Chikankata HIV/AIDS Prevalence

The origin of HIV/AIDS programme under Salvation Army Chikankata Hospital in March 1987 was preceded by the diagnosis of a skin condition, Kaposi’s sarcoma, in a patient in 1986, with another 37 more cases of AIDS diagnosed later at the end of that year.[1] As more patients with AIDS crowded the hospital wards, the idea to build a hospice was debated by the hospital staff and the community leaders and finally rejected. It was felt that the numbers of patients who would require care would soon overwhelm a hospice. Knowing that caring of the sick by families at home is an inherent strength of Zambian society, home based care approach of people living with HIV/AIDS was adopted. The system involved the family, neighbourhood and community with Chikankata Hospital as the key player. [2] This approach has been adopted up to this time due to the positive impact it has on the community.

The trends in general:
Chikankata Hospital’s Anti-Retroviral Therapy (ART) Clinic named Muka Buumi (“Mother of Life” in Tonga), together with the Voluntary Counselling & Testing (VCT) services was started in 1st September 2004. At the start of VCT in 2004, out of a total of 391 people tested, 276 (70.58%) of them were positive for HIV. In 2005, the percentage of HIV positive result came down to 60.21% (660 positive from a total of 1096 tested). The situation changed for the better in 2006, when for the first time, a fewer number of people (37.93%) tested positive for HIV as against the negatives, from the huge total of 2175 (so far the largest Chikankata Hospital has in one year). The situation remains constant in 2007 (38.22% HIV positive) when 1724 were tested and in 2008 (37.76% HIV positive) when 1533 people were tested.

Antenatal versus population-based HIV prevalence rates, Chikankata Hospital:
When HIV prevalence rates among 15 – 39 years group each from pregnant mother antenatal attendee (considered the best representative sample of the general population) [3] and the actual general population (VCT attendee) are compared, there is a huge difference. While the antenatal HIV prevalence rates of Chikankata Hospital (12.97%) closely follows that of the Zambian national antenatal prevalence (12.50%), the prevalence among general population attending the VCT at Chikankata Hospital (44.08%) is so high that in no way can it represent the general population of the area, let alone that of the nation (15.2%). [4] This high prevalence of infection among VCT attendee of Chikankata Hospital is likely due to the sampling bias as majority of the people tested are either in-hospital patients or outpatients who already had certain medical problems at the time of arrival at the hospital.

These reductions in the prevalence/incidence of HIV are, of course, a welcome shift. However, the dynamics of epidemic prove that reduction in the prevalence or incidence of infection is not a consequence of a single factor alone. Hence the following questions arise:
1. Are the observed changes a reflection of the natural progression of the epidemic? Because the HIV prevalence will not grow indefinitely, it will saturate at some level. [5]
2. Are the observed changes a product of interventions or changes in behaviour? Considering the extent of interventions being carried out by Chikankata Hospital and the resultant behaviour change visible within the community, one can be compelled to answer this question with the affirmative.

The fact that HIV prevalence within Chikankata catchment area levels off or decreases from 2006 through 2008, paints a bright picture on the wall. It gives the idea that the rate of new HIV infection per year (incidence) has also decreased, as a fall in incidence always precede the fall in prevalence. It will be wise and more accurate to agree, that the natural saturation of the HIV epidemic coupled with VCT services and behaviour change interventions carried out by Chikankata Hospital, both contribute to the fall in the incidence and prevalence of HIV in Chikankata catchment area.

References:
1. Silomba, Weddy. Manager of AIDS Management & Training Services, Chikankata, Zambia. HIV/AIDS and Development: The Chikankata Experience. March 2002
2. Dixon, Dr. Patrick. AIDS and You. 2005
3. UNAIDS. Trends in HIV incidence and prevalence: natural course of the epidemic or results of behavioural change? June 1999
4. UNAIDS. Latest epidemiology data. http://www.unaids.org/en
5. UNAIDS. Trends in HIV incidence and prevalence: natural course of the epidemic or results of behavioural change? June 1999

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.

Discovering Self

Chikankata Hospital once again is fortunate to draw on the expertise of Insights Discovery(R), a global learning and development company whose list of customers include organisations such as Air France/KLM, AstraZeneca, BC Hydro, Boeing, Deutsche Bank, Ernst & Young, HBOS, Lufthansa, Nationwide Building Society, Novartis International, Nuance Group, Pfizer, Royal Bank of Scotland, Siemens, Shell, Texas Workforce Commission, Xerox, 7-Eleven, Nike, Microsoft. And together with a personal commitment from Garry Smith, Insights Discovery licensed practitioner and Managing Director of Essex (UK) based training, coaching and consulting company Genesis TCC Ltd., who came to as far down as Chikankata to actually facilitate the Chikankata Hospital Management Training during 13th - 14th April 2009.

One may wonder at how a rural hospital in Zambia like Chikankata's can join Insights' list of elite customers like the ones mentioned above. It's all because of Garry's links with Insights and its CEO Andy Lothian who is a great supporter of The Salvation Army. Garry himself is a Divisional Envoy of The Salvation Army in Essex.

One of the most interesting parts of the training was that each delegate was provided with a personalised profile, each of which was impressively produced from analysis of 25 sets of questions each delegate has answered through an online evaluator form. Following is my own profile.

Key Strengths
+Competitive and wants to win at all costs
+Embraces change readily
+Self disciplined, confident and convincing
+Intuitive and optimistic
+Frank, honest and straightforward leader
+Ability to communicate his vision to others
+Swift and agile
+Boundless energy, capable of adopting a number of roles simultaneously
+Excellent communication and presentation skills
+Resourceful

Weaknesses
The famous Swiss psychologist, Carl Jung said: "Wisdom accepts that all things have two sides". It has also been said that a weakness is simply an overused strength. So I've no problem sharing my weaknesses with you, and here they are:
-Get so involved may ignore his own and others needs (My wife very much agreed to this!)
-Becomes defensive or dictatorial if challenged
-May not dot all the "i"s and cross all the "t"s
-Dislikes and avoids routine tasks
-Sometimes lacks a sense of humour
-High sense of urgency can create stress for others (My colleagues mostly agreed to this!)
-Doesn't suffer "fools" gladly
-Lacks tact and diplomacy
-May not finish everything he starts (Does this mean I'm the Jack?)
-Dislikes and rebuts personal criticism (So does everybody!)

Value to the Team
As a team member, Zairemthiama:
+Adds excitement to the team through intuition
+Strengthens the bonding process by being responsive and perceptive
+Will assume responsibility but deflect blame
+Is unhindered by existing procedures and practices
+Almost always delivers on time
+Brings drive and focus to the issues
+Will lead by fighting alongside the troops in the trenches
+Can focus equally upon "task" and "process"
+Is unlikely to get side tracked by peripheral items
+Has a "can do" attitude

Suggestions for Development
Zairemthiama may benefit from:
#Accepting rather than rejecting negative feedback
#Regularly reflecting on the days events
#Trying to hear and appreciate others' perspective
#Not always appearing so direct and confident
#Looking for the good in everything
#Allowing people to do their own thing
#Really listening to the views of others
#Being more prepared to acknowledge his mistake
#Meeting more people at least half way
#Slowing down and thinking things through

I am always grateful to the Almighty for choosing and using me as I am. What a privilege!!