injury by using biohazard sharp boxes where needles are disposed off un-recapped soon after use.

Voluntary Counselling and Testing (VCT): Well-informed people always know how to behave in times of crisis. VCT Centres help infected people know their HIV status long before they become sick. It encourages openness about the epidemic and hence acceptance. It enables infected pregnant women to reduce transmission risk to their babies by taking timely preventive measures.

Having said these, it must also be realised that prevention programme alone without care and support component will, at best be seen as partial response. It may lose credibility and support. Availability of care component earns the much needed community initiatives and support. Above all, the most acceptable and effective contributions always come from the HIV positives themselves through positive prevention programmes. It’s time we join hands together to face the scourge.

Care Givers Day Celebration

In Chikankata where Christianity is practically at its best, hardly a day pass by without some sort of celebration - a celebration of friendship, care, love, peace, hope, and of course, LIFE!

This time round, it's a DAY for the 'Care Givers', who earned the title of 'heroes' through their commitment and sincere dedication towards the care of people living with HIV/AIDS within the community and the homes.

Zambia, with 15% of its 12 million people having HIV and with a heavy disease burden to bear upon its own shoulder, however, does not lose hope or give up the fight. People like our care givers here are assurance we had with whom we share a common faith of overcoming one day. It's hard to predict when that day will be. But once a change has occured 'inside' with resultant resolve to face positively, then it's already happening. We are heading towards dawn.

<--The main carers of orphans due to AIDS are aunts and uncles but, with increasing ill health and deaths among them too, elderly grandmothers are increasingly also becoming the main carers. In Zambia, more than one-quarter of all children under 15 are already orphaned, and an estimated two-thirds of rural households like here in Chikankata already look after one or more orphaned children. To be in a household containing orphans has become the norm, not the exception. It can also be said that there are only two kinds of people. Those infected with HIV and those affected by it.

The first response to problems caused by HIV/AIDS comes --> from the affected children, families, and communities themselves, not from government agencies, NGOs or donors. This is because the impact of AIDS is experienced first at individual, household and family levels, and gradually more widely in the community. Since such is the case, I think Chikankata AIDS programme is doing the right thing by empowering the individual, family and the community in its fight against AIDS.

<--However, given the scale of the problems and the fact that those hardest hit are often the most disadvantaged, this first response will be insufficient on its own. Additional assistance from governments, NGOs and donors is crucial. For example, like here where each community health assistant is given a bicycle through funds coming from certain donors like the ones mentioned below.

United States Agency for International Development (USAID)-->

<--The Salvation Army Red Shield Services and others

The Salvation Army World Services Office (SAWSO)-->

<--Our 4 year old daughter Melissa has already started learning much about HIV and AIDS through her father's demonstration using her multipurpose learning board. And I belief this is a simple but significant step every individual can take towards making our community and the world a better place to live in.

"I am a very lucky little boy. My father and mother died. I am an orphan and I am infected. But I am living with a foster family and I am strong and healthy....You can't get AIDS by hugging, kissing, holding hands - we are normal. We are human beings". A testimony of Nkosi Khumalo Johnson, an 11-year-old boy with AIDS, a presentation he made during the XIII International Conference on HIV/AIDS in Durban, July 2000. He died one year later in June 2001.Your care and concern counts. Whoever we are and whatever we may do, we all can be 'Care Giver'.

AIDS Nge Hlauhawm Zawk Cholera?

He zawhna 'AIDS Nge Hlauhawm Zawk Cholera?' tih zawttu doctor hi tunge maw ni le, a hlauhawm zawk chu a hriat sa vek alawm, zawhna zawh awm pawh a ni lo e, i ti a ni mai thei. Mahse hei hi mak ti suh, Zambian ho chuan AIDS aiin Cholera (Tuihri) an hlau zawk tih hi thu dik a ni e. Hengte hian a tifiah ang-

1. Tunhnai maia Chikankata catchment area chhunga Cholera hri leng avangin Chikankata Hospital Infection Control Team din a ni a, AIDS hi inkaichhawn theih natna (infectious disease) ni ve thoin, hun kha leh chen kha bu lo khuar tawh mahse AIDS avang hian Infection Control Team meuh din a la ni ngai lo. (Tuna he team thar hian AIDS hi a hma tel ve chauh zawk a ni).

2. He Infection Control Team hi chairman nia hruai tura kan hotuten mawhphurhna min pek anga hma kan lakna kawngah pawh kan sorkar District Health Office lam hlei hlei hi Cholera chungchangah hian an lo 'sensitive' zawk daih mai tih ka hmu chhuak a ni. AIDS veite hospital ward chhungah zalen taka dahluh leh enkawl theih an nih laiin, Cholera avanga damlo nia rinhlelh ringawt pawh, kan district health office inkaihhruaina chuan isolation room-ah takngial pawh dahluh min phalsak tlat lo mai! Khawchhung atanga hla tak hmun fianrialah camp siama dahkhawma enkawl tura tih kan ni.

3. Vawinah female medical ward-a AIDS avanga damlo awmpuitu nu (attendant) pakhat chu Cholera nia rinhlelh a ni a, Isolation ward-a dah ka rawt nain ka thawhpuiten rem an ti tlat lo mai a, mi tam zawk thutlukna a lal zawk avangin kan in kianga bawkte (shed) sak sa lo awm remchang takah dahluh a ni ta. In ka haw hnua Mapuii ka hrilh chuan min lo hau titih deuh a, hlauh tur a nih loh zia ka hrilh hnu pawhin, "Heta a mi chengten an hlauh viau chuan hlauh ve mai tur a lawm, chhan a awm a ni ang," la zuk ti talh a! Nu ber hi chuan an dawn kim thin a, a awm tho e.

4. Vawinah bawk, ka ward round pahin (ka colleague te pahnih an awm remchan loh avangin ka kep a, ward panga ka round chu!) ka Danish medical student kaihhruai lai pakhat nen kan nurse-te zingah unofficial poll kan la a, AIDS nge an hlauh zawk Cholera tih zawhna an chhanna chu 'Cholera ka hlau zawk' tih a ni tho mai. Enge a chhan: Cholera kills faster than AIDS! I wish they also remember that Cholera is curable.

Engvangin nge Zambian ho hian heti taka Cholera an hlauh a, AIDS ai pawha mipuite leh sorkar thuneitute ngeng a chhun nat zawk (?) tlat mai le. AIDS hi a ram mipui 15% ngawtin an vei mek a ni a, a hluar lutuk avang hian ngaiah an nei tawh nge, kan nurse-te chhanna ang hian thawk leh khata nunna la thut chi natna anih loh vang hian an hlau lo zawk? Engpawh chu nise, AIDS avanga natna leh thihna (morbidity and mortality) hi a tam a, ram leh hnam hnuk thalaite a tuartu an nih deuh ber avangte hian ram ei leh bar dinhmun a nghawng pawi thui thin a. He rama kan thangtharte, ram hruaitute leh roreltute pawh hian AIDS chungchangah hian thlir dan thar leh zau zawk an neih chu a hun ta hle niin a lang a ni.