HIV and Health

KAREN:

• An estimated 40million people worldwide are infected with HIV


• 60% of those living with HIV live in Sub-Saharan Africa


• 7% of Sub-Saharan African adults are infected with HIV


• 2.1 million children worldwide live with HIV, with 90% living in Sun-Saharan Africa


• Approximately 7500 people are infected daily by HIV


• It is currently estimated that in developing countries, 1600 children are infected daily with HIV


• Africa has over 14million AIDS orphans


• The clinical course of paediatric HIV is more than in adults


• In developing countries, 9.5 million people require life-saving HIV drugs - only 4million (42%) actually receive the medications

Yesterday we travelled to a place called Pabbo to an Internally Displaced Persons (IDP) camp to help at a HIV clinic run by our friend, Dr George.

In the height of the war in Northern Uganda, people were forced to leave their villages to live in these camps for their personal safety from rebel troops. The camps comprised of thousands of mud huts built in very close proximity to each other. Since the end of the war 3 years ago, many people have left the camps to resettle in their villages, however, it is estimated that to this day, many of the camps remain 20% occupied. Pabbo was one of the largest camps with a population of 90,000 occupants! Today it serves as a functional community comprising of a school, church, health centre, and farming land. It is not uncommon to be greeted by a cow or a chicken as you walk around the camp!

Pabbo is a fairly remote area with limited access to costly public transport. Consequently Dr George and his outreach team frequent the camp to run a HIV clinic for the local people. HIV is a huge problem here in Uganda. Sexual transmission is a significant mode of transmission as well as mother-to-child transmission. Culturally men are permitted to have many wives. Coupled with little use of condoms, spread of the disease is rife.

The clinic was previously held outside under a tree, but now the camp have allocated a small room where the patients can be seen, blood tests can be taken, and medications can be dispensed. It was a busy clinic yesterday attended by 60 patients in total, including both adults and children. At the clinic patients can be counselled and tested for HIV, medications can be reviewed and altered, patients conditions can be assessed, and any new problems can be treated. Many complications accompany HIV including the herpes simplex virus, anaemia, and weight loss to name but a few presenting complaints. HIV patients are also at risk of developing life-threatening opportunistic infections such as pneumonia, tuberculosis, and cryptococcal meningitis as a result of a weakened immune system.

HIV delays the growth and development of children. This was our second visit to Pabbo camp. On our first visit we met two children living with their grandmother following the death of their mother to AIDS. The children were aged 5 and 7 years yet both looked about 3 years younger. Dr George explained that the youngest child had not long learnt to walk - at 5 years of age! Here in Uganda children are quite advanced in terms of development and are usually walking by the age of 10 months!

Antiretroviral (ARV) medications are a life line to a person infected with HIV. Minus these drugs, the average time from acquisition of HIV to an AIDS-defining opportunistic infection is approximately 10 years, with survival then averaging 1-2 years. Whilst the medications initially often have many side effects, it is vital to persevere to live as full and healthy life as possible.

Yet some people do not wish to know their sero-status and prefer not to know if they have the disease or otherwise, and subsequently decline testing. Despite the high prevalence of the disease here in Uganda, it is still associated with a certain degree of social stigma. Discovering you are HIV positive can often sadly lead to the breakdown of a relationship, and family isolation.

Only this week we nursed a 24year old man on our ward who had previously declined HIV testing, not wanting to know his status despite that his wife was HIV positive and on ARV therapy. He was exceptionally unwell and had a decreased level of consciousness. For many weeks he had been experiencing a fever, body weakness, weight loss, a decreased appetite, and a persistent cough. Sadly he began convulsing, and stopped breathing and died a short time afterwards. His blood tested positive for HIV. Had this young man been tested for HIV and commenced on appropriate medications, the story could have been different. The same day, I took the blood of another patient who was also found to be HIV positive. I felt devastated on his behalf and accompanied the ward Sister to inform him of his result. I was pleasantly surprised by the mans positive response. He said he had been previously tested by the results had never been bought to his attention. He informed us that he was glad of a diagnosis so that he could begin treatment! I was amazed at his upbeat spirit! Hopefully his story will have a happier ending.